Below is Sample nursing care plans Bronchiectasis:

Nursing Priorities Nursing care plans for Benign Prostatic Hyperplasia (BPH)

• Relieve acute urinary retention.
• Promote comfort.
• Provide information about disease process, prognosis, and treatment needs.
• Prevent complications.
• Help client deal with psychosocial concerns.

Sample Nursing care plans for Benign Prostatic Hyperplasia (BPH) with nursing diagnosis Urinary retention (acute or chronic)

Nursing Goals Nursing Care Plans for Bone Fractures

• Pain controlled.
• Prevented or minimized Complications
• Fracture stabilized.
• Condition, prognosis, and therapeutic regimen understood.
• Plan in place to meet needs after discharge.

Nursing Care Plans for Bone Fractures with nursing diagnosis Acute pain

Sample Nursing care plans for Asthma

Common nursing diagnosis found in Nursing care plans for anemia

Activity Intolerance, Impaired oral mucous membrane, Imbalanced Nutrition: Less than Body Requirements, Constipation/Diarrhea, Risk for Infection, Risk for deficient fluid volume, Deficient Knowledge regarding condition, prognosis, treatment, self-care, prevention of crisis, and discharge needs, Fatigue, Fear, Ineffective coping, Ineffective thermoregulation.

Sample Nursing care plans for anemia

Nursing diagnosis for Thalassemia

Nursing outcomes nursing care plans for Thalassemia

Patient and parents will:

• Verbalize the importance of balancing activity, as tolerated, with frequent rest periods.
• Demonstrate age-appropriate skills and behaviors to the extent possible.
• Express positive feelings about himself.
• Develop no cardiac arrhythmias.
• Voice feelings and concerns related to the patient’s illness.
• Remain free from signs and symptoms of infection

Nursing interventions nursing care plans for Thalassemia

• Watch for adverse reactions during and after RBC transfusions.
• Collaborative an antibiotic, and observe the patient for adverse reactions.
• Provide an adequate diet,
• Encourage the patient to drink plenty of fluids.
• Provide emotional support
• Help the patient and his family cope for chronic nature of
• Explain the need for lifelong transfusions.

Patient teaching nursing care plans for Thalassemia

• Explain how to prevent infection e.g.  nutrition, wound care
• Tell about signs of hepatitis and iron overload, which are always possible with frequent transfusions.
• Explain why child must avoid strenuous athletic activity to avoid pathologic fractures.

Nursing diagnosis nursing care plans for Cervical Cancer

Common nursing diagnosis found in nursing care plans for Cervical Cancer:

• Pain (acute) related to post procedure swelling and nerve damage
• Anxiety
• Fear
• Impaired physical mobility
• Impaired skin integrity
• Ineffective coping
• Ineffective sexuality patterns
• Risk for infection
• Sexual dysfunction

Nursing Key outcomes nursing care plans for Cervical Cancer

Pain control; Pain: Disruptive effects; Well-being, after nursing interventions patient will

• Report feeling less pain.
• Report feelings of reduced anxiety.
• Verbalize her concerns and fears related to her diagnosis and condition.
• Maintain joint mobility and range of motion.
• Free from breakdown.
• Demonstrate adaptive coping behaviors.
• Resume normal sexual activity patterns to the fullest extent possible.
• Remain free from signs or symptoms of infection.
• The patient and partner will express feelings and perceptions about changes in sexual performance.

Nursing interventions nursing care plans for Cervical Cancer

Analgesic administration; Pain management; Meditation; Transcutaneous electric nerve stimulation (TENS); Hypnosis; Heat/cold application

Collaborative

• If you assist with a biopsy, drape and prepare the patient as for a routine Pap test and pelvic examination. Have a container of formaldehyde ready to preserve the specimen during transfer to the pathology laboratory. Assist the physician as needed, and provide support for the patient throughout the procedure.
• If you assist with cryosurgery or laser therapy, drape and prepare the patient as for a routine Pap test and pelvic examination. Assist the physician as necessary, and provide support for the patient throughout the procedure.
• Preinvasive lesions (CIS) can be treated by conization, cryosurgery, laser surgery, or simple hysterectomy (if the patient’s reproductive capacity is not an issue). All conservative treatments require frequent follow-up by Pap tests and colposcopy because a greater level of risk is always present for the woman who has had CIS Administer analgesics and prophylactic antibiotics, as ordered.

Independent

• Listen to the patient’s fears and concerns, and offer reassurance when appropriate. Encourage her to use relaxation techniques to promote comfort during diagnostic procedures.
• When a patient requires surgery, prepare her mentally and physically for the surgery and the postoperative period.
• After any surgery, monitor vital signs every 4 hours.
• Watch for and immediately report signs of complications, such as bleeding, abdominal distention, severe pain, and wheezing or other breathing difficulties. Encourage deep breathing and coughing.

