NURSING CARE PLAN ON LAPROTOMY. - MCI Nursing … ON laproto… · · 2018-05-23A COMPLETE COACHING FOR THE PREPARATION OF STAFF NURSE/AIIMS/PGI/RPSC/ B.Sc NURSING. /M/Sc.NURSING

A COMPLETE COACHING FOR THE PREPARATION OF STAFF NURSE/AIIMS/PGI/RPSC/ B.Sc NURSING.

/M/Sc.NURSING BY SAHU SIR-8947879143

NURSING CARE PLAN

ON

LAPROTOMY.

SUBJECT: ADVANCE NURSING PRACTICE

SUBMITTED TO: SUBMITTED BY:



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SUBMITTED ON: 15/07/2013

1. BIOGRAPHIC DATA:

Name : Mr. Sushanth

Age : 34 years

Sex : Male

Address :Ratangarh

MRD No. : 278402

Education : 10th standard

Occupation : Driver (auto)

Income : Rs. 4000

Marital Status : Married

Religion : Hindu

Mother tongue : Kannada

Language known : Kannada

Ward : Post-Operative Ward

Date of admission : 10.07.2013

Diagnosis : Intestinal Obstruction

Date of surgery : 15.07.2013

Type of anaesthesia : General anaesthesia

Operation done : Laparotomy

Name of the surgery: resection of part of ascending colon and anastomosed

to transverse colon.

2. HISTORY COLLECTION:

Chief complaints:-

- Constipation- 3-4 days

- Edema (pedal)

- Fever- 2-3 days

Present history of illness:-

Medical- pain was apparently normal 9 days back when he developed



pain abdomen. Pain was in constricting type on & off.

Due to this reason he came to Victoria Hospital for treatment

and got admitted on 08.02.2010 and was posted for surgery.

Surgical- Laparotomy

Past history of illness:-

Medical- there is no any history of any medical illness, except

occasional cough and cold.

Surgical- there is no history of any surgery done.

Personal Habits:-

Habits – Smoker, 2 cigarettes per day and

Alcohol - occasionally

Diet- he takes a mixed diet, and eats two meals per day.

Sleeping habits- regular, 5-6 hours per day, but the last 2-3 days he is

not able to sleep due to abdominal pain.

Hobby- hanging out with his friends.

Bowel and Bladder habits- urinate 5-6 times per day and the bowel

pattern is regular, except the last 3-4

days he is having constipation.

Socialization- he is a socialise person and a loving person.

Family history:-

34 yrs

27

yrs

5

yrs

3

yrs



There is no any history of any hereditary disease like HTN, DM, asthma, epilepsy or seizures

in the client’s family. The client is married to his wife and has two children, one son and one

daughter. All of them are enjoying a good and healthy life.

Sl

no.

Name Age Qualification/

Occupation

Relation to

Mr.sushanth.

Health status

1. Mr.sushanth. 34 yrs 10th standard Client unhealthy

2. Mrs.srinidhi 28 yrs 5th standards Wife Healthy

3. Ms. Sneha. 5 yrs 1st standards Daughter Healthy

4. Mast.sunil. 3 yrs - Son Healthy

Socio- economic status:-

Condition of the house- the client lived in his own house with his

family, which is kaccha with two small rooms including the kitchen. They used stove for

cooking. The house is supplied with electricity.

Water supply- water supply is from the corporation.

Drainage system- closed drainage system.

Surrounding environment- their surrounding environment is unhealthy.

Economic status- the client is the only source of income in their family,

his monthly income is Rs.4000 per month.

3. PHYSICAL EXAMINATION:

Vital signs:-

Temperature : 1000 F

Pulse : 98 beat per minute

Respiration : 22 per minute

Blood Pressure: 130/80 mmHg

Height and weight:-

Height: 168cm



Weight: 65 kg

General appearance:-

Constitution : Thin

State of nutrition : Poor

Personal appearance: Normal

Posture : Normal

Skin and hair : dark complexion

Emotional state : Anxious

Co-cooperativeness: cooperative

HEAD TO FOOT EXAMINATION:-

Head:

Skull - has no abnormalities noted.

Hair - black hair, hair distribution normal

Movement of head- has full range of movement

Fore head - no scar or lesion noted

Face - anxious looking

Eyes:

Eye brows - equal and even distribution

Eye lids - no lesion or scar noted.

Lacrimation - clear fluid expression

Conjunctiva- appears pale and clear

Sclera - appears white

Cornea - appears moist

Irish pupil - appears round and central in the sclera.

