Nursing Care Plan

Diarrhea Assessment Subjective Apat na beses na akong dumudumi as "verbalized by the patient" Objective -Loose bowel movement with yellowish watery stool minimum of thrice a day. -Increase bowel sounds/ peristalsis. -Nausea and Vomiting -Abdominal cramping Nursing Diagnosis Diarrhea related to infectious processes Background Knowledge Result from Infectious(viral, bacteria or parasitic) Increase absorption of fluid by the intestinal mucosa Hyper motility of the intestine DIARRHEA - Remove stool promptly. Provide room deodorizers. - Identify foods and fluids that precipitate diarrhea, such as raw vegetables and fruits, whole-grain cereals, condiments, carbonated drinks, and - Reduces noxious odors to avoid undue client embarrassment. Planning Within 8 hours of nursing interventions, the patient will report reduction in frequency of stools and return to more normal stool consistency Interventions - Observe and record stool frequency, characteristics, amount, and precipitating factors. - Promote bed rest and provide bedside commode. Rationale -Helps differentiate individual disease and assesses severity of episode. Evaluation After 8 hours of nursing interventions, the client was be able to report reduction in frequency of stools and returned to more normal stool consistency

- Rest decreases intestinal motility and reduces the metabolic rate when infection or hemorrhage is a complication.

- Avoiding intestinal irritants promotes intestinal rest.

milk products. - Restart oral fluid intake gradually. Offer clear liquids hourly and avoid cold fluids. - Provides colon rest by omitting or decreasing the stimulus of foods and fluids. - Presence of disease with unknown cause that is difficult to cure and that may require surgical intervention can lead to stress reactions that may aggravate condition.

- Provide opportunity to vent frustrations related to disease process.

- May signify that toxic megacolon or -Observe for fever, perforation and tachycardia, lethargy, leukocytosis, decreased peritonitis are serum protein, anxiety, imminent or have occurred, and prostration. necessitating immediate medical intervention. - Decreases GI motility or propulsion (peristalsis) and diminishes digestive

- Administer medications, as

indicated: Antidiarrheals, such as diphenoxylate (Lomotil), loperamide (Imodium), and anodyne suppositories.

secretions to relieve cramping and diarrhea.

Deficient fluid volume Assessment Subjective Halos sampung beses akong dumumi at apat na beses na nagsuka, as verbalized by the patient. Background Knowledge Deficient fluid Rapid propulsion volume related to of intestinal excessive losses contents through through normal the small bowels routes as may lead to a evidenced by serious fluid frequent passage volume deficit. of loose watery The body would stool and vomiting want to expel the foreign objective as much as possible thus it doesnt undergo its normal speed, with that, the digestive system organs are not able to absorb the excess fluids that are usually absorbed by the body. Nursing Diagnosis Planning Short term Within 4 hours of nursing interventions, the patient will report understanding of causative factors for fluid volume deficit Long Term Within 3 days of nursing interventions, the patient will maintain fluid volume at functional level as evidenced by being well hydrated, intake is equal as output, and normal skin turgor 4. Maintain adequate hydration, increase fluid intake 5. Provide oral as well as eye care 4. To correct losses and maintain hydration status Interventions 1. Place patient in comfortable position 2. Administer PLR 1L as prescribed Rationale 1. To make the patient relax Evaluation Short term After 4 hours of nursing interventions, the patient reported understanding of causative factors for fluid volume deficit Long Term After 3 days of nursing interventions, the patient maintained fluid volume at functional level as evidenced by being well hydrated, intake was equal as output, and normal skin turgor

2.To prevent peaks and valleys in fluid level 3. To ensure accurate picture of fluid status

3. Monitor input and output balance

Objective

abdominal cramping dehydration nausea fatigue weakness dry mucous membrane confusion

