CJ406 MOD6 PROJECT TWO Competency In this project, you will

Carl Bowden: Alcoholism Case Study Carl Bowden, a 58-year-old male with a history of hypertension and type 1 diabetes, was admitted today to the medical-surgical unit for treatment of a left foot wound. The patient had been binge drinking when he fell and sustained the cut to his foot one week ago. He had been treating the wound at home but has noticed increased swelling and redness to his foot, and the wound is not healing. He has been drinking heavily for the past 6 months since he lost his job. He states “I learned my lesson when I fell, and I am going to quit drinking.” His last drink was 3 days ago, and he is beginning to show signs of alcohol withdrawal. Mr. Bowden is married, and his wife is very supportive. His home medications are lisinopril, atenolol, Lantus insulin, and Humalog insulin Phase 1 Monday 14:15 You assume care for Mr. Bowden and receive a report from the charge nurse who has started the admissions process. She mentions the labs tests were drawn, and radiology has been notified to transport Mr. Bowden when they are ready to perform the MRI. The nurse tells you she is concerned that the admitting provider might be unaware of the patient’s withdrawal symptoms. You enter Mr. Bowden’s room to perform a head-to-toe assessment. You find an obese, unkempt, unshaven man. You verify his identification with double identifiers. Mr. Bowden is alert but repeatedly asks where he is and what time it is. He appears slightly agitated and answers your questions curtly. He complains that the unit is “very loud and irritating” and asks whether you could turn off the lights as they are “really bright.” …Vital Signs… Temperature: 99.0 degrees Fahrenheit (37.2 degrees Celsius), tympanic… Heart rate: 100, radial Blood pressure 140/72 mmHg, right arm, sitting… Respirations: 20… Oxygen saturation: 93% via room air per finger probe… Height: 6 ft 1 in… Weight: 268 lbs, patient statement… You hear S1S2 in a regular rhythm with no murmur. Peripheral pulses in the femoral, popliteal, right anterior tibial, right dorsalis pedis, brachial, and radial areas are normal. Left anterior tibial and left dorsalis pedis are nonpalpable. His extremities are generally cool and pale. Capillary refill is normal in upper extremities and right foot but greater than 3 seconds in the left foot. Mucous membranes are pink and moist. Left foot with 4-plus pitting edema and reddened. No cardiac problems are found. Mr. Bowden’s breathing pattern is even and unlabored, and lung fields are clear bilaterally in all fields but slightly diminished in the lower posterior fields. You note the presence of a dry, nonproductive cough that the patient describes as a “smoker’s cough” during examination. Muscle strength and movement is normal in all extremities but you notice some small tremors in both upper and lower extremities during the assessment. Mr. Bowden states “I don’t shake!” Neurological examination of cranial nerves II-XII is normal. The patient’s gait is steady and his cerebellar function is also normal. Reflexes are hyperreflexive and symmetrical bilaterally in all extremities. His pupils are equal, 2 mm, with brisk reaction to light. Mr. Bowden’s skin is expected color, slightly cool, and diaphoretic with good elasticity and intact with no lesions except for foot wound. Mr. Bowden’s abdomen is round and his bowel sounds are hyperactive in quality and intensity in all areas. He had a bowel movement this morning that was “normal” brown. He denies any bowel or urinary problems. His urinal at the bedside contains 250 mL cloudy amber urine. The previous nurse has dressed Mr. Bowden’s foot with a moist gauze dressing until the wound consult staff ordered specific dressing changes. She stated “I don’t want the tissue to become dry.” You note red streaking emanating from the wound, moving towards the calf. The entire right foot appears red and swollen, but the patient states the pain is “the same as usual,” ranking it as 6 out of 10 on a numeric pain scale and describing it as constant and throbbing. He grimaces when you touch his foot or ask him to move it, and he has had no relief of pain. You wash your hands and leave the room. The patient remains agitated and is still complaining of pain that he rates as 6 out of 10 on a numerical pain scale and describes as constant and throbbing in his feet and legs. He also reports increased nausea. You decide to administer the indicated medications and initiate appropriate patient teaching regarding medication and alcohol withdrawal. Develop a care plan to address the patient’s needs and document nursing interventions implemented based on your care plan. Include 2 nursing diagnosis, thinking about the concept focus for this VCBC. Make sure to include reasonable or expected outcomes and your rationales.] Image transcription text Add Care Plan Saved Care Plan Select Medical Diagnosis: Interprofessional Problem (Required): Enter text to search medical diagnosis Enter text t… Show more How do I add nursing intervention Develop a care plan to address the patient’s needs and document nursing interventions implemented based on your care plan. Include 2 nursing diagnosis, Make sure to include reasonable or expected outcomes and your rationales.

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