Pupil - PERRLA

Ears:

Appearance- no mass or lesion noted

Discharge - None

Hearing - normal

Lesion - none

Nose:

Appearance - no septum deviation, Ryle’s tube present on the left nostril.

Discharge - none



Patency -both nostrils are patent

Sense of smell- good

Mouth and throat:

Lips - dry

Tongue - coated tongue

Teeth - yellowish in colour

Gums - brownish black

Buccal mucosa- no lesion and ulceration

Tonsil - not palpable

Taste - abnormal

Neck:

General appearance- normal

Lymph nodes - not palpable

Thyroid glands - not palpable

Cysts and tumour - absent

Chest:

Inspection- size and shape are normal

Palpation- no local swelling noted

Auscultation- S1S2 heard.

Abdomen:

Inspection- normal in shape and size, drainage on the right side present. An

incision on the lower abdominal region. No redness and swelling noted

Palpation- soft, no organomegally

Percussion- tenderness present

Auscultation- peristalsis movement present, bowel sound absent.

Spine and back:

Spine and curvature- no lordosis or kyphosis noted.

Movement - all movement are normal

Tenderness - no tenderness noted

Genitalia:

Normal. Urinary catheter present. No discharge noted or observed.

Upper and lower extremities:



Upper- normal movement, no lymph node enlargement noted

Lower- normal anatomically.

Skin:

Colour of skin- dark complexion

Edema- pedal edema present

Moisture- dry

Turgor- moderate

SYSTEMIC ASSESSMENT:-

Nervous system:

Conscious- client is conscious

Orientation- oriented to time, place and person.

Obeys commands- yes, client obeys commands.

Cardiovascular system:

S1- present

S2- present

S3- absent

S4- absent

Murmur- absent

Respiratory system:

Inspiration & expiration- present

Respiration rate- 22 per minute

Ronchi/ wheezing- present

Gastro-intestinal system:

Peristalsis movement- present



Bowel pattern- irregular, constipated for the last 3 to 4 days.

Organomegally- absent

Urinary system:

Frequency- 5 to 6 times per day normally

Burning micturation- absent

Catheterization- present; Input = 1500ml, Output = 2200ml

Urine colour- dark straw colour

4. INVESTIGATION:

Sl

no.

Investigation Patient’s value Impressi

-on

Normal value

1.

Blood Test

Complete blood

count-

Hb= 11.2 g/dl

Total WBC= 11,000cells/cmm

Neutrophil=60%

Lymphocytes=35%

Eosinophils=4%

Monocytes=5%

Basophil=01%

ESR=15mm

Platelet count=3lac/L

RBS= 68mg/dl

Anaemic

Infection

Normal

Normal

Infection

Normal

Normal

Infection

Normal

Low

Hb= 14-16.5 g/dl

WBC= 5-10,000cells/cmm

Neutrophil= 47-63%

Lymphocytes=24-40%

Eosinophils=0-3%

Monocytes=4-9%

Basophil=0-2%

ESR=0-9mm

Platelet count=1.5-4lac/L

RBS= 70-120mg/dl



2.

3.

Electrolyte

X-ray

Serology

Sodium= 144mmmol/L

Potassium=4.6mmol/L

Chlorine=107mmol/L

Serum creatinine=0.8mg/dl

Serum BUN=33mg/dl

No abnormality detected

Hbs Ag= non- reactive

HIV= non reactive

Normal

Normal

Normal

Normal

High

Normal

Normal

Normal

Sodium=135-145mmol/L

Potassium=3.5-5.0mmol/L

Chlorine=97-107mmol/L

Serum creatinine=0.7-1.4mg/dl

Serum urea=8-20 mg/dl

-

Negative

5. MEDICATION:

Sl

no

Medication Dose,

route &

time

Action of drug Side effect Nursing

responsibility

1.

2.

Inj. Omnatax

Inj. Metrogyl

1gm

IV

BD

100ml

IV

It is active against gram

–ve organisms and

betalactamase

producing organisms. It

is active against

pseudomonas,

anaerobes, and

spirochaetes.

A direct acting

trichomonocide and

amebicide that works at

Nausea, skin rash,

drug, fever,

diarrhoea, pruritis,

local reaction and

pain,

thrombocytopenia

and luekopenia.

Headache, vertigo,

seizures, abdominal

cramping, nausea,

- check vital signs.

- follow strictly the

five rights.

- monitor closely the

patient for any side

effect of the drugs

given.

-observe the site of

injection carefully.



APPLICATION OF THEORY

Name : Mr. Sushanth.