5. To prevent injury from dryness 6. To prevent fatigue 7. To reduce pressure on fragile skin and tissues

6. Encourage bed rest 7. Change position every 2 hours

8. Administer Metoclopramide and Omeprazole 40 g OD as prescribed 9. Keep side-rails up

8. To limit gastric and intestinal losses

9. To avoid falls since the patient is experiencing weakness, fatigue and confusion 10. To avoid recurrence of condition

10. Discuss factors related to occurrence and ways to prevent dehydration 11. Identify and instruct in ways to meet specific fluid needs

11. To promote wellness

Acute Pain Assessment Subjective Mahapdi ang sikmura ko, as verbalized by the patient. Objective Verbalization of pain with a pain scale of 6/10 Appears weak Limited range of motion Restlessness Impaired thought process Reduced interaction with people Nursing Diagnosis Acute pain related to gastric irritation as evidenced by pain scale of 6/10 Background Knowledge Gastric irritation Release of cytokine and prostaglandin Increase in vascular permeability Pain in the abdomen Planning Within 1 hour of nursing interventions, the patient will report a decrease of pain Interventions 1. Place patient in supine position 2. Encourage patient to do deep breathing exercise 3. Limit environmenta l stimuli such as noise Rationale 1. To make the patient comfortable 2. To reduce sensation of pain Evaluation After 1 hour of nursing interventions, the patient reported a decrease of pain from a pain scale of 6/10 to 3/10

3. Excessive environmenta l stimuli can contribute to feeling of increasing pain 4. To lessen or alleviate pain

4. Instruct the relative to massage the area where pain is elicited if not contraindicate d 5. Encourage doing diversional

5. To distract patients attention

activities, such as visualization, verbalization of feelings or listening to music 6. Provide adequate rest

from pain

6. To reduce pain and promote relief or comfort 7. To avoid bed sores

7. Change position every 2 hours 8. Provide cool environment

8. To make the patient feel more relax

9. Keep side-rails 9. To promote up patients safety 10. Review ways to lessen pain, including techniques such as therapeutic touch, biofeedback, self-hypnosis 10. Part of pain management

and relaxation skills 11. Identify specific signs and symptoms and changes in pain characteristics requiring medical follow-up 11. To promote timely intervention

Medications
DRUG GENERIC NAME: Omeprazole CLASSIFICATION gastrointestinal agent; proton pump inhibitor DOSAGE 40g IV OD ACTION An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells. INDICATION Duodenal and gastric ulcer. Gastroesophage al reflux disease including severe erosive esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory conditions such as ZollingerEllison syndrome, multiple endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with Helicobacter pylori. CONTRA INDICATION Long-term use for gastroesophagea l reflux disease, duodenal ulcers; lactation. ADVERSE EFFECT CNS:Headache, dizziness, fatigue. GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital:Hema turia, proteinuria. Skin:Rash. NURSING INTERVENTION Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use.

BRAND NAME: Losec,Prilosec

DRUG GENERIC NAME: Dobutamine

CLASSIFICATION Inotropic agent

DOSAGE Dobutamine drops 2 ampule

ACTION Dobutamine is an inotropic agent whose primary activity is the stimulation of beta receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic and vasodialative effects. Causes an increase in cardiac output (C.O) usually not associated with a marked increase in heart rate, while the stroke volume is usually increased. Systemic vascular resistance is usually decreased due to stimulation of beta 2 receptors which contributes to the increased C.O.

INDICATION -Severe cardiac failure secondary to AMI or cardiomyopathy. -Cardiogenic shock. -Septic shock. -Congestive cardiac failure. -Acute pulmonary oedema

BRAND NAME: Dobutamine Hydrochloride

CONTRA INDICATION Idiopathic hypertrophic subaortic stenosis; hypersensitivity to any component of the product; dobutamine with dextrose should not be administered simultaneously with blood through the same infusion set because of the possibility of pseudoagglutina tion of red cells.

ADVERSE EFFECT

Heart- Increased heart rate and blood pressure, chest pain, palpitation. LocalInflammation of vein. MiscellaneousNausea, vomiting, headache, anxiety, fatigue and shortness of breath Potentially FatalHeart diseases.

