Question

LAULAPAU WA FUVI UL ULUWI niin Nursing Diagnosis Nursing Diagnosis Interventions Interventions Positive Outcomes Positive Outcomes Negative Outcomes Negative Outcomes Evaluation Evaluation

care of patient with a fever of unknown origin concept map

Answer 1

Fever: A higher than normal body temperature of a person usually caused by a disease.

Fever of unknown origin

Nursing diagnosis(1)

* Elevated body temperature above normal range related to ( infection or illness) as evidenced by hot, flushed skin.

Interventions

* Assessment

- Monitor the vital signs ( temperature, pulse, respiration and Blood pressure) : to obtain base line data

- Identity the causative or triggering factors

* Remove excess clothing and covers: exposure the skin to room air can reduce the warmth of skin

* Adjust environmental factors such as room temperature and bed of the patient

* Encourage plenty fluids by mouth : to prevent dehydration.

* Provide tepid sponging with cool water if it is indicated : to reduce body temperature to normal.

* Administer antipyretics as prescribed by the physician

Positive outcome

* Patient maintains body temperature below 39 degree C

Negative outcome

- Patient reports an increase in body temperature even after the nursing interventions

- Patient's body temperature remains same ( hypothermia)

Evaluation

After all the nursing i intervention, patient body temperature is reduced to normal as evidenced by temperature monitoring ( 38 degree C)

Nursing diagnosis (2)

* Fluid volume deficit related to dehydration ( profuse sweating) due to fever as evidenced by less skin turgidity.

Interventions

- Assess the other signs of dehydration such as cracked or dried lips or skin.

- Provide moisturizing gel to apply on skin and lip balms.

- Provide plenty of fluids orally to the patient: to rehydrate him

- Provide liquid diet to the patient

- Administer IV fluids as prescribed by the physician

Positive outcome

- Patient maintains skin turgidity ( skin snaps back immediately)

Negative outcome

- Patient still shows the signs of dehydration ( less skin turgidity or dried lips) ( in case of continuous vomiting or diarrhoea)

Evaluation

Patient maintains appropriate skin turgor , in the skin turgidity test.

Patient shows no signs of dehydration( as evidenced by intact skin and mucous membrane , normal skin turgidity)