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This Concept Map has information related to: nov 28 2007, prochlorperazine pyschotherapeutic agent Management of manifestations of psychotic disorders, of excessive anxiety, tension, and agitation,, interventions: -assess weight -note total daily intake -provide diet modification and protein packs -increase amount of petemen pt will: -maintain adequate weight -free of signs of malnutrition, pt demographics African America male 75 yrs old admitted to NSU from VA medical center pt had chronic right SDH pt was exhibiting confusion, decrease mental status, unresponsiveness, and lethargic, PMHx -schizophrenia -heart failure CVA -dementia -prostate cancer -HTN -DM, Interventions: -explain to the treatment plan -include pt in her own treatment -tell pt what the meds does before giving it to her -give pt comfort to the environment pt will -verbalize and understand her treatment plan -pt more comfortable with her environment. -participate in learning process, phenytoin anticonvulsant Inhibits seizure activity, acetylcesteine decreases viscocity of secretion tx: pulomary edema, Admission Dx Nursing Dx: ineffective cerebral tissue perfusion related to right subdural hematoma as evidenced by interruptionof blood flow by thrombus in the brain, and increase draining of blood and fluid in brain, altered LOC, restlessness, and decreases in sensory responses interventions: -determine presence of physical, psychological stressors -note environmental factors affecting sleep -evaluate patient's fear or anxiety -determine sleep pattern -observe signs of fatigue -sleeping medications -assess pain -provide a calming and quiet environment, Admission Dx Nursing Dx: ineffective cerebral tissue perfusion related to right subdural hematoma as evidenced by interruptionof blood flow by thrombus in the brain, and increase draining of blood and fluid in brain, altered LOC, restlessness, and decreases in sensory responses nursing dx: impaired gas exchange related to PE as evidenced by huge amount of lung secretions, abnormal lung sounds :bronchi upper L&R and crackles in the bases of the lungs, pt on 35% O2 through ETT, regular insulin Nrusing Dx: Risk for infection risk factors include delay wound healing, neuropathy, decreased leukocytes interventions: -assess distal extremities especially the leg foot (r foot amputated) -assess sensation -assess skin integrity -assess wound site -clean wound site frequent -keep sterile to prevent infection