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DEFICIENT FLUID VOLUME (hyper/hypotonic) Nursing Care Plan

Deficient fluid volume is a condition where the fluid output exceeds the fluid intake and body electrolytes became imbalance as a result of dehydration, blood loss, vomiting or diarrhea which causes cells in our body to not function properly. Below is an example of nursing care plan for patients with deficient fluid volume.

ASSESSMENT
Subjective:
“I feel exhausted, I’m thirsty.” as verbalized by the patient.

Objectives:
The patient is pale, has dry mouth, dry skin and dry mucous membrane. Other objectives for the patient are decrease urine output, experiencing weight loss and confusion. Vital signs are taken and noted as follows: Body temperature is 38.1 degrees Celsius, blood pressure is 90/70 mmHg, pulse rate is 129 beats per minute, and respiratory rate is 20 cycles per minute. The client has fever as manifested by his/her body temperature which is above normal.

DIAGNOSIS
Deficient fluid volume related to exhaustion as manifested by increased pulse rate and dry skin and mucous membranes. (Exhaustion in this diagnosis refers to extreme physical tiredness.)

PLANNING
 After 4 hours of nursing intervention, the patient will maintain fluid volume at functional level as evidenced by stable vital signs, moist mucous membrane and good skin turgor. (We need to regain his/her fluid deficiency as soon as possible to prevent continuous fluid lossy may lead to severe dehydration that can cause more severe complications.)

INTERVENTION
Evaluate nutritional status and note the current intake and weight changes. Remember that clients with very young age cannot describe or verbalized thirst. While elderly patients are often have a decreased thrust relax and may not aware of water needs.

Monitor client's vital signs regularly especially blood pressure, take blood pressure with the client lying, sitting, and standing when possible. Also, monitor confusion of his/her loss of ability to carry out usual activity, lethargy and dizziness. Confusion is caused by sufficient dehydration due to poor cerebral perfusion and electrolyte imbalances.

Monitor urinary output so that you could accurately determine the fluid replacement needs. Administer fluids and electrolytes as indicated, oral fluid intake is indicated in patients with mild dehydration. Provide beverages and fluids with high fluid content and encourage the patient to limit intake of alcohol and caffeinated beverages that tend to exert a diuretic effect. Severe fluid deficiency can be manage through intravenous fluid infusion, administer blood products as prescribe by physician and regulate the intravenous flow rate. If symptoms of fluid overload manifest, stop or lower the infusion and notify the physician. Maintain accurate input and output and instruct the client and relatives in how to measure and record the input and output.

If diarrhea is present, administer anti-diarrheal medication as indicated. If vomiting is present, administer anti-emetic medication as prescribe. If the patient has regional enteritis, liquids and food containing sodium is restricted. 

EVALUATION
After 4 hours of nursing intervention, the patient has maintained fluid volume at functional level as evidenced by stable vital signs, moist mucous membrane and good skin turgor.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

FEAR Nursing Care Plan

The sample care plan about fear above is not the only way, you can create thousands of specific care plan about fear. In creating nursing care plan about fear, you must specify your focus. Example: fear of snakes.



Fear is a depensive mechanism in protecting oneself or response to perceived threat but if left unchecked, it can become disabling to the client's life.



ASSESSMENT

Subjective:
"I'm afraid of what will be the result of my operation," as verbalized by the patient.

Objectives:
The patient was diminished his/her self-esteem, he/she has loss competence and narrowed focus on the source of fear. Vital signs are taken and noted as follows: Body temperature is 36.5 degrees Celcius, blood pressure is 140/90 mmHg, respiratory rate of 22 cycles per minute, and pulse rate of 108 beats per minute. 

DIAGNOSIS
Fear related to possible unwanted result as evidenced by narrowed focus on the source of fear and increase pulse pressure. 

PLANNING
After 4 hours of nursing intervention, the patient will verbalize accurate knowledge of safety related to current situation. 

