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NCP Nursing Care Plan for Abdominal Trauma. Blunt and penetrating abdominal injuries may damage major blood vessels and internal organs. Intra-abdominal trauma is usually not a single organ system injury; as more organs are injured, the risks of organ dysfunction and death climb. Such injuries are potentially fatal; the prognosis depends on the extent of injury and the organ damaged but is improved by prompt diagnosis and surgical repair.
Blunt injuries occur when there is no break in the skin; they often occur as multiple injuries. In blunt injuries, the spleen and liver are the most commonly injured organs. Injury occurs from compression, concussive forces that cause tears and hematomas to the solid organs such as the liver, and deceleration forces.
Penetrating injuries are those associated with foreign bodies set into motion. The foreign object penetrates the organ and dissipates energy into the organ and surrounding areas. The most commonly involved abdominal organs with penetrating trauma include the intestines, liver, and spleen.
Causes for Abdominal Trauma
Blunt (nonpenetrating) abdominal injuries usually result from motor vehicle accidents, fights, falls from heights, and sports accidents. Penetrating abdominal injuries usually result from stabbings and gunshots.
Complications for Abdominal Trauma
The abdominal cavity contains solid, gas filled, fluid filled, and encapsulated organs. These organs are at greater risk for injury than are other organs of the body because they have few bony structures to protect them. Immediate life threatening complications include hemorrhage and hypovolemic shock. Later complications include infection and dysfunction of major organs, such as the liver, spleen, pancreas, and kidneys.
Nursing Assessment Nursing Care Plan for Abdominal Trauma
- The patient’s history reveals an accidental or forcibly inflicted abdominal injury. Symptoms vary with the degree of injury and the organs damaged. History of the mechanism of injury by including a detailed report from the pre-hospital professionals, witnesses, or significant others. The patient with a blunt or penetrating abdominal injury typically is in obvious discomfort or pain.
- Inspection pinpoints the type of abdominal injury and helps determine its severity. Depending on the severity of the injury, the patient may be pale, cyanotic, or dyspneic. Inspection of the patient with a blunt abdominal injury may also reveal bruises, abrasions, contusions and, possibly, distention, For a patient with a penetrating abdominal injury, inspection reveals the type of wound and associated blood loss. Internal bleeding caused by this type of trauma may be further determined by diagnostic tests. Gunshots usually produce both entrance and exit wounds, with variable blood loss, pain, and tenderness. The patient may also exhibit pallor, cyanosis, tachycardia, shortness of breath, and hypotension.
- Palpation may reveal the extent of pain and tenderness and, in blunt abdominal injuries, abdominal splinting or rigidity. Rib fractures commonly accompany blunt abdominal injuries.
- Auscultation may disclose tachycardia, decreased breath sounds, absent or decreased bowel sounds, or bowel sounds in the chest. Auscultate all four abdominal quadrants for 2 minutes per quadrant to determine the presence of bowel sounds. Although the absence of bowel sounds can indicate underlying bleeding, their absence does not always indicate injury
If the patient is hemorrhaging from a critical abdominal injury, he or she may be profoundly hypotensive with the symptoms of hypovolemic shock.
Diagnostic tests for Abdominal Trauma
- Abdominal and Chest X-rays
- Computed tomography (CT) scan
- Focused abdominal sonogram fortrauma
- Arterial blood gas analysis evaluates respiratory status
- Excretory urography and cystourethrography show renal and urinary tract damage
Nursing diagnosis Nursing Care Plan for Abdominal Trauma
Common nursing diagnosis found in Nursing Care For Abdominal Trauma
- Acute pain
- Decreased cardiac output
- Deficient fluid volume
- Impaired gas exchange
- Ineffective tissue perfusion: Renal, cardiopulmonary, gastrointestinal
- Imbalanced nutrition: Less than body requirements
- Impaired skin integrity
- Risk for infection
- Risk for post trauma syndrome
Nursing outcomes Nursing Care Plan for Abdominal Trauma
Nursing Key Outcome Nursing care Plan For Abdominal Trauma, Patient Will:
- Express feelings of comfort and relief of pain.
- Express that he feels less anxious.
- Show signs of adequate cardiac output.
- Fluid volume will remain within acceptable range.
- Express understanding of special dietary needs.
- Maintain adequate ventilation.
- Regain skin integrity.
- Develop effective coping mechanisms.
- Show signs of adequate cardiopulmonary, renal, and gastrointestinal perfusion.
- Exhibit no further signs or symptoms of infection.
- Express his feelings and fears about the traumatic event.
Nursing interventions Nursing Care Plan for Abdominal Trauma
- Provide emergency care, as needed, to support the patient’s vital functions, maintain airway and breathing.
- Pain Management Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient
- Analgesic Administration Use of pharmacologic agents to reduce or eliminate pain
- Environmental Management Comfort Manipulation of the patient’s surroundings for promotion of optimal comfort
- Hemodynamic Regulation Optimization of heart rate, preload, afterload, and contractility
- Cardiac Care Limitation of complications resulting from an imbalance between myocardial oxygen supply and demand for a patient with symptoms of impaired cardiac function
- Circulatory Care Mechanical Assist Devices Temporary support of the circulation through the use of mechanical devices or pumps
- Fluid Management: Promotion of fluid balance and prevention of complications resulting from abnormal or undesired fluid levels
- Hypovolemia Management: Reduction in extracellular and/or intracellular fluid volume and prevention of complications in a patient who is fluid overloaded
- Shock Management Volume: Promotion of adequate tissue perfusion for a patient with severely compromised intravascular volume.
- Respiratory Monitoring Collection and analysis of patient data to ensure airway patency and adequate gas exchange
- Oxygen Therapy Administration of oxygen and monitoring of its effectiveness
- Airway Management Facilitation of patency of air passages
- Nutrition Management Assisting with or providing a balanced dietary intake of foods and fluids
- Wound Care Prevention of wound complications and promotion of wound healing, Wound Site Care Cleansing, monitoring, and promotion of healing in a wound
- Pressure Ulcer Care Facilitation of healing in pressure ulcers
- Anxiety Reduction Minimizing apprehension, dread, foreboding, or uneasiness related to an unidentified source or anticipated danger, Calming Technique: Reducing anxiety in patient experiencing acute distress
- Infection Protection Prevention and early detection of infection in a patient at risk
- Infection Control Minimizing the acquisition and transmission of infectious agents
- Infection Surveillance Purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making
- Coping Enhancement: Assisting a patient to adapt to perceived stressors, changes, or threats that interfere with meeting life demands and role, Identify supportive persons for client
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