Mr. and Mrs. Brady Bunch (Brady 8-12-35 and Betty 7-4-32) have recently moved into the long-term care center where you are attending clinical. They have six children, two in the immediate area, and 14 grandchildren.
Brady has always been a very proud man, raised in the post WWII generation, asking for very little assistance and stoic with his emotions-unless it involves his wife of 67 years. His occupation was construction architect, and he was named Father of the Year following an essay by his daughter, Marcia. He has been followed by his general practitioner for COPD, he was a smoker for 60 years, and for BPH. He does present with pre-diabetes, controlled with diet. Height 5’7” Weight 143 lbs. Allergies: NKA (no known allergies) MD: Dr. Zhivago.
His medications include1. :1. Tamsulosin (generic) Flomax (brand) 0.4mg po (by mouth) once daily, 30 minutes after am meal. (he does note min dizziness-a common side effect of Flomax)2. 2. Acetaminophen 325 mg 1-2 tablets as needed for pain, every 4 hours.3. Albuterol (ProAir-brand) inhaler every morning and evening and every 4 hours as needed for SOB, dyspnea.
Betty is a different story and she is the reason that they have moved into the couple’s units at the LTC facility. She is a very sweet lady, who was a stay-at-home mother, who was very involved in her Lutheran church. She has been diagnosed with early dementia, congestive heart failure (following many years of HTN), and hypothyroidism. She experiences lower extremity edema with mild
pain secondary to her decreased vascular circulation, and CHF. Her height is 5’1”, Weight 145 lbs. and she is Allergic to: PCN. MD: Dr. Zhivago.
Her medications include:1. Synthroid 75 mcg po every morning (without food)2. Acetaminophen 325 mg 1-2 tablets as needed for pain every 6 hours.3. HCTZ 25 mg po every morning (hold if systolic blood pressure < 100 or diastolic < 60 and notify MD)4. 4. Digoxin (generic) Lanoxin (brand) .125 mg po every morning (hold if apical pulse rate < 60 and notify MD)
Please come up with three nursing diagnosis, one problem oriented and one at risk for, for each of the Brady’s. Write your nursing Dx. out in the preferred format. Choose one medication for each of them and research it. Tell me the class, mechanism of action, reason for taking, and nursing concerns for that medication.
Expert Solution Preview
Introduction:
Mr. and Mrs. Brady Bunch have recently moved into a long-term care center. Mr. Brady has COPD, pre-diabetes, and BPH. Mrs. Brady has early dementia, congestive heart failure, hypothyroidism, and edema. As a medical professor, we are required to come up with three nursing diagnoses each for Mr. and Mrs. Brady, along with one problem-oriented nursing diagnosis and one nursing diagnosis at risk for each. We also need to choose one medication each for them, research its class, mechanism of action, reason for taking, and nursing concerns for that medication.
Nursing Diagnoses for Mr. Brady:
1. Inadequate airway clearance related to COPD.
2. Risk for falls related to dizziness caused by Tamsulosin.
3. Imbalanced nutrition: less than body requirements related to pre-diabetes.
Nursing Diagnoses for Mrs. Brady:
1. Impaired memory related to early dementia.
2. Impaired tissue perfusion related to congestive heart failure.
3. Risk for injury related to edema.
Problem-Oriented Nursing Diagnosis:
1. Impaired gas exchange related to chronic lung disease and decreased lung capacity.
Nursing Diagnosis at Risk for:
1. Risk for infection related to decreased immunity caused by aging.
Medication for Mr. Brady:
Tamsulosin
Class: Alpha-1 blockers
Mechanism of Action: Tamsulosin relaxes the muscles in the prostate and bladder neck, making it easier to urinate.
Reason for taking: Tamsulosin is used to treat symptoms of benign prostatic hyperplasia (BPH), such as difficulty urinating and frequent urination.
Nursing Concerns: Tamsulosin can cause dizziness, especially when standing up from a sitting or lying down position. Patients should be advised to stand up slowly and be cautious while performing activities that require attention and coordination.
Medication for Mrs. Brady:
HCTZ
Class: Thiazide diuretic
Mechanism of Action: HCTZ works by reducing the amount of salt and water in the body, which decreases blood pressure and improves heart function.
Reason for taking: HCTZ is used to treat high blood pressure and edema caused by heart failure or kidney disease.
Nursing Concerns: HCTZ can cause dehydration and electrolyte imbalances, such as low potassium and sodium levels. Patients should be advised to drink plenty of fluids and consume foods that are high in potassium. HCTZ can also cause dizziness, especially when standing up from a sitting or lying down position. Patients should be advised to stand up slowly and be cautious while performing activities that require attention and coordination.