INTERVENTION
Identify sensory deficits that may be present such as vision or hearing impairment. Sensory deficits may lead to misinterpretation of the environment. Determine the client's age or his/her developmental level. This will help in understanding on usual or typical fears. Toddler often has different fears than adolescent or older people. Investigate client's reports of subjective experiences, which could be indicative of delusions or hallucinations. Note degree of incapacitation. Be alert to signs of denial and depression. Be alert to and evaluate potential for violence. Measure vital signs and physiological responses to situation.

Stay with the client more often to have someone else to be there because it provides client with desired support person that can diminished feeling of fear. Listen to the client's concern, it promotes atmosphere of caring and permits exploration of misperception. Acknowledge normalcy of fear, pain, despair, and give "permission" to express feelings appropriately. This promotes attitude of caring and opens door for discussion about feelings and addressing reality of situation. If necessary, provide presence or physical contact such as hugging, refocusing attention or rocking a child. These soothe fears and provide assurance.

Manage environmental factors such as loud noises, harsh lightning, changing of person's location or stranger in care. These can cause stress, especially to very young or to order individuals. Speak in simple sentences and concrete terms because it facilitates understanding and retention of information. Provide opportunity for questions and answer honestly to enhance sense of trust and nurse client relationship. Avoid arguing about client’s perceptions of the situation to limit conflicts when fear response may impair rational thinking. Encourage contact with a peer who has successfully dealt with a similarity fearful situation. This provides a role model and client is more likely to believe others who had similar experience. Enhances sense of control by identifying client's responsibility for the solutions while reinforcing that the nurse will be available for help if desired or needed. Check use of anti-anxiety medications and reinforce use as prescribed. Assist in identifying areas in which control can be exercised and those in which control is not possible, thus enabling client to handle fearful situations. Instruct in use of relaxation or visualization and guided imagery skills. Explain procedures within client's ability to understand and handle to prevent confusion and overload.

EVALUATION
After 4 hours of nursing intervention, the patient verbalized accurate knowledge of safety related to the current situation.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

FATIGUE Nursing Care Plan

Causative factors related to fatigue may be psychological such as stress, anxiety, boring lifestyle or depression. It is also maybe environmental (noise, lights, humidity, temperature) or situational (occupation, negative life events). But mostly fatigue is due to physiological such as increased physical exertion, sleep deprivation, pregnancy, disease states, and malnutrition. Below is a sample of nursing care plan for patients with fatigue.

ASSESSMENT
Subjective:
 “I’m so tired, I need some rest,” as verbalized by the patient.

Objectives:
The patient is lethargic and drowsy. He/she is not interested to his/her environment and he/she didn't want to socialize with others. Vital signs are taken and noted as follows: Body temperature is 36.5 degrees Celcius, blood pressure is 120/80 mmHg, respiratory rate is 17 cycles per minute, and pulse rate of 88 beats per minute.

DIAGNOSIS
Fatigue related to lethargy as manifested by lack of energy and disinterest in the surroundings. (Lethargy is a condition when a person is irritable, can't stay still and can't find his/her comfort).

PLANNING
After 8 hours of nursing intervention, the patient will report improve sense of energy.

INTERVENTION
Ascertain client’s belief of about what is causing the fatigue. Assess vital signs to evaluate the fluid status and cardiopulmonary response to activity. Determine presence of sleep disturbances because fatigue can be a  consequences of sleep deprivation. Interview parent or relatives regarding specific changes. Note daily energy patterns. Measure physiological response to activity: changes in blood pressure, heart rate and respiratory rate. Evaluate need for individual assistance. Established realistic activities with the client and encourage forward movement.

Instruct in methods to conserve energy such as sitting instead of standing during daily care, carry several small leads instead of big one, combine and simplify activity. Take frequent short rest breaks during activities and delegate task for assistance. Encourage use of activities device to conserve energy for other tasks. Avoid exposure to extreme temperature and humidity which can negatively impact energy level. Provide pleasurable activities. Discuss routines to promote restful sleep. Promote overall health measures: nutrition, adequate fluid intake and appropriate vitamin supplementation.

