CAD is the most common type of heart disease. Lifestyle changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people. Other names for Coronary Artery Disease are Atherosclerosis, Coronary heart disease, Hardening of the arteries, Heart disease, Ischemic heart disease, and Narrowing of the arteries.

1 Decreased Cardiac Output

Cad causes narrowing of blood vessels. This condition leads to intense pressure exerted on the walls of the blood vessels. The body’s compensatory mechanism is to increase the work load of the heart and thus the patient has decreased cardiac output.

5 Coronary Artery Disease Nursing Care Plans Original source at: Nurseslabs

Because heart failure causes vascular congestion, it is often called congestive heart failure, although most cardiac specialist no longer use this term. Other terms used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency and ventricular failure (Joyce M. Black, 2008).

1. Decreased Cardiac Output

The heart fails to pump enough blood to meet the metabolic needs of the body. The blood flow that supplies the heart is also decreased thus decrease in cardiac output occurs, blood then is insufficient and making it difficult to circulate the blood to all parts of the body thus may cause altered heart rate and rhythm, weakness and paleness

10 Congestive Heart Failure Nursing Care Plans Original source at: Nurseslabs

A cholecystectomy consists of excising the gallbladder from the posterior liver wall and ligating the cystic duct, vein, and artery. The surgeon usually approaches the gallbladder through a right upper paramedian or upper midline incision if necessary, the common duct may be explored through this incision. When stones are suspected in the common duct, operative cholangiography may be performed (if it has not been ordered preoperatively). The surgeon may dilate the common duct if it is already dilated as a result of a pathologic process. Dilation facilitates stone removal. The surgeon passes a thin instrument into the duct to collect the stones, either whole or after crushing them.

After exploring the common duct, the surgeon usually inserts a T0tube to ensure adequate bile drainage during duct healing (choledochostomy). The T-tube also provides a route for postoperative cholangiography or stone dissolution, when appropriate.

see other nursing care plans by clicking here

A conventional open cholecystectomy is indicated when a laparoscopic cholecystectomy does not allow for retrieval of a stone in the common bile duct and when the client’s physique does not allow access to the gallbladder. Occasionally, when a client is very obese, the gallbladder is not retrievable via laparoscopic instruments. Further, a surgeon may have difficulty accessing the gallbladder in an adult with a small frame and may need to perform the conventional open cholecystectomy.

1 Acute Pain Cholecystectomy Nursing Care Plan

The flow of bile in the gall bladder is obstructed due to the presence of stones. When the bladder releases bile, it contracts and there is spasm, thus it cannot adequately release bile due to the stone, it stimulates the release of cytokines resulting to pain.

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2 Fear RT Outcome of Surgery Cholecystectomy Nursing Care Plan

Undergoing open cholecystectomy, the patient may perceive threat like the outcome of the surgery that is consciously recognized by the client as danger

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3 Risk for Aspiration Cholecystectomy Nursing Care Plan

Prior to any surgical invasion, general anesthesia is induced. It relaxes the muscles of the body and depresses the sensation of pain, thus the gag and swallowing reflex is temporarily suppressed that may lead to aspiration.

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4 Post-Op Acute Pain Cholecystectomy Nursing Care Plan

In performing cholecystectomy, surgical incision is done. By which, the incision causes direct irritation to the nerve endings by chemical mediators released at the site such as bradykinin. This irritation will send signal to the cortex and thalamus of the brain thus producing pain perception.

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5 Impaired Physical Mobility Cholecystectomy Nursing Care Plan

Presence of surgical incision procedures causes the pt. to be reluctant in doing movements such as ROM, because those may result in the stimulation of the nerve endings, during movement, thus, increase pain sensation.

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6 Activity Intolerance Cholecystectomy Nursing Care Plan

Post-op pt. usually is under bed rest for few days that may hinder them to their usual activity. Presence of surgical incision procedures causes the pt. to be reluctant in doing personal activities, because those may result in the stimulation of the nerve endings, during movement, thus, increase pain sensation.

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7 Risk for Infection Cholecystectomy Nursing Care Plan

The patient is at risk of acquiring infection due to the break in the continuity of the first line defense which is the skin. The patient shall have undergone cholecystectomy, thus there is an incision and suture made in the abdomen. If there is a breakage in the skin, the pathogens will easily invade the body’s system thus increasing risk for infection.