• Check to see whether the radioactive source is to be inserted while the patient is in the operating room (preloaded) or at bedside (afterloaded). If the source is preloaded, the patient returns to her room hot and safety precautions begin immediately.
• Remember that safety precaution time, distance, and shielding begin as soon as the radioactive source is in place. Inform the patient that she will require a private room.
• Check the patient’s vital signs every 4 hours
• Assist the patient with range-of-motion arm exercises.
• Avoid leg exercises and other body movements that could dislodge the source. If ordered, administer a tranquilizer to help the patient relax.
• Provide activities that require minimal movement.
• Watch for treatment complications by listening to and observing the patient and monitoring laboratory studies and vital signs. When appropriate, perform measures to prevent or alleviate complications.

Grading System for Abruptio Placentae (placenta abruption)

Grade 0 Less than 10% of the total placental surface has detached; the patient has no symptoms; however, a small retroplacental clot is noted at birth.

Grade I approximately 10%–20% of the total placental surface has detached; vaginal bleeding and mild uterine tenderness are noted; however, the mother and fetus are in no distress.

Grade II Approximately 20%–50% of the total placental surface has detached; the patient has uterine tenderness and tetany; bleeding can be concealed or is obvious; signs of fetal distress are noted; the mother is not in hypovolemic shock.

Grade III More than 50% of the placental surface has detached; uterine tetany is severe; bleeding can be concealed or is obvious; the mother is in shock and often experiencing coagulopathy; fetal death occurs.

Central abruption, the separation occurs in the middle, and bleeding is trapped

Between the detached placenta and the uterus, concealing the hemorrhage

Marginal abruption, separation begins at the periphery and bleeding accumulates between

The membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage.

Causes for Abruptio Placentae (placenta abruption)

The cause of abruptio placentae is unknown; however, any condition that causes vascular changes at the placental level may contribute to premature separation of the placenta. Predisposing factors include:

• Traumatic injury.
• Placental site bleeding from a needle puncture during amniocentesis,
• Chronic or pregnancy-induced hypertension.
• Multiparity
• Short umbilical cord
• Dietary deficiency
• Smoking
• Advanced maternal age
• Pressure on the vena cava from an enlarged uterus.

The spontaneous rupture of blood vessels at the placental bed may result from a lack of resiliency or to abnormal changes in the uterine vasculature. The condition may be complicated by hypertension or by an enlarged uterus that can’t contract sufficiently to seal off the torn vessels. Consequently, bleeding continues unchecked, possibly shearing off the placenta partially or completely.

Complications for Abruptio Placentae (placenta abruption)

• Hemorrhage and shock.
• Renal failure,
• Disseminated intravascular coagulation.
• Maternal and fetal death.

Nursing Assessment Nursing Care Plans for Abruptio Placentae (placenta abruption)

Abruptio placentae produce a wide range of clinical effects, depending on the extent of placental separation and the amount of blood lost from maternal circulation.

Obtain patient history obstetric history. Determine the date of the last menstrual period to calculate the estimated day of delivery and gestational age of the infant. Inquire about alcohol, tobacco, and drug usage, and any trauma or abuse situations during pregnancy

• Mild Abruptio placentae with marginal separation usually report mild to moderate vaginal bleeding, vague lower abdominal discomfort, and mild to moderate abdominal tenderness.
• Moderate Abruptio placentae are about 50% placental separation usually report continuous abdominal pain and moderate, dark red vaginal bleeding. Onset of symptoms may be gradual or abrupt. Vital signs may indicate impending shock. Palpation reveals a tender uterus that remains firm between contractions.
• Severe Abruptio placentae about 70% placental separations patient usually report abrupt onset of agonizing, unremitting uterine pain (described as tearing or knifelike) and moderate vaginal bleeding. Vital signs indicate rapidly progressive shock. Palpation reveals a tender uterus with board like rigidity. Uterine size may increase in severe concealed abruptions.

Psychosocial Assessment to understanding patient’s situation and also the significant other’s degree of anxiety, coping ability, and willingness to support the patient

Diagnostic tests for Abruptio Placentae (placenta abruption)

• Pelvic examination under double setup
• Ultrasonography
• Decreased hemoglobin level
• Decreased platelet count.
• Periodic assays for fibrin split products aid in monitoring the progression of abruptio placentae and in detecting DIC.