Note the age, gender and developmental stage, although, some studies show a prevalence of fatigue in adolescent girls, the condition may be present in any person at any age. Identify presence of physical and psychological conditions such as factors said above. Review medication regimen or use. Certain medications, including prescription (especially beta - adrenergic blockers), over-the-counter, herbal supplements, and combinations of drugs or substances, are known to cause and exacerbate fatigue. Note recent lifestyle changes, including conflicts (expanded responsibilities or job related conflicts); maturational issues such as adolescent with eating disorder); and developmental issues such as new parenthood, loss of spouse. Assess psychological and personality factors that may affect reports of fatigue level. Evaluate aspect of "learned helplessness" that may be manifested by giving up. This can perpetuate a cycle of fatigue, impaired functioning, and increased anxiety and fatigue. Obtain client descriptions of fatigue like lacking energy or strength, tiredness, weakness lasting over length of time. Note presence of additional concerns such as irritability, lack of concentration, difficulty making decisions, problems with leisure, relationship difficulties. These assist in evaluating impact on client's life. Rate client's fatigue from 1-10 and note its effects on ability to participate in desired activities. Discuss lifestyle changes or limitations imposed by fatigue state. Interview parent regarding specific changes observed in child or elder, this client may not be able to verbalize feelings or relate meaningful information. 

EVALUATION
After 8 hours of nursing intervention, the patient reported improved sense of energy.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

ADULT FAILURE TO THRIVE Nursing Care Plan

Adult failure to thrive is a person who has been a socially active, emotionally healthy and physically fit but are now a socially withdrawn, emotionally distress and physically atoned. There are three major factors of adult failure to thrive: Depression, major disease/degenerative condition, and ageing process. In pediatric patient, failure to thrive describes as a weight loss of more than 5%. Here we will share to you a sample of nursing care plan for patients who diagnosed as adult failure to thrive.

ASSESSMENT
Subjective
"I want don't want to live!" as verbalized by the patient.

Objective
I observed from the client that he/she had decreased in social skills. Social skills are the inability of a person to interact and communicate to others. The client also withdrawn him/herself to socialized with others. The client lacks on interest to almost everything or in apathy, he/she didn't want to eat and took a bath for almost a week so the client is self-care deficit.

Vital signs was taken and noted as follows: Body temperature is 35.8 C, blood pressure is 110/80 mmHg, respiratory rate is 16 cpm and pulse rate, 69 bpm. Three of his/her vital signs are normal, the body temperature, blood pressure, and respiratory rate while his/her pulse rate is below the normal rate.

DIAGNOSIS
You can use "Adult failure to thrive related to verbalized desire to death as manifested by social withdrawal and self-care deficit". Actually, saying "I don't want to leave", does not directly pertains to desire to death by rather the undesire to live.

PLANNING
After 4 hours of nursing intervention the patient will identify corrective and adaptive measures for individual situation. Why 4 hours? A patient who verbalized desire to death may attempt to suicide or will cause violent or inappropriate actions, so we need to accomplish our nursing care intervention as quick as possible.

INTERVENTION
The first thing you need to do is to get information about the patient's previous and current life situations. Find out changes and losses that may probably affects him/her. After that, identify also the expectations regarding the current condition. Determine the client's cognitive, perceptual ability and effect on self-care ability and use a collaborative and comprehensive assessment to determine the extent of limitations affecting about to thrive and potential positive interventions.

Encourage client to talk about and listen actively to the client's perception of problem. Discuss his/her concerns about feelings of loss and relationship between his/her feelings and current decline in well being. Have the client took enough time to talk everything he/she wants to say and just have time to listen to him/her. Encourage client, to talk about positive aspects of life and to keep a physically active as possible. Offer opportunities that enhance hopefulness for future. Encourage strengths and coping behaviors that the client used previously promote commitment to goals and plan which maximizing outcomes by assisting the client to develop goals for dealing with life or illness situation. In addition, you can assist client to join useful community resources such as support groups, social workers, home care and assistive care which can enhance coping assists with problem solving, and may reduce risks to client.

After the smooth conversations, develop a nursing care plan with client, to meet immediate needs for nutrition, safety and self-care ability. Another nursing care plan is needed immediately to target his/her nutrition since the client did not eat for a few days so that he/she will regain his/her health deficiency. To make it easy and effective, you can coordinate with the client and the nutritionist to identify specific dietary needs and creative ways to stimulate intake such as offering the client's favorite food, family's style meals and happy hour. You can include safety and regaining self-care ability in the interventions and actions.

