Patient History Female, 92

Nervous Syncope, Glaucoma Anxiety r/t fear of falling Use therapeutic touch and healing touch techniques Risk for injury r/t transient loss of consciousness Evaluate patient for fall risk and take appropriate actions; keep patient in the room that is closest to the nurse's station Timolol ophthalmic

Cardiovascular HTN, CVA, Hypercholesterolemia Activity intolerance r/t weakness or fatigue Allow for periods of rest before and after planned exertion periods such as meals, baths, treatments, and physical activity Anxiety r/t change in physical or emotional condition Monitor client for depression; use appropriate interventions and referrals Lisinopril- held for systolic pressure less than 180 Norvasc- Held for systolic pressure less than 190 Pravastatin Clopidogrel

Goals: Patient will be able to walk steadily. Patient will be able to be independent in self care Evaluation: Patient's gait is steady and is able to walk around the floor without assistance Patient was able to perform AM and oral care on her own with minimal assistance