Treatment for Abruptio Placentae (placenta abruption)

Medical Treatment management goals of abruptio placentae are to assess, control, and restore the amount of blood lost and to deliver a viable infant and prevent coagulation disorders.

After determining the severity of placental abruption and appropriate fluid and blood replacement, prompt cesarean delivery is necessary if the fetus is in distress. If the fetus isn’t in distress, monitoring continues; delivery is usually performed at the first sign of fetal distress.

Nursing diagnosis Nursing Care Plans for Abruptio Placentae (placenta abruption)

Primary nursing diagnosis nursing care plans for abruptio placentae (placenta abruption) fluid volume deficit related to blood loss. Common nursing diagnosis fond in Nursing Care Plans for Abruptio Placentae (placenta abruption):

• Acute pain
• Anxiety
• Deficient fluid volume
• Dysfunctional grieving
• Fear
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)

Key outcomes Nursing Care Plans for Abruptio Placentae (placenta abruption) the patient will:

• Express feelings of comfort.
• Express feelings of reduced anxiety.
• Communicate feelings about the situation.
• Discuss fears and concerns.
• Use available support systems, such as family and friends, to aid in coping.
• Remain hemodynamically stable.
• Patient’s fluid volume will remain within normal parameters.

Nursing interventions Nursing Care Plans for Abruptio Placentae (placenta abruption)

• Monitor Vital sign; blood pressure, pulse rate, respirations, central venous pressure, intake and output, and amount of vaginal bleeding.
• Monitor fetal heart rate electronically.
• If vaginal delivery is elected, provide emotional support during labor.
• Because of the neonate’s prematurity, the mother may not receive an analgesic during labor and may experience intense pain. Reassure the patient of her progress through labor, and keep her informed of the fetus’s condition.
• Encourage the patient and her family to verbalize their feelings. Help them to develop effective coping strategies. Refer them for counseling, if necessary.

Patient teaching discharge and home healthcare guidelines for abruptio placentae

Teach the patient to identify and report signs of placental abruption, such as bleeding and cramping.

• Explain procedures and treatments to allay patient’s anxiety.

• Teach the patient to notify the doctor and come to the hospital immediately if she experiences any bleeding or contractions.

• Prepare the patient and her family for the possibility of an emergency cesarean delivery, the delivery of a premature neonate, and the changes to expect in the postpartum period. Offer emotional support and an honest assessment of the situation.
• Tactfully discuss the possibility of neonatal death. Inform the patient that the neonate’s survival depends primarily on gestational age, the amount of blood lost, and associated hypertensive disorders.
• Inform the patient that frequent monitoring and prompt management greatly reduce the risk of death.

After Postpartum Patient teaching discharge and home healthcare guidelines

Give the usual postpartum instructions for avoiding complications. Inform the patient that she is at much higher risk of developing abruptio placentae in subsequent Pregnancies. Instruct the patient on how to provide safe care of the infant. Provide a list of referrals to the patient and significant others to help them manage their loss, If the fetus has not Survived

Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. The disorder occurs predominantly in females and begins in adolescence or early adult life. Between 1% and 3% of adolescent and young females meet the diagnostic criteria for bulimia nervosa; 5% to 15% have some symptoms of the disorder.

Causes for Bulimia Nervosa

The exact cause of bulimia is unknown, but bulimia is generally attributed to a combination of psychological, genetic, and physiological causes. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression.

Complications for Bulimia Nervosa

• Dental caries result from repetitive vomiting in bulimia nervosa.
• Erosion of tooth enamel.
• Parotitis
• Gum infections.
• Arrhythmias and even sudden death result from electrolyte imbalances.
• Ipecac syrup intoxication can cause cardiac failure in patients who rely on this drug to induce vomiting.
• Esophageal tears and gastric ruptures rare complications.
• Mucosal damage can occur if patient with bulimia nervosa use laxatives.
• Potential psychiatric complication of bulimia nervosa is suicide.
• Bulimia nervosa patients are more prone to psychoactive substance use disorders.

Nursing Assessment Nursing Care Plans for Bulimia Nervosa

Patient history of bulimia nervosa is characterized by episodic binge eating that may occur up to several times per day. The patient commonly reports a binge-eating episode during which she continues eating until abdominal pain, sleep, or the presence of another person interrupts it. The preferred food usually is sweet, soft, and high in calories and carbohydrate content.

Unlike the anorexic patient bulimic patient usually can keep her eating disorder hidden, because patient’s weight frequently fluctuates, but usually stays within the normal range through the use of diuretics, laxatives, vomiting, and exercise.

The patient may complain of abdominal and epigastric, Amenorrhea, Painless swelling of the salivary glands, hoarseness, throat irritation or lacerations, and dental erosion.