EVALUATION
After 4 hours of nursing intervention, the patient identified the corrective and adaptive measures for the client's situation.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

DEFICIENT DIVERSIONAL ACTIVITY Nursing Care Plan

Deficient diversional activity is a state when a person is experiencing decreased simulation from a particular activity. Deficient diversional activity may be due to long-term hospitalization, bedridden, fatigue, pain, and depression. Below is an example of nursing care plan for patients with deficient diversional activity.

ASSESSMENT
Subjective:
"I'm bored, I wish there is something I can do," as verbalized by the patient.

Objectives:
The patient is lethargic, inattentive, restless and lack of interest in eating. When you feel lethargic, you are sluggish and lacking of energy. It makes anything hard to be done when you are lethargic. Vital signs was taken and noted as follows: Body temperature is 36.8 degrees Celcius, blood pressure is 120/80 mmHg, respiratory rate is 16 cycles per minute, and pulse rate of 90 beats per minute. Only his/her respiratory rate is normal, his/her pulse rate is below normal range, the client's body temperature is above normal and also the blood pressure which is categorize as pre-hypertension. 

DIAGNOSIS
Deficient diversional activity related to boredom as manifested by lethargy and inattentiveness.

PLANNING
After 4 hours of nursing intervention, the patient will engage in satisfying activities within personal limitation. (Time frame may increase since this kind of deficiency does not overcome so easily and quick. It may gradually manage over time.)

INTERVENTION
You must determine the client's actual ability to participate in available activities. Review client's physical, cognitive, emotional, and environmental status. With this, it can validate reality of environmental deprivation when it's exists or considers potential for loss of desired diversional activities in order to plan for prevention or early interventions.

Note the age and the developmental level, gender, cultural factors, and the importance of a given activity in client's life in order to support client participation in something which promotes self-esteem and personal fulfillment.

After that, provide comparative baseline for assessment and intervention to check for any disability and illness in lifestyle. Establish therapeutic relationship and support hopeful emotions by acknowledging reality of situation and feelings of the client. Review history of lifelong activities and hobbies client has enjoyed. Discuss reasons client is not doing these activities now and determine whether client would like to resume these activities.

Continue appropriate actions to engage with concomitant conditions such as anxiety, depression poor grief because these interfere the individual's ability to engage in meaningful diversions activities. Encourage client to assist in scheduling required and optional activities such as if client's favorite TV show occurs at bathtime, reschedule bath for a later time. Structure the client's schedule according to his/her wishes for time of care, relaxation and promotional activities. This could increase client's sense of control. Refrain from making changes in schedule without discussing with client. This is very important for staff to be responsible in making and following through on commitments to client.

EVALUATION
After 4 hours of nursing intervention, the patient engaged in satisfying activities within his/her personal limitations.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

DIARRHEA Nursing Care Plan

Diarrhea is condition when a person is experiencing hyperactive bowel movement and at least three loose liquid stools per day. The stool is usually loose and unformed. If your looking for nursing care plan for constipation, just search to our website and look for constipation nursing care plan. Below is an example of nursing care plan for patients with diarrhea.

ASSESSMENT
Subjective:
"I poop five times this day and my stomach is aching up until now, " as verbalized by the patient.

Objective:
I observed from the patient that his/her mouth is dry and had a poor skin turgor. His/her skin is cold and clammy. (Dry mouth and poor skin turgor is caused by dehydration or low body fluids secondary to diarrhea.) I scaled his/her pain 6/10 and the client's vital signs are taken and noted as follows: Body temperature is 36.2 degrees Celcius, blood pressure is 120/80 mmHg, respiratory rate is 16 cycles per minute and pulse rate of 110 beats per minute. Body temperature, respiratory rate and pulse rate are all normal, while his/her blood pressure is above normal and categorize as pre-hypertension.

DIAGNOSIS
Diarrhea related to five loose liquid stools in a day secondary to stomachache and cold clammy skin. (A cold clammy skin is a cool, moist and usually pale skin caused by cold sweat.)