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7 Cholecystectomy Nursing Care Plans Original source at: Nurseslabs

Nursing Diagnosis: Acute Pain
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

• Comfort Level
• Medication Response
• Pain Control

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

• Analgesic Administration
• Conscious Sedation
• Pain Management
• Patient-Controlled Analgesia Assistance

NANDA Definition: Pain is a highly subjective state in which a variety of unpleasant sensations and a wide range of distressing factors may be experienced by the sufferer. Pain may be a symptom of injury or illness. Pain may also arise from emotional, psychological, cultural, or spiritual distress. Pain can be very difficult to explain, because it is unique to the individual; pain should be accepted as described by the sufferer. Pain assessment can be challenging, especially in elderly patients, where cognitive impairment and sensory-perceptual deficits are more common.

Defining Characteristics

• Patient reports pain
• Guarding behavior, protecting body part
• Self-focused
• Narrowed focus (e.g., altered time perception, withdrawal from social or physical contact)
• Relief or distraction behavior (e.g., moaning, crying, pacing, seeking out other people or activities, restlessness)
• Facial mask of pain
• Alteration in muscle tone: listlessness or flaccidness; rigidity or tension
• Autonomic responses (e.g., diaphoresis; change in blood pressure [BP], pulse rate; pupillary dilation; change in respiratory rate; pallor; nausea)

Related Factors

• Postoperative pain
• Cardiovascular pain
• Musculoskeletal pain
• Obstetrical pain
• Pain resulting from medical problems
• Pain resulting from diagnostic procedures or medical treatments
• Pain resulting from trauma
• Pain resulting from emotional, psychological, spiritual, or cultural distress

Expected Outcomes

• Patient verbalizes adequate relief of pain or ability to cope with incompletely relieved pain.

Ongoing Assessment

• Assess pain characteristics:
  • Quality (e.g., sharp, burning, shooting)
  • Severity (scale of 1 to 10, with 10 being the most severe) Other methods such as a visual analog scale or descriptive scales can be used to identify extent of pain.
  • Location (anatomical description)
  • Onset (gradual or sudden)
  • Duration (how long; intermittent or continuous)
  • Precipitating or relieving factors
• Observe or monitor signs and symptoms associated with pain, such as BP, heart rate, temperature, color and moisture of skin, restlessness, and ability to focus. Some people deny the experience of pain when it is present. Attention to associated signs may help the nurse in evaluating pain.
• Assess for probable cause of pain. Different etiological factors respond better to different therapies.
• Assess patient’s knowledge of or preference for the array of pain-relief strategies available. Some patients may be unaware of the effectiveness of nonpharmacological methods and may be willing to try them, either with or instead of traditional analgesic medications. Often a combination of therapies (e.g., mild analgesics with distraction or heat) may prove most effective.
• Evaluate patient’s response to pain and medications or therapeutics aimed at abolishing or relieving pain. It is important to help patients express as factually as possible (i.e., without the effect of mood, emotion, or anxiety) the effect of pain relief measures. Discrepancies between behavior or appearance and what patient says about pain relief (or lack of it) may be more a reflection of other methods patient is using to cope with than pain relief itself.
• Assess to what degree cultural, environmental, intrapersonal, and intrapsychic factors may contribute to pain or pain relief. These variables may modify the patient’s expression of his or her experience. For example, some cultures openly express feelings, while others restrain such expression. However, health care providers should not stereotype any patient response but rather evaluate the unique response of each patient.
• Evaluate what the pain means to the individual. The meaning of the pain will directly influence the patient’s response. Some patients, especially the dying, may feel that the “act of suffering” meets a spiritual need.
• Assess patient’s expectations for pain relief. Some patients may be content to have pain decreased; others will expect complete elimination of pain. This affects their perceptions of the effectiveness of the treatment modality and their willingness to participate in additional treatments.
• Assess patient’s willingness or ability to explore a range of techniques aimed at controlling pain. Some patients will feel uncomfortable exploring alternative methods of pain relief. However, patients need to be informed that there are multiple ways to manage pain.
• Assess appropriateness of patient as a patient-controlled analgesia (PCA) candidate: no history of substance abuse; no allergy to narcotic analgesics; clear sensorium; cooperative and motivated about use; no history of renal, hepatic, or respiratory disease; manual dexterity; and no history of major psychiatric disorder. PCA is the intravenous (IV) infusion of a narcotic (usually morphine or Demerol) through an infusion pump that is controlled by the patient. This allows the patient to manage pain relief within prescribed limits. In the hospice or home setting, a nurse or caregiver may be needed to assist the patient in managing the infusion.
• Monitor for changes in general condition that may herald need for change in pain relief method. For example, a PCA patient becomes confused and cannot manage PCA, or a successful modality ceases to provide adequate pain relief, as in relaxation breathing.
• If patient is on PCA, assess the following:
  • Pain relief The basal or lock-out dose may need to be increased to cover the patient’s pain.
  • Intactness of IV line If the IV is not patent, patient will not receive pain medication.
  • Amount of pain medication patient is requesting If demands for medication are quite frequent, patient’s dosage may need to be increased. If demands are very low, patient may require further instruction to properly use PCA.
  • Possible PCA complications such as excessive sedation, respiratory distress, urinary retention, nausea/vomiting, constipation, and IV site pain, redness, or swelling Patients may also experience mild allergic response to the analgesic agent, marked by generalized itching or nausea and vomiting.
• If patient is receiving epidural analgesia, assess the following:
  • Pain relief Intermittent epidurals require redosing at intervals. Variations in anatomy may result in a “patch effect.”
  • Numbness, tingling in extremities, a metallic taste in the mouth These symptoms may be indicators of an allergic response to the anesthesia agent, or of improper catheter placement.
  • Possible epidural analgesia complications such as excessive sedation, respiratory distress, urinary retention, or catheter migration Respiratory depression and intravascular infusion of anesthesia (resulting from catheter migration) can be potentially life-threatening.

