77 Year Old Female Case Study - NSAIDS - Nursing Assignment Help

Assignment Study

77 year old female that lives alone since she is widowed for the last 6 years that was a dog groomer until her arthritis got “too bad”.  She’s allergic to NSAIDS, Morphine, Omeprazole, Statins, shellfish.  She is moved to an assisted living facility after multiple occurrences of Atrial Fibrillation with Rapid Ventricular Rate.  If P.W. ever codes in the hospital, she wants to be revived but does not want to be intubated.
She has a history of GI bleeds, pulmonary nodules, left breast cancer resolved with a Left total mastectomy, long term anticoagulation therapy with Coumadin, duodenal ulcers, cataracts, bilateral carpal tunnel with release for the left in 1998 and the right in 2000, rheumatoid arthritis, Coronary Artery Bypass Graft with stent placement after a myocardial infarction, pulmonary embolus, thrombocytopenia, Atrial fibrillation, coronary artery disease, anxiety, and a subdural hematoma that required a burr hole surgery from a recent fall that left.  
This left P.W. with decreased mobility due to generalized weakness and her rheumatoid arthritis resulting in wheelchair use.  She knows who she is but is otherwise not familiar with things like dates, times, or places.  She is incontinent of urine so she wears a brief but requires a toileting schedule to decrease stool incontinent occurrences.  Her bilateral knuckles stay red and swollen and her fingers are deformed at the joints from her R.A. She has right eye bruising, right hip and femur bruising from her fall.  Her pupils are fixed due to the cataracts and brain surgery but generally are 4mm sclera white, conjunctiva pink & moist.  She lives in an assisted living facility where a private nursing company checks her four times daily.  Her nurse reports T 99.6 orally, HR 108, O2 sats 99% on room air, BP 182/100, RR 14. Bilateral lungs are diminished in bases. Patient is in Afib on auscultation with 2+ pulses in both radius’s and dorsalis pedis’s.  She has 2+ bilateral hand edema, dry, flaky skin, moist & pink lips and mucous membranes with dentures.  Cap refill is < 3 secs. The right side of her head is shaved due to recent surgery with a dime sized scabbed wound to her parietal area from the burr hole.  Head wound is open to air with no drainage or s/s of infection.  Her assisted living facility is discussing the possibility of long term placement with her 2 daughters.  P.W. struggles with her ADL’s and requires at least 1 assist with most all of them.  Her urine is straw colored with sediment.  The nurse has collected a urine specimen and some labs to check her Coumadin levels.  The nurses notices a non blanchable half dollar sized reddened area mid back when toileting P.W. and applies a mepilex dressing which will be changed daily.  She applies some skin barrier cream to P.W.’s reddened groin after her shower that the nurse performs. P.W. c/o pain in her hands and stomach of 9/10 after her shower. She uses warm compresses 4 times daily to help with the pain since she can’t have anything other than Tylenol right now due to her previous GI bleeds.  P.W. belly appears rounded and distended with hypoactive bowel sounds in all quadrants.  The nurse observes when assisting P.W. to the restroom that her stool is a black tar color.  P.W. states when the nurse asks about her stools “it’s probably all of those nasty ensure shakes that my daughter keeps bringing me”.

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