PLANNING
After 4 hours of nursing intervention, the patient's normal pattern of bowel functioning will be reestablished and maintained.

INTERVENTION 
Factors associated with diarrhea maybe psychological (anxiety), situational such as using laxatives, alcohol abuse, or toxins and physiological such as inflammation, irritation, infectious process, and malabsorption. To assess these factors, ascertain onset and pattern of diarrhea, noting whether acute or chronic. Note the volume and the frequency of the stool. Also observe for presence, location and characterised of bowel sounds. And to eliminate causative factors, you can consider the following nursing interventions below:

Assist in treatment of underlying conditions such as infections, malabsorption syndrome and complication of diarrhea. Therapies can include treatment of fever, pain, and infectious agents.

In diarrhea, hydration and electrolyte imbalance must be addressed. Administer anti-diarrheal medications, as indicated to decreased gastrointestinal motility and minimizes fluid losses. Encourage oral intake of fluids containing electroless, such as juices, bouillon, or commercial preparations, as appropriate.

To maintain skin integrity, provide prompt diaper change and gentle cleansing because skin breakdown can occur quickly when diarrhea is present. Apply lotion or ointment as skin barrier and provide dry linen but expose perineum or buttocks to air.

To promote return to normal bowel functioning, increased fluids intake and return to normal diet as tolerated but avoid intake of irritating fluids. Recommend to the patient foods such as natural fiber, plain natural yogurt to restore normal bowel flora. Administer medications as ordered to treat infectious process, decrease motility, and absorb water. Also provide privacy during defecation and physiological support as necessary.

Remember to emphasize importance of handwashing to prevent spread of infectious causes of diarrhea such. Review causative factors and appropriate interventions to prevent recurrence of diarrhea. Review food preparation, emphasizing adequate coming time and proper refrigeration to prevent bacterial growth and contamination. Discuss possibility of dehydration and importance of proper fluid replacement.

EVALUATION
After 4 hours of nursing intervention the patient's normal pattern of bowel functioning was reestablished and maintained.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

IMPAIRED DENTITION Nursing Care Plan

Impaired dentition is a state in which a person experiences a disruption in the integrity of his/her teeth. Our teeth serves a major role in the process of digestion. We use our teeth for biting, cutting, and chewing of food which is the start of the process of digestion so we need to take care of them. Here is a sample of nursing care plan for patients with impaired dentition.

ASSESSMENT
Subjective:
"My tooth is aching, "as verbalized by the patient.

Objectives:
I smell fowl odor from the patient's mouth as he/she is talking to me. This fowl smell of his/her breath is called halitosis. I also noticed that he/she has a tooth enamel discoloration and erosion. There are excessive plaque all over her/his teeth as well as dental carries. By observing him/her, I assume that he/she had a toothache because the patient is guarding his/her left, lower quadrant of his/her face. I've used pain scale to the patient and graded it 7/10.

Vital signs was taken and noted as follows: Body temperature is 35.5 degrees Celcius, blood pressure is 120/80 mmHg, respiratory rate is 17 cycles per minute, and pulse rate is 120 beats per minute. Body temperature, respiratory rate, and pulse rate are normal while his/her blood pressure is above normal and categorize as pre-hypertention.

DIAGNOSIS
Impaired dentition related to toothache as evidenced by tooth enamel discoloration and excessive plaque. (Toothache if a pain or soreness perceive by the person located within or around his/her tooth. Enamel is a hard substance that create a thin layer which covers the tooth).

PLANNING
After 4 hours of nursing intervention the patient's toothache will be diminished. (You can also add to your planning, "also his/her tooth enamel discoloration and excessive plaque will be treated."

INTERVENTION
The first you need to do is to evaluate the patient's current status of dental hygiene and oral health to determine the possible intervention and treatment needs. Note the absence of teeth and dentures and ascertain its significance in terms of nutritional needs and aesthetics. Document presence of factors affecting dentition such as chronic user of tobacco, coffee or tea because these drinks are tooth-stainer causes enamel damage. Bulimia and vomiting causes stomach acid goes to the mouth which destroys the tooth enamel.