Age : 34 years

Sex : Male

Ward : Post-Operative ward

Present compliant : - Pain in incision site

- Constipation- 3-4 days

- Edema (pedal)

- Fever- 2-3 days

Diagnosis : Intestinal Obstruction

3.

4.

Inj. Rantac

Inj. Tramadol

TDS

50mg

IV

BD

50mg

IV

BD

both intestinal and extra

intestinal sites.

Competitively inhibits

action of histamine on

the H2 at receptor sites

of parietal cells

decreasing gastric acid

secretion.

Weak agonist at opiod

receptors especially

receptors.

rash, constipation,

anorexia.

Vertigo, malaise,

headache, blurred

vision, jaundice,

burning and itching

at the injection site.

Nausea, vomiting,

dizziness, sweating,

stupor, psychiatric

reaction

check vital signs.

- follow strictly the

five rights.

- monitor closely the

patient for any side

effect of the drugs

given.



DOROTHEA E JOHNSON’S BEHAVIOURAL

MODEL

Johnson define a system as a whole that function as a whole by virtue of the

interdependence of its parts individual strive to maintain stability and balance in those parts

through adjustment and adaptation to the forces, the impinge of them. A behaviour system is

pattern, repetitive and purposeful.

Johnson’s key concepts describe the individual as a behavioural system composed of

seven sub systems.

1) Attachment- Affiliative: Sub system provides survival and security. Its

consequences are social inclusion, intimacy and the formation and maintenance of

a strong social bond.

2) The dependency sub system: problem helping behaviour that calls for a nurturing

response. Its consequences of approval, attention or recognition and physical

assistance.

3) The ingestive system: Sub system satisfies appetite. It is governed by social and

psychological consideration as well as biologic.

4) The eliminative: Sub system excretes body wastes.

5) The sexual subsystem functions dually for procreation and gratification.

6) The achievement: Sub system attempts to manipulate the environment. It controls

or masters an aspect of the self or environment to some standards or excellence.

7) The aggressive: Subsystem protects and preserves the self and society within the

limits imposed by society.

Each of the above subsystem has the same functional requirement, protection

nurturance and stimulation. The subsystem’ responses are developed through motivation,

experience and learning and are influenced by bio-psychosocial factors.



Other concepts associated with Johnson’s model are equilibrium, a stabilised but more

or less transitory resting state in which the individual is in harmony with the self and the

environment tension. A state of being stretched or stained and stressors. Internal or external

stimuli that produced tension and result in a degree of instability.

Assessment of Mr.Ravi Chandran by using Johnson’s Behavioural System

Model:

Eight Sub-systems:

Achievement-

Mr. Sushanth is 34 years old has basic education upto 10th standard, has one daughter

and one son. He has not accomplished all his responsibility in his life with regard to the

family. He wanted to see his children going to school.

Affiliative-

Mr. Sushanth is head of the family and all things under his control. He is working as a

auto driver. He is loved and respect by his friends and family members.

Aggressive/Protective-

Mr. Sushanth is not productive himself and used to take alcohol 2-3 pegs per day and

smoke 2-3 cigarettes per day.

Dependency-

Mr.Sushanth lives with his family and he is the only source of income, earned 1000-

1500 per month and now he feels alone and thinks how he will manage their economic

condition.

Eliminative-

He has no complaints of elimination previously and now he says that he is having

constipation for the last 3-4 days after the operation.

Ingestive-



Mr. Sushanth has no complaint regarding food, no nausea or vomiting after admission.

He weight is not appropriate with his age and height. He takes two meals per day and he

takes mixed diet.

Restorative-

Mr. Sushanth is admitted with complaints abdominal pain

Sexual-

Mr. Sushanth is having a good relationship with his wife

Environment Assessment:-

Familial-

Mr. Sushanth has one daughter and one son, he wanted to see his children going to

school and becoming an educated person. He is worrying about his children education. He is

worried more about how he take care of his family.

Socio-cultural-

Mr. Sushanth belongs to Hindu religion. He believes god and go to temple. He

maintains regular social relationship with his relatives, friends and neighbour.

Ecological-

Mr. Sushanth lives in his own hose which is kaccha with two small rooms including the

kitchen. Their surrounding environment is unhealthy.

Developmental-

Mr. Sushanth is 34 years old man. he has a good relationship with his family members.




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CALL:- 8947879143 (SAHU SIR)







DOROTHY E. JOHNSON’S BEHAVIOURAL SYSTEM MODEL

Attachment- unable to meet his family &

friends because of hospitalisation

Dependency-dependency for self Achievement- proper

care activity & living education for

his children

Protective- smoking and

drinking alcohol.