NURSING INTERVENTION Ideally monitor BP continuously. PA catheter often desirable. -Patient must be on cardiac monitor. - ECG, BP, and hourly urine measures must be continuously monitored while PAWP and C.O should be monitored wherever possible. - Dobutamine is chemically stable for 24 /24 and should be changed every 24/24. - Dobutamine can be administered by a peripheral line. - Dobutamine must always be administered via a volumetric infusion pump.

DRUG GENERIC NAME: Paracetamol

CLASSIFICATION Non-narcotic analgesic, Antip yretic

DOSAGE Per Orem: 500mg q4h for temp. above 37.8

ACTION -Decreases fever by a hypothalamic effect leading to sweating and vasodilation -Inhibits pyrogen effect on the hypothalamicheat-regulating centers -Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis -Does not cause ulceration of the GI tract and causes no anticoagulant action.

INDICATION -Control of pain due to headache, earache, dysmenorrhea, arthralgia, myalgia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy -TO reduce fever in viral and bacterial infections -As a substitute for aspirin in upper GI disease, bleeding disorders clients in anticoagulant therapy and gouty arthritis

CONTRA INDICATION -Renal Insufficiency -Anemia

ADVERSE EFFECT -Minimal GI upset. -Methemo Globinemia -Hemolytic Anemia -Neutropenia -Thrombocytope Nia -Pancytopenia -Leukopenia -Urticaria -Liver Damage

BRAND NAME: Biogesic, Panadol, Tylenol

NURSING INTERVENTION -Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children. -Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults. -Extended-Release tablets are not to be chewed. -Monitor CBC, liver and renal functions. -Assess for fecal occult blood and nephritis.

DRUG GENERIC NAME: Metoclopram ide BRAND NAME Clopra, Emex , Maxeran , Maxolon, Reglan:

CLASSIFICATION gastrointestinal agent; prokinetic agent (gi stimulant); autonomic nervous system agent; directacting cholinergic (parasympatho mimetic); antiemetic

DOSAGE q8 PRN

ACTION Potent central dopamine receptor antagonist. Structurally related to procainamide but has little antiarrhythmic or anesthetic activity. Exact mechanism of action not clear but appears to sensitize GI smooth muscle to effects of acetylcholine by direct action.

INDICATION Management of diabetic gastric stasis (gastroparesis); to prevent nausea and vomiting associated with emetogenic cancer chemotherapy (e.g., cisplatin, dacarbazine); to facilitate intubation of small bowel; symptomatic treatment of gastroesophageal reflux.

CONTRA INDICATION Sensitivity or intolerance to metoclopramide; allergy to sulfiting agents; history of seizure disorders; concurrent use of drugs that can cause extrapyramidal symptoms; pheochromocytoma ; mechanical GI obstruction or perforation; history of breast cancer. Safety during pregnancy (category B) or lactation is not established.

ADVERSE EFFECT CNS: Restlessness ,drowsiness, fatigue, insomnia dizziness, anxiety CV: tansient hypertension GI: nausea and diarrhea

NURSING INTERVENTION the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Extrapyramidal symptoms are most likely to occur in children, young adults, and the older adult and with highdose treatment of vomiting associated with cancer chemotherapy. Symptoms can take months to regress. during early treatment period, serum aldosterone may be elevated; after prolonged administration periods, it returns to pretreatment level.

DRUG GENERIC NAME: piperacillin and tazobactam BRAND NAME: Zosyn

CLASSIFI CATION Antibiotic

DOSAGE 4.5LMS Then 2.75 LM q8hr

ACTION Inhibits bacterial cell wall mucopeptide synthesis

INDICATION indicated for the treatment of patients with moderate to severe infections caused by piperacillinresistant, piperacillin/tazoba ctamsusceptible, lactamase producing strains of the designated microorganisms.

CONTRA INDICATION contraindicated in patients with a history of allergic reactions to any of the penicillins, cephalosporins, or -lactamase inhibitors.

ADVERSE EFFECT signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

NURSING INTERVENTION Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration. Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and platelet count). Monitor patient carefully during the first 30 min after initiation of the infusion for signs of hypersensitivity (see Appendix F).