The nursing goal for patients with stroke can be towards maintaining effective tissue perfusion, preventing further complications, and enhancing coping. This is a nursing care plan for patients with hemorrhagic stroke.

1 Ineffective Cerebral Tissue Perfusion

The presence of partial blockage of the blood vessel can be multifactorial. These can be due to vaso constriction, platelet adherence on rough surface, fat accumulation and therefore decreases elasticity of vessel wall leading to alteration of blood perfusion with the initiation of the clotting sequence. This may later lead to the development of thrombus which can be loosened and dislodged in some areas of the brain such as mid cerebral carotid artery that may lead to alteration of blood perfusion and further develop to cerebral infarct.

NCP- CVA- Ineffective- Tissue- Perfusion

14 Cerebrovascular Accident 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.

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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

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Impaired Physical Activity

CVA is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. This is due to the rupture of blood vessels thus causing hemorrhage wherein there is accumulation of blood in the skull. The affected area of the brain with hemorrhage is unable to function leading to inability to move the body

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Hemorrhagic Cerebrovascular Accident/Stroke Nursing Care Plans Original source at: Nurseslabs

A bone fracture

Types of Fractures:

• Complete fracture: A fracture in which bone fragments separate completely.
• Incomplete fracture: A fracture in which the bone fragments are still partially joined.
• Linear fracture: A fracture that is parallel to the bone’s long axis.
• Transverse fracture: A fracture that is at a right angle to the bone’s long axis.
• Oblique fracture: A fracture that is diagonal to a bone’s long axis.
• Spiral fracture: A fracture where at least one part of the bone has been twisted.
• Comminuted fracture: A fracture in which the bone has broken into a number of pieces.
• Compacted fracture: A fracture caused when bone fragments are driven into each other.

Pathophysiology

The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture Hematoma. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring phagocytes to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen  fibers. In this way the blood clot is replaced by a matrix of collagen. Collagen’s rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.

At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial “woven” bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature “lamellar” bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.

Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. The bone shards can also embed in the muscle causing great pain. Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures

9 Fracture Nursing Management and Care Plans Original source at: Nurseslabs