Ingestive- decreased appetite due to

smoking and alcohol, constipation.

Mr. Sushanth

34 years, male

Intestinal Obstruction



Nursing Diagnosis (problem identified)

1. Pain (acute) related to incisional site as evidenced by report of pain, facial grimace,

restlessness.

2. Body temperature: imbalanced related to infection as evidenced by raised in

temperature, increased pulse rate.

3. Anxiety related to surgery and fear of death as manifested by restlessness increased

awakeness, facial tension.

4. Nutrition imbalanced: less than body requirement related to loss of appetite as

evidenced by considerable weight loss and paleness of eye.

5. Constipation related to lack of food and fluid intake, immobility as manifested by

infrequent passage of stool.

6. Knowledge deficit regarding disease condition, treatment regimen and prognosis as

evidenced by lack of questioning and verbalized.



A COMPLETE COACHING FOR THE PREPARATION OF STAFF NURSE/AIIMS/PGI/RPSC/ B.Sc NURSING. /M/Sc.NURSING BY SAHU SIR-8947879143

Nursing theory Assessment Nursing

diagnosis

Goal Planning Implementation Evaluation

Johnson behavioural

system model:-

It is identified that due

to the mode of

intervention, the client

has pain in the

incisional site, nurses

identified the problem

and take appropriate

action or intervention.

Subjective data:

The client says, “I

am having pain in

the incisional

region.”

Objective data:

-facial grimace

-restlessness

-irritable

-pain scale measure

40-60%

Pain (acute)

related to

incisional site as

evidenced by

report of pain,

facial grimace,

restlessness.

Relieving of

pain

-assess the level of pain.

(severity & location)

-provide adequate and

comfortable position.

-check the incisional site

for redness or swelling.

-maintain pain scale for

the client.

-daily changing of

dressing under sterile

technique.

-instruct the client to

report pain.

-monitor other associated

signs and symptoms.

-administer medication

as prescribed.

-assessed the level of pain.

(severity & location)

-provided comfortable

position and adequate rest.

-incisional site checked for

redness and swelling.

-pain scale maintained.

-dressing changed under

sterile technique.

-instructed the client to

intimate if he feels pain.

-vital signs monitoring

done every 15 minutes.

-Inj. Tramadol 50 mg IV

given.

-20%.



diagnosis


Johnson behavioural

system model:-

Subjective data:


will die today or

tomorrow and i

won’t be able to

recover from my

surgery.”

Objective data:

-facial tension

-poor eye contact

-increased

questioning

Anxiety related

to surgery and

fear of death as

manifested by

restlessness

increased

awakeness,

facial tension.

Reducing the

anxiety of the

client.

-assess the level and

cause of fear.

-check client’s very often

and assure the client that

close monitoring ensure

prompt treatment.

-encourage client to call

for nurse when pain or

fear develops.

-establish rest period

between care and

procedure.

-provide adequate rest

and a quiet and calm

environment.

-explain about the

disease condition and

prognosis and treatment

regimen.

-the client is having

moderate pain.

-every 15 minutes asked

the client about his

condition and vital signs

monitor.

-encourage him to respond

to his pain and fear by

calling the nurse.

-rest period is provided

between the procedure.

-quiet and calm

environment provided.

-explained to the client

about the disease

condition, treatment and

prognosis in simple and

understandable words.

The client

appears calm

and express trust

in medical

treatment.



diagnosis


Johnson behavioural

system model:-


to mode of

intervention, nurses

identified problem of

imbalanced nutrition

and take appropriate


Subjective data:


am not having

appetite.”

Objective data:

-weight loss

-Ryle’s tube present.

-look anorexic

Nutrition

imbalanced: less

than body

requirement

related to loss of

appetite as

evidenced by

considerable

weight loss and

paleness of eye.

To maintain

normal body

weight of the

client.

-assess the weight of the

patient.

-monitor laboratory

values indicate

nutritional well-being.

-encourage calorie intake

appropriate for body

type and life-style.

-encourage client to be

more aware of

nutritional habits.

-discourage smoking and

alcohol and explain

about its hazards.

-advise and encourage

for oral care before and

after meals.

-aspiration to be done

-the client’s weight is 53

kg and is not appropriate

with the height.

-monitored laboratory

values of serum

Hb=11.2gm/dl.

-encouraged the client to

take high calorie high

protein diet like dal, egg,

milk, and green vegetables.

-explain the client the

hazards of smoking and

alcohol.

-advised for oral care

before and after each feeds.

-aspiration done before

every tube feeding.