In addition, the patient may exhibit calluses of the knuckles or abrasions and scars on the dorsum of the hand, resulting from tooth injury during self-induced vomiting.

A bulimic patient commonly is perceived by others as a perfect student, mother, or career woman; an adolescent may be distinguished for participation in competitive activities, such as gymnastics, sports, or ballet.

However, the patient’s psychosocial history may reveal an exaggerated sense of guilt, symptoms of depression, childhood trauma (especially sexual abuse), parental obesity, or a history of unsatisfactory sexual relationships.

Symptomatology for Bulimia Nervosa

• Patients with Bulimia Nervosa usually solitary and secret and patients with Bulimia Nervosa able to consume thousands of calories in one episode.

• Loss of control to stop eating After the binge has begun
• Following the binge, the individual engages in inappropriate compensatory measures to avoid gaining weight (e.g., self-induced vomiting; excessive use of laxatives, diuretics, or enemas; fasting; and extreme exercising).
• Eating binges may be viewed as pleasurable but are followed by intense self-criticism and depressed mood.
• Individuals with bulimia are usually within normal weight range, some a few pounds underweight, some a few pounds overweight.
• Obsession with body image and appearance is a predominant feature of this disorder. Individuals with bulimia display undue concern with sexual attractiveness and how they will appear to others.
• Binges usually alternate with periods of normal eating and fasting.
• Excessive vomiting may lead to problems with dehydration and electrolyte imbalance.
• Gastric acid in the vomitus may contribute to the erosion of tooth enamel.

Treatment Bulimia Nervosa

Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously. Merely promoting weight gain isn’t sufficient to guarantee long-term recovery. A patient whose physical status is severely compromised by inadequate or chaotic eating patterns is difficult to engage in the psychotherapeutic process.

Psychotherapy focuses on breaking the binge-purge cycle and helping the patient regain control over eating behavior. Treatment may occur in either an inpatient or outpatient setting. It includes behavior modification therapy, possibly in highly structured psychoeducational group meetings. Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self-control strategies. Antidepressant drugs, particularly the selective serotonin reuptake inhibitor fluoxetine, may be used to supplement psychotherapy.

The patient may also benefit from participation in self-help groups such as Overeaters Anonymous or in a drug rehabilitation program if she has a concurrent substance abuse problem.

Nursing diagnosis Nursing Care Plans for Bulimia Nervosa

• Anxiety
• Chronic low self-esteem
• Constipation
• Deficient fluid volume
• Disturbed body image
• Disturbed sleep pattern
• Imbalanced nutrition: Less than body requirements
• Ineffective coping
• Social isolation

Nursing Key outcomes Nursing Care Plans for Bulimia Nervosa, The patient will:

• State strategies to reduce levels of anxiety.
• Express positive feelings about self.
• Have regular bowel elimination patterns.
• Acknowledge change in body image.
• Verbalize feeling well rested.
• Display appropriate eating patterns, including regular, nutritious meals.
• Participate in decision-making about case.
• Interact with family or friends.
• Fluid balance will remain stable, with intake equal to or greater than output.

Nursing interventions Nursing Care Plans for Bulimia Nervosa

• Supervise the patient during mealtimes and for a specified period after meals, usually 1 hour. Set a time limit for each meal. Provide a pleasant, relaxed environment for eating.
• Using behavior modification techniques, reward the patient for satisfactory weight gain.
• Establish a contract with the patient, specifying the amount and type of food to be eaten at each meal.
• Encourage the patient to recognize and verbalize her feelings about her eating behavior. Provide an accepting and nonjudgmental atmosphere, controlling your reactions to her behavior and feelings.
• Encourage the patient to talk about stressful issues, such as achievement, independence, socialization, sexuality, family problems, and control.
• Identify the patient’s elimination patterns.
• Assess the patient’s suicide potential.
• Refer the patient and her family to the National Eating Disorders Association and the National Association of Anorexia Nervosa and Associated Disorders as sources of additional information and support.

Nursing interventions for bulimia nervosa base on its nursing diagnosis:

Nursing Diagnosis Imbalanced nutrition: Less than body requirements

• If client is unable or unwilling to maintain adequate oral intake, physician may order a liquid diet to be administered via nasogastric tube.
• Nursing care of the individual receiving tube feedings should be administered.
• In collaboration with dietitian, to provide realistic (according to body structure and height) weight gain, determine number of calories required to provide adequate nutrition.
• Explain to patient’s behavior modification program as outlined by physician.
• Explain benefits of compliance with prandial routine and consequences for noncompliance.
• Sit with client during mealtimes for support and to observe amount ingested. Give to the patient a time limit for meals.
• Client should be observed for at least 1 hour following meals.
• Client may need to be accompanied to bathroom.
• Weigh client daily; use same scale, if possible.
• Do not discuss food or eating with client.