Document or get a photo before treatment to provide pictorial baseline for future comparison or evaluation. Encourage the client to use soft toothbrush and use tap water, saline or diluted alcohol-free mouthwashers. If needed, administer antibiotics to treat oral or gum infection and analgesics of topical analgesics for
dental pain. In addition, encourage the patient to limit sugary foods and midnight snacks because as food left on teeth at night is more likely to cause cavities. Note: If the client is baby, regarding age-appropriate concerns, refrain from letting the baby fall asleep with milk or juice in bottle instead use water or pacifier during night. Avoid sharing the eating utensils among family members and don't forget to teach children to brush teeth while young.

For further management of the teeth, refer the client to appropriate care providers such as dental hygienists, dentists, periodontists or oral surgeon.

EVALUATION
After 4 hours of nursing intervention, the patient's toothache has been diminished. (If you add the tooth enamel discoloration and excessive plaque in your planning, just add to your evaluation, "and his/her tooth enamel discoloration and excessive plaque were treated)."

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

CONSTIPATION Nursing Care Plan

Constipation is a condition in which a person cannot regularly eliminate his/her bowel or cannot even complete it's elimination due to the stool that is hard and dry cause by a diet that lacks of fiber and fluids. This condition is common and it affects all ages so it is better that you knew how to manage this condition. Here's an example of nursing care plan for constipation.

ASSESSMENT
Subjective:
"I'am having difficulty in defecation because of my dry stool," as verbalized by the patient.

Objectives:
I observed from the patient that he/she has a distended abdomen and upon palpation, the patient has a tender abdomen without palpable muscle resistance. Through percussion, I detected dullness in the abdomen. (We consider a patient that he/she had a distended abdomen when his/her belly is swelling, distended abdomen is usually called swelling of the abdomen. While tender abdomen is when you palpate the abdominal area and you feel that it is hard and had a mass.) His/her sample stool is hard-dry.

The patient's vital signs are taken and noted as follows: Body temperature is 37.2 degrees Celcius, blood pressure is 120/80 mmHg, respiratory rate is 17 cycles per minute, pulse rate is 82 beats per minute. Respiratory rate and pulse rate is normal while the patient's body temperature is above normal. His/her blood pressure is categorized as pre-hypertention.

DIAGNOSIS
Constipation related to observed hard, formed stool as evidenced by distended abdomen and palpable abdominal mass. (Constipation is the condition of being unable to easily release solid waste from your body. Stool is a solid waste product of the body while the liquid waste is the urine. The process of removing waste products inside the body, either solid or liquid, is called excretion.)

PLANNING
After 8 hours of nursing intervention, the patient will regain normal pattern of bowel functioning. (Once a day is considered a regular bowel. One a week is considered the patient is constipated while five or more are a day is a condition which is called diarrhea.)

INTERVENTION
Review your client's dietary regimen and note if the diet is deficient in fiber. Fiber helps food to move through your digestive tract more quickly for healthy elimination. So encourage the client to have a balanced diet that rich in fiber. Fiber-rich foods are whole foods, fruits and vegetables.

Ask the client about his/her fluid intake and evaluate his/her hydration status. Encourage the client to have adequate fluid intake because this will promote passage to stool. Tell the patient to drink at least 8 glasses of water everyday.

There are other factors you should consider such as activity level and exercise, pain in defecation, and bowel obstructions. (Did you know that sedentary lifestyle may affect elimination patterns and activities beyond the body's limit reduces stimulation for contractions of intestines?) Pain in defecation is sometimes caused by hemorrhoids, it is the swelling of veins in the rectum and anus. Fecal impaction is one of the most causes of bowel obstruction.

Encourage the client for treatment of underlying medical causes of constipation where appropriate to improve organ function, including bowel. Administer enemas and/or digitally remove impacted stool and establish bowel program to include glycerin suppositories and digital simulation, as appropriate, when long-term or permanent bowel dysfunction is present.

EVALUATION
After 8 hours of nursing intervention, the patient regained the normal pattern of bowel functioning.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

ACUTE CONFUSION Nursing Care Plan

Acute confusion is a state in which a person's cognitive function is below from a previously attained baseline level of cognitive function. A person with disturbance to its thought process accompany with decrease in level of conciousness is experiencing acute confusion. We provide an example of nursing care plan for acute confusion with a 3-hour nursing care intervention. 