The client is

able to take food

by mouth.



diagnosis


Johnson behavioural

system model:-


to mode of

intervention, nurses


constipation and take

appropriate action or

intervention.

Subjective data:


am not passing stool

regularly.”

Objective data:

-bowel sound

absent.

Constipation

related to lack of

food and fluid

intake,

immobility as

manifested by

infrequent

passage of stool.

To maintain

normal

elimination

pattern.

-assess the bowel sound,

movement, type of stool

pass.

-advise the patient to

take more vegetables,

which contain fiber and

fruits for easy digestion.

-advise to take more

fluids such as more

amount of water,

coconut water etc.

-encourage patient to

increase bowel

movement by his own.

-establish daily routines

-assessed the bowel sound,

movement, type of stool

pass.

-advised the patient to take

more vegetable items,

which contain fiber and

fruits for easy digestion.

-advised to take more

fluids such as more amount

of water, coconut water etc.

-encouraged patient to

increase bowel movement

by his own.

-established a daily

routines to have a regular

The client

identifies and

consumes foods

high in fibre.

before every feeding.


to have a regular timing.

-maintain privacy and

position for defecation

timing


diagnosis


Johnson behavioural

system model:-


to mode of

intervention, nurse


fever, and take

appropriate action or

intervention.

Subjective data:


am feeling very hot

and my body are

aching.”

Objective data:

-T= 101 0 F

P=96 bpm

Resp.= 22/ min

BP= 120/70mmHg

Body

temperature:

imbalanced

related to

infection as

evidenced by

raised in

temperature,

increased pulse

rate.

To maintain

the normal

body

temperature.

-assess the condition of

the client.

-monitor the vital signs

every 15 minutes.

-advise to drink more

fluid like fruit juices,

coconut water etc.

-advise to remove excess

clothing.

-encourage taking high

calorie high protein diet

like egg, milk, meat and

-assessed the condition of

the client.

-vital signs monitor every

15 minutes.

-advised to drink more

fluid like fruit juices,

coconut water etc.

- excess clothing removed

from the client’s bed.

-encouraged taking high

calorie high protein diet

like egg, milk, meat and

Temperature

reduced

T-99.80F

Pulse- 90bpm

Resp- 20/min


green vegetables.

-encourage cold

compress.

-administered

medication if prescribed.

green vegetables.

-cold compress given.


diagnosis


Johnson behavioural

system model:-


to mode of

intervention, nurse


lack of knowledge and

take appropriate


Subjective data:

The client says, ““I

am not able to

understanding my

condition.”

Objective data:

Asking too many

questioned regarding

his condition.

Knowledge

deficit regarding

disease

condition,

treatment

regimen and

prognosis as

evidenced by

lack of

questioning and

verbalized.

To increased

the

knowledge

level of

patient

-assess the level of

knowledge of the client

about the disease and

treatment.

-explain to the client in

simple and

understandable words

regarding the disease

condition and treatment.

-encourage the client to

-assessed the level of

knowledge of the client.

- explained to the client in

simple and understandable

words regarding the

disease condition and

treatment.


clear his doubt.

The client is

following the

treatment

regimen without

any confusion.


clear his doubt.

-encourage the client to

ask and clarify all his

doubts.

-explain to the client

about the diet,

medication and

exercises.


ask and clarify all his

doubts.

-explained to the client

about the diet, medication

and exercises.



Conclusion.

Mr. Sushanth came to hospital with the chief complaints of constipation and edema and

intestinal pain and he was diagnosed as intestinal obstruction and he underwent laprotomy

surgery now he is recovering from his condition.

Bibliography.

Lewis SM,Heitkemper MM,Dirksen SR.medical surgical nursing,assessment and management of clinical problems.6th ed.missouri:mosby;2004.p.1078-81.

Suzane cs,Brenda gb,jonice lh, Textbook of Medical-Surgical Nursing.10th ed.wolters klwwer; 2004.p1054-56.

Silverstri LA..comprehensive review of nclex.rn.examination .3rd ed.pennylvania:saunders;2006.p.677-87

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Study material for:- staff Nurse:- AIIMS/ M.Sc.NURSING/B.Sc.NURSING

VISIT REGULAR:- www.mcinursing.com

CALL:- 8947879143 (SAHU SIR)


CALL:- 8947879143 (SAHU SIR)





Documents

NURSING CARE PLAN ON LAPROTOMY. - MCI Nursing … ON laproto… · · 2018-05-23A COMPLETE COACHING FOR THE PREPARATION OF STAFF NURSE/AIIMS/PGI/RPSC/ B.Sc NURSING. /M/Sc.NURSING