Question

nursing care plan for pt who have dvt and taking comoudin for 5 days.

And also a care plan for a pneumonia PT who have productive cough with yellow sputum who is taking PO antibiotic?

Answer 1

* Nursing care plan for DVT

Assessment	Nursing diagnosis	Planning	Implementation and rationale	Evaluation
Subjective data Pain over the extremities. numbness on dvt affected extremity. Chest pain or breathing difficulty if pulmonary embolism occur. Objective data Pheripheral pulses are decreased on affected extremity. Swollen and warm legs.	Acute pain related to inflammmatory process in the affected vein. Ineffective tissue perfusion related injury in the blood vessel wall. Risk of bleeding related to anticoagulant therapy(comoudin)	Reduce the pain level of patient. Maintain adequate tissue perfusion. Reduce risk of bleeding.	Acute pain. Assess the pain level of the patient to know about degree of inflammation and chances of development of complication. Regular vital signs monitoring to identify changes temperature or heart rate because of fever or discomfort related dvt. Providing adequate rest periods to reduce problems associated with muscle contraction of affected extremity during movement. Give analgesics to control pain. Ineffective tissue perfusion Promote patient to change position to improve circulation of pheripheral tissues. Elevation of affected extremity above heart level to increase venous return and improve circulation. Apply compression stockings to improve venous return . Administer anticoagulant therapy (comoudin) to prevent further clot formation and improve circulation of blood. Risk of bleeding Assess the signs and symptoms of bleeding due to anticoagulant therpy to take remedial measures to control it. Checking of coagulation test results and platelet count to know about risk of bleeding. If bleeding occur during anticoagulant therapy stop the infusion and recheck coagulation level to avoid further complications.	Evaluate the pain level of patient. Evaluate the vital signs of the patient to know circulatory status. Evaluate the effectiveness of comoudin treatment. .

* Nursing care plan of patient with pneumonia.

Assessment	Nursing diagnosis	Planning	Implementation and rationale.	Evaluation
Subjective data Chest pain ,feeling of warmth,chills. Objective data Productive cough. Yellow sputum. Tachypnea.	Ineffective airawy clearance related to tracheobronchial secretion Activity intolerance related to impaired respiratory function.. Risk of deficient fluid volume related to fever and rapid respiratory rate.	Improve patency of airway of the patient. Maintain proper fluid volume. Enhance rest and conserve energy.	Improve patency of airway. Provide humidified air using high humidity face mask to maintain airway patency. Provide nasotracheal suctioning if needed to remove secretions from the airway. Encourage hydration to loose secretions. Antibiotic therpy to eliminate bacteria which cause pneumonia. Promote fluid intake. Promote use of oral fluids and give IV fluids if necessay to maintain fluid volume in the body. Monitor intake output chart to assess the fluid level for make changes in amount of fluid administration. Enhance rest and conserve energy. Give adequate resting hours to reduce exacerbation of symptoms due to overactivity. Provide comfortable position to improve breathing. Provide position change to enhance clearance of secretions and maintain normal ventillation perfusion ratio.	Evaluate the respiratory rate. Evaluate the activity level of patient. Evaluvate the intake output balance of patient.