ASSESSMENT
Subjective:
"I hear a voice of a little boy and a ball dribbling," as verbalized by the patient.

Objectives:
I observed from the patient that he/she is experiencing restlessness; a person who doesn't able to relax or rest. The decreased in level of conciousness and inappropriate responses are clearly manifested. I also noticed that there is poor eye contact and fluctuation in his/her body movement.

The vital signs are taken and noted as follows: Body temperature is 36.8 degrees Celcius which is above normal level of 36.5, blood pressure is 110/80 mmHg which is considered normal, pulse rate of 85 bpm and respiratory rate of 18 cycle per minute. Both pulse rate and respiratory rate are normal.

DIAGNOSIS
(You may use "Acute confusion related to acoustic hallucination as manifested by strategic level of consciousness and inappropriate responses.") Acoustic hallucination refers when a person is hearing a sound or void that seems real to them but does not really exist. The patient verbally said that he/she is hearing a voice of a little boy and a ball dribbling which is actually not exist in his/her room.

PLANNING
After 3 hours of nursing intervention, the patient will regain usual reality, orientation and level of consciousness. (Why 3u hours? Actually, it depends on how much time you would take to accomplish all your actions and interventions to manage the patient's problem).

INTERVENTION
Before anything, you must first investigate the possibility of alcohol and other drug withdrawal or intake. Too much alcohol intake can make a person hallucinate and do inappropriate responses. If the patient was drunk, make a plan for acute confusion due to alcohol intake. Drug withdrawal or intake, like alcohol, could also cause hallucinations.

After investigation had done, you must evaluate vital signs for indicators of poor tissue perfusion. Lack of oxygen in the brain also cause hallucinations. You must also assess the diet and nutritional status of the patient, so that you can identify the deficiency of essential vitamins and nutrients which may cause confusion.

Orient the client to surroundings, staffs and necessary things needed, you must concisely and briefly presents reality and give only simple directions. You allow sufficient time for the client to respond, communicate and make decisions. If possible, encourage his/her family members to participate in the reorientation as well as providing out aping input. While doing this, you must maintain calm environment and eliminate extraneous stimuli to prevent exacerbation of psychiatric conditions. Note behavior that may be indicative of potential for violence and take appropriate actions. Note: Limit use of restraints because it may wooden the situation and it may increase likelihood of untoward complications.

EVALUATION
After 3 hours of nursing intervention, the patient regained usual reality, orientation and level of consciousness. (Remember that this is your goal, if the patient still experiencing the problem, try to reassess the patient again.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

BOWEL INCONTINENCE Nursing Care Plan

ASSESSMENT
Subjective:
"I'm unable to control my defecation," as verbalized.

Objectives:
I observed from the client that his/her clothing and bedding were stained by feces. The room has a fecal odor which was came from the patient. The patient had a red in his/her perianal skin and there's a soft stool protruding in his/her rectal orifice.  Vital signs were taken and noted as follows: Body temperature of 37.5 degrees Celcius, blood pressure of 130/90, respiratory rate of 18 cycles per minute and pulse rate of 98 beats per minute. Both of his/her respiratory and pulse rate are normal but his/her body temperature and blood pressure are above normal.

DIAGNOSIS
Bowel incontinence related to inability to control defecation as evidenced by fecal staining of clothing. (Defecation is a process when a person eliminates his/her own feces).

PLANNING
After 4 hours of nursing intervention, the patient will participate in therapeutic regimen to control incontinence and maintain a regular pattern of bowel function.

INTERVENTIONS

Identify pathophysiology factors present such as multiple sclerosis, acute and chronic cognitive and self-care impairments, spinal cord injury, stroke, ileus, ulcerative colitis. Rescue results of diagnostic studies such as abdominal x-ray, colon imaging, complete blood count, serum chemistries, stool for blood guaiac as appropriate. Determine historical aspects of incontinence with preceding/precipitating events. Review medication regimen that might increase potential for bowel problems. Auscultate the abdomen and look for the presence, location, and tenderness. Palpate the abdomen for distention, masses and tenderness.