Therapeutic Interventions

• Anticipate need for pain relief. One can most effectively deal with pain by preventing it. Early intervention may decrease the total amount of analgesic required.
• Respond immediately to complaint of pain. In the midst of painful experiences a patient’s perception of time may become distorted. Prompt responses to complaints may result in decreased anxiety in the patient. Demonstrated concern for patient’s welfare and comfort fosters the development of a trusting relationship.
• Eliminate additional stressors or sources of discomfort whenever possible. Patients may experience an exaggeration in pain or a decreased ability to tolerate painful stimuli if environmental, intrapersonal, or intrapsychic factors are further stressing them.
• Provide rest periods to facilitate comfort, sleep, and relaxation. The patient’s experiences of pain may become exaggerated as the result of fatigue. In a cyclic fashion, pain may result in fatigue, which may result in exaggerated pain and exhaustion. A quiet environment, a darkened room, and a disconnected phone are all measures geared toward facilitating rest.
• Determine the appropriate pain relief method.
• Pharmacological methods include the following: Nonsteroidal antiinflammatory drugs (NSAIDs) that may be administered orally or parenterally (to date, ketorolac is the only available parenteral NSAID).
• Use of opiates that may be administered orally, intramuscularly, subcutaneously, intravenously, systemically by patient-controlled analgesia (PCA) systems, or epidurally (either by bolus or continuous infusion). Narcotics are indicated for severe pain, especially in the hospice or home setting.
• Local anesthetic agents.
• Nonpharmacological methods include the following: Cognitive-behavioral strategies as follows:
  • Imagery The use of a mental picture or an imagined event involves use of the five senses to distract oneself from painful stimuli.
  • Distraction techniques Heighten one’s concentration upon nonpainful stimuli to decrease one’s awareness and experience of pain. Some methods are breathing modifications and nerve stimulation.
  • Relaxation exercises Techniques are used to bring about a state of physical and mental awareness and tranquility. The goal of these techniques is to reduce tension, subsequently reducing pain.
  • Biofeedback, breathing exercises, music therapy
• 2. Cutaneous stimulation as follows:
  • Massage of affected area when appropriate Massage decreases muscle tension and can promote comfort.
  • Transcutaneous electrical nerve stimulation (TENS) units
  • Hot or cold compress Hot, moist compresses have a penetrating effect. The warmth rushes blood to the affected area to promote healing. Cold compresses may reduce total edema and promote some numbing, thereby promoting comfort.
• Give analgesics as ordered, evaluating effectiveness and observing for any signs and symptoms of untoward effects. Pain medications are absorbed and metabolized differently by patients, so their effectiveness must be evaluated from patient to patient. Analgesics may cause side effects that range from mild to life-threatening.
• Notify physician if interventions are unsuccessful or if current complaint is a significant change from patient’s past experience of pain. Patients who request pain medications at more frequent intervals than prescribed may actually require higher doses or more potent analgesics.
• Whenever possible, reassure patient that pain is time-limited and that there is more than one approach to easing pain. When pain is perceived as everlasting and unresolvable, patient may give up trying to cope with or experience a sense of hopelessness and loss of control.
• If patient is on PCA: Dedicate use of IV line for PCA only; consult pharmacist before mixing drug with narcotic being infused. IV incompatibilities are possible.
• If patient is receiving epidural analgesia: Label all tubing (e.g., epidural catheter, IV tubing to epidural catheter) clearly to prevent inadvertent administration of inappropriate fluids or drugs into epidural space.
• For patients with PCA or epidural analgesia: Keep Narcan or other narcotic-reversing agent readily available. In the event of respiratory depression, these drugs reverse the narcotic effect.
• Post “No additional analgesia” sign over bed. This prevents inadvertent analgesic overdosing.

