Care Plan Assignment PDF

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In-Class Care Plan Assignment: Case Study - Mrs. Butler

Sally Horsfall Eaton School of Nursing, George Brown College NURS 1067: Foundations of Nursing Theory Professor Carly Epps November 25, 2021

Right Hip Surgery Medical history: Case Study: 3 :Student Name

Gender: Female

Age: 71 Rationale Opioids, such as morphine are primary causes of .constipation

Goal (Expected (Outcome

Nursing Diagnosis

Consult with prescriber - Client will for alternative achieve bowel medications that is not movement within 48hrs an opioid, as they can cause constipation

:Priority Risk for constipation, related to post surgery care

Interventions ●

(Epps, C. (2021) NURS 1067: Management of Dehydration & Common Gastrointestinal Issues [Powerpoint Presentation]. Blackboard. Retrieved from George Brown College Website: https://bbgbc.blackboard.com/bbcsw ebdav/pid-6983754-dtcontent-rid96096936_1/xid-9609693 6_1)

Assessment Subjective: Mrs.Bu states and points to lower right and left quadrant of her abdomen. She says .feels uncomfortabl

Adequate fluid intake is ● necessary to prevent hard, dry stool. Dietary fibre intake promotes normal bowel elimination. (Potter, Perry, Stockert, Hall P. (1228- 1229

increase fiber (veggies, grains, etc) in diet as well as fluid input to approximately 2L per day

:Objective By assessing her abdomen, it feels fi and appears disten Incontinent of stool Last bowel moveme was the day of her surgery (2 days pri Intake: 1400ml (coffee,water, apple juice, tea), Output: 1050ml uri

● “Patients should feel relaxed when moving their bowels.” (Potter, Perry, Stockert & Hall, 2019, p. 1228)

Measuring and recording baseline weight and essential laboratory values such as blood glucose daily at .same time

Secondary: Risk for falls, related to .post hip surgery

Medications and/ lab results (if (applicable The client is curren on morphine for pa management.

● “ Medication can soften the stool and prevent straining.” (Lilley et al., 2016)

:References Approved nanda nursing diagnosis list 2018-2020. (n.d.). Retrieved November 19, 2021, from .https://ar.israa.edu.ps/uploads/documents/2020/02/4gcM0.pdf Potter, P. A., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2019). Canadian fundamentals of nursing .(6th Cdn. ed.) (B. J. Astle & W. Duggleby, Cdn. Adapt.). Toronto, ON: Elsevier Canada Epps, C. (2021) NURS 1067: Management of Dehydration & Common Gastrointestinal Issues [Powerpoint Presentation]. Blackboard. Retrieved from George Brown College Website: https://bb-

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