Establish bowel program worth predictable time for defecation efforts, use suppositories and digital simulation when indicated. Place bedpan at specified interval to take into consideration of individual needs and incontinent patterns. Maintain daily program initially. Progress to alternate days dependent on usual pattern of amount of stool. Take client to the bathroom or place on commode or bedpan at specific intervals, taking into consideration individual needs and incontinence patterns to maximize success of program. Provide perineal care and hygiene to prevent perineal infection and excoriation. 


Promote exercise program, as individually able, to increase muscle tone and strength, including perineal muscles. Provide incontinence aid or pads until control is obtained. Note that incontinence pads should be changed frequently to reduced incidence of skin rashes or breakdown. Demonstrate techniques such as contacting abdominal muscles, leaving forward on a commode, manual compression to increase intra-abdominal pressure during defecation, and left to right abdominal massage to stimulation of peristalsis.

Refer to ND diarrhea if incontinence is due to uncontrollable diarrhea and ND constipation if incontinence is due to impaction.

Instruct the use of suppositories or stool softeners, if indicated to stimulate timed defecation. Note the stool characteristics such as color, odor, consistency, amount, shape and frequency to provide a comparative baseline. Identify foods such as daily bran muffins, prunes that promote regular bowel and encourage the client in high-fiber diet and adequate amount of warm fluids. 

Provide emotional support to client, especially when condition is long-term or chronic because it enhances coping with difficult situation.

EVALUATION
After 4 hours of nursing intervention, the patient participated in therapeutic regimen to control incontinence and maintained a regular pattern of bowel function.

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DECISIONAL CONFLICT Nursing Care Plan

Decisional conflict is when a person is uncertain about which course of action to choose when the choices have involve risk, challenge, or negative or disadvantage to personal life values. Here's a good sample of nursing care plan for decisional conflict.

ASSESSMENT
Subjective:
"I want to start my surgery but it will take 3 months before I will fully recover. My 
family depends on me and the 3-month absences in my work would cause us to much trouble," as verbalized by the patient.

Objectives:
I observed that the patient is vacillating between alternative choices. (Vacillation  is when a person cannot decide from the possible choices). Because of that, there is a delay on decision-making and self-focus. Restlessness also observed as the client can find his/her comfort and cannot stay still.

Vital signs are taken and noted as follows: Body temperature is 36.6 degrees Celcius, blood pressure is 130/80 mmHg, respiratory rate is 18 cycles per minute, and pulse rate is 112 beats per minute. The client's body temprature, blood pressure, and pulse rate are normal but his/her blood pressure is categorize as pre-hypertention.

DIAGNOSIS
Decisional conflict related to moral obligation requires performity or not performing actions as manifested by delayed decision-making. (Working for your  family and to sustain their daily needs is one kind of moral obligations).

PLANNING
After 4 hours of nursing intervention the patient will be able to make decision and express satisfaction with the choice and free of physical signs of distress. (Why 4 hours? The primary goal is to help the client make the best decision for him/her self, to decide on a short period of time but have enough time to think about his/her decision).

INTERVENTION
Before you start any intervention, try to actively listen to the reason of your client for indecisiveness because this will clarify the problem and work toward to a solution. While listening to the patient, determine usual ability to manage own affairs. Note for expressions of indecision and dependence on others. Note: Remember that accurate and clearly understood information about situation will help the client make the best decision for self. Also you must accept verbal expressions of anger or guilt but you need to set limits on maladaptive behavior to promote client safety. If you find something that your patient was misinterpreted or misconcepted, correct it and provide factual information because this will provide better decision.

Choices may have risky, uncertain outcomes and msg reflect a need to make value judgements or may generate anticipated regret over having to reject positive choice and accept negative consequences. Just support the client for decisions made, especially if consequences are unexpected or difficult to cope with. Provide positive feedback for efforts and progress noted.

EVALUATION
After 4 hours of nursing intervention the patient was able to make decision and expressed satisfaction with the choice and free of physical signs of distress. (It's okay if the patient took much more time to completely decide but if the patient is still can't decide on his/her own. Try to reassess the patient and make a nursing care plan again).

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