Education/Continuity of Care

• Provide anticipatory instruction on pain causes, appropriate prevention, and relief measures.
• Explain cause of pain or discomfort, if known.
• Instruct patient to report pain. Relief measures may be instituted.
• Instruct patient to evaluate and report effectiveness of measures used.
• Teach patient effective timing of medication dose in relation to potentially uncomfortable activities and prevention of peak pain periods.
• For patients on PCA or those receiving epidural analgesia: Teach patient preoperatively. Anesthesia effects should not obscure teaching.
• Teach patient the purpose, benefits, techniques of use/action, need for IV line (PCA only), other alternatives for pain control, and of the need to notify nurse of machine alarm and occurrence of untoward effects.

Source: (1) (2)

Acute Pain Nursing Diagnosis Original source at: Nurseslabs

This post contains 4 nursing care plans regarding acute pyelonephritis.

Ineffective Renal Tissue Perfusion

Capillaries are an integral part of the nephrons which are responsible for oxygenation. When the nephrons are destroyed or impaired such as in the progress of a renal disease like Pyelonephritis, there will be progressive decline in kidney perfusion. This hypoperfusion affects the kidney’s production of erythropoietin factor responsible for the production of RBC. A decreased in RBC levelproduction will then result to decreased oxygen supply to the kidney

Hyperthermia

In response to infection, inflammatory mediators and neutrophils are activated which will travel to the infected area via increased blood flow and chemotaxis. WBCs, particularly neutrophils, migrate into the site to perform phagocytosis. Neutrophils immediately die after performing their function, and release pyrogens. Pyrogens stimulate fever by increasing heat production and conservation. Fever stimulates immune system activity and kills microorganisms

Acute Pain

As the chemical mediators are released in response to infection, increased renal blood flow and infiltration of WBCs occur in the infected area. These stretch the renal capsule which irritates the nerve endings in the area, causing the activation of pain receptors. The location of the pain is attributed to the retroperitoneal anatomic site of the kidney.

Impaired Urinary Elimination

The entry of microorganisms in the urinary tract triggers the defenses built in our urinary system. One of these is an increase in urine production. The urine flow flushes / washes away microorganisms present in the tract. When the bladder detects the microbes, bladder wall irritation occurs. The bladder contracts its smooth muscles to eradicate the pathogens along with the urine.

Conclusion

Nursing goal should be towards preventing further infection, managing pain, and establishing effective urinary elimination. Hope you’ve found this post useful, if you do, please subscribe and enter your email address below, or you can also drop a comment, thanks for reading!

Acute Pyelonephritis Nursing Care Plans Original source at: Nurseslabs

Causes of pleural effusion can be grouped into four major categories:

• Increased systemic hydrostatic pressure (e.g., heart failure)
• Reduced capillary oncotic pressure (e.g., liver or renal failure)
• Increased capillary permeability (e.g., infection or trauma)
• Impaired lymphatic function (e.g., lymphatic obstruction caused by tumor)

1 Ineffective Breathing Pattern

Ineffective breathing pattern occurs when inspiration and expiration does not provide adequate ventilation. Pleural inflammation causes sharp localized pain that increases deep of breathing, coughing and movement. This can result to shallow and rapid breathing pattern. Distal airways and alveoli may not expand optimally with each breath, increasing the possibility of atelectasis and impaired gas exchange.

6 Pleural Effusion Nursing Care Plans Original source at: Nurseslabs

The nursing goal for client’s with CRF is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

1 Fluid Volume Excess

Renal disorder impairs glomerular filtration that resulted to fluid overload. With fluid volume excess, hydrostatic pressure is higher than the usual pushing excess fluids into the interstitial spaces. Since fluids are not reabsorbed at the venous end, fluid volume overloads the lymph system and stays in the interstitial spaces leading the patient to have edema, weight gain, pulmonary congestion and HPN at the same time due to decrease GFR, nephron hyperthrophized leading to decrease ability of the kidney to concentrate urine and impaired excretion of fluid thus leading to oliguria/anuria.

