Question

Medical Suge White out nunsiag o peens Fhe fellauny medical debn /mceuting tha esesnet ndeus nseu diagnesis plannins un tevetun(uith Rotnal) EValuation Heart Failure beabeto melaitus ulcerative coiti pat sugey FMactured gemun

Answer 1

1.Heart Failure

●Nursing Diagnosis

Decreased cardiac output related to loss of vascular function as evidenced by dyspnea, edema of legs

●Assessment

• Subjective data
  • Difficult breathing while walking ,mild activity
  • Tiredness
  • Unable to lie in supine position
• Objective data
  • Swelling (generalised)
  • Tachycardia
  • Tachypnea
  • Dizzy
  • Increased blood pressure

●Goal

To maintain a normal cardiac output and relieve discomfort like dyspnea

●Nursing intervention and Rationale

• Monitor vital signs ,it provides base line data to plan for care
• Follow a strict low or restricted salt ,fat free diet to peevbt prevent metabolic changes
• Monitor weight of the patients daily to assess for fluid overload
• Maintain intake and output chart,to monitor patient status

●Evaluation

The patient is able to breathe easily

2.Diabetes Mellitus

●Nursing Diagnosis

Impaired blood glucose level related to decreased insulin production as evidenced by increased blood glucose level

●Goal

To maintain normal blood glucose level

●Assessment

• Subjective data:
  • Increased urine output
  • Increased thirst
  • Hungry
  • Fatigue
• Objective data:
  • Alterations in blood glucose level
  • weakness

●Nursing intervention and rationale

• Monitor blood glucose level ,to plan for care
• Provide a diabetic diet
• Assess for signs of hypoglycemia,as patient will experience after medication or insulin
• Encourage patient to do regular exercise as this aides in glucos metabolism
• Avoid carbohydrate, high calories,refined sugars foods which will increase the glucose level

●Evaluation

The patient is maintaining normal blood sugar ranges

3.Ulcerative colitis

●Nursing Diagnosis

Acute pain in abdomen related to erosion of the intestinal layers as evidenced by verbalization,pain scale

●Goal

To relieve pain

●Assessment

• Subjective data
  • Verbalization of pain
  • Facial expression
  • Pain while defecating
• Objective data
  • Pain on palpation
  • Abdominal distension
  • Diarrhoea
  • Fever

●Nursing Diagnosis

• Assess the pain level to provide baseline care
• Administer medication to relieve pain ,diarrhoea
• Monitor vital signs as the patient will have fever dir to infection
• Provide a diet as per nutritionist advice

●Evaluation

The pain will be relieved

4.Fractured femur (post surgery)

●Nursing diagnosis

Acute pain related to surgery as evidenced by surgicalincision

●Goal:To relieve pain

●Assessment :

• Subjective data
  • Verbalization of pain
  • Pain score
• Objective data
  • Loss of cooperation due to pain
  • Facial grimace

●Nursing intervention

• Assess the pain level intensity, duration, frequency to plan for care
• Administer medication to relieve pain
• Position the patient properly with a triangle pillow in between things to prevent dislocation
• Frequent change of position to prevent bed sore

●Evaluation

The patient will be relieved of pain