Question

Care of the Operative Patient-Ruptured Spleen Nursing Diagnosis Nursing Diagnosis Interventions Interventions Positive Outcomes Positive Outcomes Negative Outcomes Negative Outcomes Evaluation Evaluation

Answer 1

Ans) Nursing Care plan for post operative- Ruptured spleen.

Nursing diagnosis:

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

- Lack of exposure/recall, information misinterpretation

- Unfamiliarity with information resources

Possibly evidenced by:

- Statement of the problem/concerns, misconceptions

- Request for information

- Inappropriate, exaggerated behaviors (e.g., agitated, apathetic, hostile)

- Inaccurate follow-through of instructions/ development of preventable complications

Desired Outcomes:

- Verbalize understanding of disease process/perioperative process and postoperative expectations.

- Correctly perform necessary procedures and explain reasons for the actions.

- Initiate necessary lifestyle changes and participate in treatment regimen.

Nursing Interventions & Rationale:

• Assesspatient’s level of understanding.

- Facilitates planning of preoperative teaching program, identifies content needs.

• Review specific pathology and anticipated surgical procedure.Verify that appropriate consent has been signed.

- Provides knowledge base from which patient can make informed therapy choices and consent for procedure, and presents opportunity to clarify misconceptions.

• Use resource teaching materials, audiovisuals as available.

- Specifically designed materials can facilitate the patient’s learning.

• Implement individualized preoperative teaching program:

Preoperative or postoperative procedures and expectations, urinary and bowel changes, dietary considerations, activity levels/ transfers, respiratory/ cardiovascular exercises; anticipated IV lines and tubes (nasogastric [NG] tubes, drains, and catheters).

- Enhances patient’s understanding or control and can relieve stress related to the unknown or unexpected.

Preoperative instructions: NPO time, shower or skin preparation, which routine medications to take and hold, prophylactic antibiotics, or anticoagulants, anesthesia premedication.

- Helps reduce the possibility of postoperative complications and promotes a rapid return to normal body function. Note: In some instances, liquids and medications are allowed up to 2 hr before scheduled procedure.

Intraoperative patient safety: not crossing legs during procedures performed under local or light anesthesia.

- Reduced risk of complications or untoward outcomes, such as injury to the peroneal and tibial nerves with postoperative pain in the calves and feet.

• Expected or transient reactions (low backache, localized numbness and reddening or skin indentations).

- Minor effects of immobilization and positioning should resolve in 24 hr. If they persist, medical evaluation is required.

• Inform patient or SO about itinerary, physician/SO communications. Logistical information about operating room (OR) schedule and locations (recovery room, postoperative room assignment), as well as where and when the surgeon will communicate with SO relieves stress and mis-communications, preventing confusion and doubt over patient’s well-being.

• Discuss individual postoperative pain management plan. Identify misconceptions patient may have and provide appropriate information.

- Increases likelihood of successful pain management. Some patients may expect to be pain-free or fear becoming addicted to narcotic agents.

• Provide opportunity to practice coughing, deep-breathing, and muscular exercises.

- Enhances learning and continuation of activity postoperatively

Positive outcomes:

- Able to understand the post operative care.

- Upates information & monitors for any complications.

Negative outcomes:

- Doubts

- Lack of understanding

- Lack of responding to appropriately

Evaluation:

- The patient is able to verbalize/demonstrate appropriate post operative care.