GROUP PRESENTATION

(LEG WEAKNESS, PERIPHERAL AUTONOMIC NEUROPATHY)

Presenters: Jeff (Mr.Lee), Catherine, Antoinetta
Class: Kaiser Sunset, Nursing 502A
Clinical instructor: Mrs. Queen, Davis
Date: 11/23/2010

1. Clint data
The patient name is C.E. 59yrs old, female, African American, Reason of hospitalization: Leg weakness,
Peripheral autonomic neuropathy idiopathic, chronic medical Dx: Varietic (BMI 50 ) ,essential HTN, Strain of
back, atrial arrhythmia, Chronic kidney Dz (stage 2), Anemia, Anxiety DO, Osteoarthritis of lower leg, Full
code, Erikson stage is Generativity vs. stagnation
2. Pathophysiology of disease process.
Peripheral neuropathy is caused by nerve damage. It can result from such problems as traumatic injuries,
infections, metabolic problems and exposure to toxins. One of the most common causes is diabetes. Peripheral
neuropathy often causes numbness and pain in your feet. People typically describe the pain of peripheral
neuropathy as tingling or burning, while they may compare the loss of sensation to the feeling of wearing a thin
stocking or glove. In many cases, peripheral neuropathy symptoms improve with time — especially if it's
caused by an underlying condition that can be treated. A number of medications such as Lidocaine ointment,
Norco tab are often used to reduce your painful symptoms of peripheral neuropathy.
3. Environmental factors
• Physical: She stays in mostly bed, but she can eat by herself so partially compensatory. She is
incontinence, and her diaper is always wet. She needs to change diaper often and check skin break-
down.
• Social: She likes to talk, mostly on the phone. She doesn’t like to be alone.
• Cultural: Trying to do her best she can, so she is optimistic person. TV/ Radio are on, but she doesn’t
listen to those because she was talking with someone.
• Spiritual: Alumni of LASC and very proud of school, always bible on the table, pray for god, and she
used to go to church sometimes.
4. Lab result pertinent to the DX.
She was having Heparin drip which is high alert, double check meds, so monitor the anticoagulation data (Safe
range, INR: 2.0-3.0)
CBC test ->Hgb 11.0 (Low), RBC 3.96(Low), Hct 35.0 (Low): R/T anemia
PTT-> INR 2.1, Heparin Unfr 0.25 (Low): R/T Heparin Drip
5. Medications relevant to the patient
5a. Temazepam, Restoril
Classification
Therapeutic: sedative/hypnotics
Pharmacologic: benzodiazepines
For Anxiety

5b. Atenolol, Tenormin

Classification
Therapeutic: antianginals, antihypertensives
Pharmacologic: beta blockers
For Hyperlipidemia

5c. Gabapentin, Neurontin

Classification
Antiseizure medication
Therapeutic: analgesic adjuncts, therapeutic, anticonvulsants, mood stablilizers
For her nerve pain. Side effects may include drowsiness and dizziness.

5d. nortriptyline , Aventyl, Pamelor

Classification
Therapeutic: antidepressants
Pharmacologic: tricyclic antidepressants
Relieves pain by interfering with the brain and spinal cord process.

5e. acetaminophen, Tylenol

Classification
Therapeutic: antipyretics, nonopioid analgesics
For pain

6. Summary of client’s physical assessment focusing on defining characteristics of the nursing diagnosis
59 y.o. female obese, alert, oriented, non-ambulatory. Patient has a hep lock on the right arm. She is incontinent.
Patient feels a burning sensation in both legs with movement.
Patient is partial compensatory.

7a. NANDA Diagnosis #1:

Bathing/hygiene Self-care deficit r/t neuromuscular impairment AEB inability to get in and out of bed to wash
body and dry body.

8a. Goal:

Client will remain free of body odor and maintain intact skin by 11/23/10.

9a. Nursing Interventions and Rationales:

• Ask the client for input on bathing habits and cultural bathing preferences.
o Creating opportunities for guiding personal care honors long-standing routines, increases
control, and makes bath time more pleasant for caregiver.
• Individualize bathing by identifying function of bath (e.g., odor, urine removal), frequency required to
achieve function, and best bathing form (e.g., towel bathing, tub, shower) to meet client preferences,
preserve client dignity, make bathing a soothing experience, and reduce client aggression.
o Individualized bathing produces a more positive bathing experience and preserves client dignity.
Client aggression is increased with shower (especially) and tub bathing. Towel bathing
increases privacy and eliminates need to move the client to central bathing area; therefore it is a
more soothing experience than either showering or tub bathing.
• Provide for privacy and keep the client warmly covered.
o Clients may experience evaporative cooling during and after bathing, which produces an
unpleasant cold sensation.
• Enhance communication during bathing. Allow the client to participate as able in bathing and provide
praise for accomplishments.
o Improved communication decreases aggression during bathing and individualizes care.
• Inspect skin condition during bathing.
o Observation of skin allows detection of skin problems. Towel bathing facilitates inspection of
skin.
7b. NANDA Diagnosis #2

Impaired physical mobility r/t BMI of 50 AEB limited ROM and difficulty turning;

8b. Goal:

Client will verbalize feeling of increased strength and ability to move

9b. Nursing Interventions and Rationales:

• Screen for mobility skills and record the client's ability to tolerate activity and use all four extremities;
note pulse rate, blood pressure, dyspnea, and skin color before and after activity.
o The activity tolerance and abilities of the client should be assessed to determine how best to
facilitate movement and plan of care.
• Before activity, observe for and, if possible, treat pain. Ensure that the client is not oversedated.
o Pain limits mobility and is often exacerbated by movement.
• Perform passive ROM exercises at least twice a day unless contraindicated; repeat each maneuver three
times. Inactivity rapidly contributes to muscle shortening and changes in periarticular and
cartilaginous joint structure. The formation of contractures starts after 8 hours of immobility.
• Increase independence in ADLs, encouraging self-efficacy and discouraging helplessness as the client
gets stronger. Providing unnecessary assistance with transfers and bathing activities may promote
dependence and a loss of mobility

10. Discharge plans for the client

- Patient should continue medication regimen to manage pain.
- Patient should exercise with exception from the doctor
- Patient should start a healthy diet to keep nerves healthy
- Patient should elevate the legs to increase circulation
- Patient should avoid putting pressure on legs