Nursing Diagnosis Deficient fluid volume

• Teach client importance of daily fluid intake of 2000 to 3000 ml. This information is required to promote client safety and plan nursing care. Keep strict record of intake and output.
  • Weigh client daily; use same scale, if possible.
• Assess and document condition of skin turgor and any changes in skin integrity.
• Hot water and soap are drying to the skin, .Discourage client from bathing every day if skin is very dry.
• Monitor laboratory serum values, and notify physician of significant alterations.
• Client should be observed for at least 1 hour after meals and may need to be accompanied to the bathroom if self-induced vomiting is suspected.
• Assess and document moistness and color of oral mucous membranes.
• To minimizing risk of tissue infection. Encourage frequent oral care to moisten mucous membranes, reducing discomfort from dry mouth, and to decrease bacterial count.
• Help client identify true feelings and fears that contribute to maladaptive eating behaviors.

Nursing Diagnosis Ineffective coping

• Establish a trusting relationship with.
• When nutritional status has improved, begin to explore with client the feelings associated with his or her extreme fear of gaining weight,
• Explore family dynamics. Help client to identify his or her role contributions and their appropriateness within the family system
• Initially, allow client to maintain dependent role. To deprive the individual of this role at this time could cause his or her anxiety to rise to an unmanageable level.
• Give Positive reinforcement to increases self-esteem and encourages the client to use behaviors that are more acceptable.
• Explore with client ways in which he or she may feel in control within the environment, without resorting to maladaptive eating behaviors.

Patient teaching Nursing Care Plans for Bulimia Nervosa

• To monitor the treatment progress Teach the patient how to keep a food journal.
• Teach about risks abuse of laxative, emetic, and diuretic to the patient.
• To help the patient gain control over her behavior and achieve a realistic and positive self-image Provide assertiveness training.
• If the patient is taking a prescribed tricyclic antidepressant, instruct her to take the drug with food. Warn her to avoid consuming alcoholic beverages; exposing herself to sunlight, heat lamps, or tanning beds; and discontinuing the medication unless she has notified the physician.

]]> http://www.lifenurses.com/nursing-care-plans-for-bulimia-nervosa/feed/ 0 http://www.lifenurses.com/nursing-care-plans-for-urinary-tract-infections-utis/ http://www.lifenurses.com/nursing-care-plans-for-urinary-tract-infections-utis/#comments Sat, 15 May 2010 17:11:24 +0000 Lifenurses http://www.lifenurses.com/?p=302 Nursing care plans for Urinary tract infections (UTIs). Urinary tract infections (UTIs) are common and usually occur because of the entry of bacteria into the urinary tract at the urethra

Nursing Assessment Nursing care plans for Urinary tract infections (UTIs)

Patients History. The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. The patient may complain of urinary urgency and frequency, dysuria, bladder cramps or spasms, itching, a feeling of warmth during urination, nocturia. Other complaints include low back pain, malaise, nausea, vomiting, pain or tenderness over the bladder, chills, and flank pain. Inflammation of the bladder wall also causes hematuria and fever. Ask the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually transmitted infection (STI).

Physical Examination. Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, and character. Surveillance for STIs is recommended as part of the examination.

Diagnostic tests Urinary tract infections (UTIs).

Several tests are used to diagnose lower UTIs:

• Leukocyte esterase dip test
• Clean-catch urinalysis.
• Clean-catch collection is preferred to catheterization, which can reinfect the bladder with urethral bacteria.
• Sensitivity testing is used to determine the appropriate antimicrobial drug.
• Stained smear of urethral discharge can be used to rule out sexually transmitted disease.
• Voiding cystourethrography or excretory urography

Nursing diagnosis Nursing care plans for Urinary tract infections (UTIs).

• Acute pain
• Deficient knowledge (prevention)
• Disturbed sleep pattern
• Impaired urinary elimination
• Risk for infection
• Risk for injury
• Sexual dysfunction

Nursing Key outcomes Nursing care plans for Urinary tract infections (UTIs)

The patients will:

• Report increased comfort.
• Identify risk factors that exacerbate the disease process or condition and modify his lifestyle accordingly.
• Verbalize feeling well rested after undisturbed periods of sleep.
• Remain free from signs or symptoms of infection.
• Avoid or minimize complications.
• Reestablish sexual activity at the preillness level.
• Patient and family will demonstrate skill in managing elimination problem.