Fluid- Volume- Excess- CRF

5 Chronic Renal Failure Nursing Care Plans Original source at: Nurseslabs

Nursing goal for a patient with Rectal CA can be towards managing pain, managing symptoms, and patient education.

Acute Pain

The patient has colorectal cancer and one of its symptoms is abdominal pain. The pain is a subjective unpleasant sensation resulting from stimulation of sensory nerve endings by injury, or other harmful factors. Pain is activated when a pt’s pain threshold is reached. Pain threshold is the point at which a stimulus activates pain receptors to produce a feeling of pain. Pain usually accompanies inflammation. It results from the synthesis of prostaglandins, which are hormones produced during the inflammatory process.

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Constipation

Due to decrease physical activity of patient, the movement of feces through the large intestine is slow, thus, the patient manifest difficulty or decreased frequency in defecation. And also there is a presence of blockage in the intestines forming bulk and therefore the stool cannot pass through. (Ed notes: also there is painful and straining-like passage of stool)

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Impaired Bed Mobility

Abdominal cramping because of colorectal cancer there is a blockage of stool and formation of masse It starts from the synthesis of prostaglandins, which are hormones produced during the inflammatory process. The pain is triggered when the patient is moving so the response of the patient  he/she will not move to prevent initiation of pain.

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Activity Intolerance

Activity intolerance is brought about by the weakness. Weakness is caused by cancer, cancer cells get the nutrients that normal cell needs. In this situation normal cell lack nutrients so they cannot perform their functions. There will energy that the body can use so instead of doing daily activities the patient will just take rest.

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Self-Care Deficit

Restriction on the physical mobility of the client has resulted to a decreased ability for selfcare.  Specifically for this client, he has been unable to perform activities like bathing (and other measures of grooming), dressing up and attend to toileting needs by herself, thus, there is selfcare deficit. Weakness that is brought by cancer normal cells are lacking in nutrients. That the body needs in order to perform activities of daily living.

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Knowledge Deficit

They cannot understand diagnostic procedures that’s why doctors and nurses must explain medical procedures to the patient level of understanding. And also they lack knowledge about the surgery. The affected colon must be remove as what the doctor decides.

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Risk for Impaired Skin Integrity

Prolonged physical immobilization may cause pressure ulcers. Pressure ulcers may be caused by inadequate blood supply and as a result of  reperfusion injury when blood reenters tissue. A simple example of a mild pressure sore may be experienced by healthy individuals while sitting in the same position for extended periods of time: the dull ache experienced is indicative of impeded blood flow to affected areas

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Conclusion

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Source:

• eMedicine: Rectal Adenocarcinoma

Rectal Adenocarcinoma Nursing Care Plans Original source at: Nurseslabs

Gastroenteritis

The major clinical manifestations are diarrhea of varying degrees and abdominal pain and cramping. Associated clinical manifestations are nausea, vomiting, fever anorexia, distention, tenesmus, and borborygmi.

The nursing goals for patients with Acute Gastroenteritis are toward: avoiding dehydration and management of diarrhea. This post contains 4 nursing care plans.

1. Diarrhea

Diarrhea is defined as an increase in the frequency, volume and fluid content of stool. Rapid propulsion of intestinal contents through the small bowel results in diarrhea. Diarrhea is a hallmark sign of gastroenteritis.

7 Gastroenteritis Nursing Care Plans Original source at: Nurseslabs

View the surgical procedure for TAHBSO

Post-operative nursing care for patients who underwent TAHBSO would include:

1. Determines patient’s immediate response to surgical intervention.
2. Monitor patient’s physiologic status.
3. Assess patient’s pain level and administers appropriate pain relief measures.
4. Maintains patient’s safety(airway, circulation, prevention of injury)
5. Administer medication, fluid and blood component therapy, if prescribed.
6. Assess patient’s readiness for transfer to in hospital unit or for discharge home based on institutional policy.

This post includes several nursing care plans for post-TAHBSO patients.

1 Acute Pain

Due to surgical procedure done that needs a surgical incision there will be presence of trauma in the area that signals an actual tissue damage and inflammation, this damage will cause an inflammation of the nerves when the nerves are affected, there will be the presence of pain.

8 TAHBSO Nursing Care Plans Original source at: Nurseslabs