Medical-Surgical Nursing Care - Essay Example

"Medical-Surgical Nursing Care" is a great example of a paper on care.
Physical Assessment

1. Activities: general fatigue
2. Circulation: changes in BP (hypertension or hypotension); pulse may be irregular; pulse deficit; the sound of irregular heart rhythm, extra sounds, beats down; skin colour and moisture changes such as pallor, cyanosis, sweating; edema; decreased urine output when cardiac output decreased weight.
3. fluid: loss of appetite, anorexia, food intolerance, nausea, vomiting, weight Perubatan, changes in skin moisture
4. Neuro-sensory: dizziness, throbbing, headache, disorientation, confusion, lethargy, pupillary changes.
5. Pain/discomfort: mild to severe chest pain, may be lost or not with anti-angina drugs, anxiety
6. Respiratory: chronic lung disease, shortness of breath, cough, change in velocity/depth of breathing; additional breath sounds (krekels, crackles, wheezing) may have shown respiratory complications such as left heart failure (pulmonary edema) or pulmonary tromboembolitik phenomenon; hemoptysis.

Nursing assessing is carried out  in the provision  of care in  patients .done by:

• assessing heart functionality
• patient nutrition status.
• Activity torelance
• Sleep pattern disturbance
• Patient knowledge of the condition:
• Assessment and monitoring heart complications
• Pain assessment
• Assessing vital signs

          Nursing diagnosis

­­deacrease in cardiac output related to activity intolerance

Goals & expected outcomes :

 reduced levels of dyspnoea

• Patient activity and increased tolerance.

Nursing interventions:

• Monitor vital signs
• Monitor  & evaluate cardiac rhythm.
• Positioning semi fowlers.
•  Oxygen delivery and therapy.

2 Activity intolerance related to decreasing cardiac output

Goals & expected outcomes

• Response verbally  to decreased fatigue
• Increased range of motion

Nursing interventions:

• Bed rest until the patient condition improves
• Monitor increased levels of activity.
• Educate patient on self-care

Postoperative. Include the following being done

Pain management

Pain is assessed in a scale of  0-10(0 being no pain 10 being the worst pain ever felt) this guides on the analgesics to give

Good pain management reduces complications after surgery and improves patients comfort. pain management can be done by giving

1pain reducing medications orally

2 giving intramuscular injections (i.m)

Other methods such as aromatherapy are used

Epidural analgesia management. Pain management relief is achieved by giving analgesics

Patient comfort.

Patient comfort is vital. The patient should be positioned in a semi fowlers position for comfort. (that is 45 degrees) positioning aids in the respiration of the patient

Vital signs

Blood pressure pulse temperature respiration periphery oxygen saturation this guides one to know when the patient condition is deteriorating. The balance of the fluid of the electrolyte and the mechanism of the balance of the fluid usually attempts for maintenance of homeostasis. The two major partitions of the fluids, that is, ICF found in cellular membrane while the ECF which is contained in the extrinsic cells. These cells dissect into two components which involves the intravascular volume and the interstitial fluid surrounding the cells. Water and other solutes usually shift between the partitions via the semi-permeable membranes allowing the molecules to pass through it. Transportation of the fluids of the body across the semi-permeable membranes primarily occurs via diffusion, active transport, osmosis, filtration among others. This fluid usually shifts from compartment to the other to have an effect on the urine directly. The shifting of the fluids may occur at the medical operation leading to oedema as a result of inflammatory actions that is started during the operation. The liquid is normally un present making its replacement important to protect shock and the volume of the circulatory system reduces.  For the victims make use of diuretics for stimulation of the output of the urine making it dangerous due to the removal of fluids from the volume of extracellular leading to collapsing of circulatory. Colloids and the crystalloids are among the commonly used fluids for surgery.  They are used in supporting the level of ECF. The saline which is isotonic solution causes the osmotic pressure which is identical to the pressure of the cells. The saline will not move to the fluids of the body in great quantities due to the similarity of osmolarity.

 The infusions of the colloid expand the plasma for supporting the extracellular division. The size of the molecules of the proteins present in fluids are hindered from shifting across the cell membrane and the high osmotic pressure enables shifting of the fluid to the extracellular space from intracellular space rising the intravascular volume.  The primary aim of management of the fluids during surgery is for supporting fluid level maintenance of intracellular and intracellular for maintaining homeostasis.

 The monitoring of oxygen therapy has become a key routine in the wards for surgery with the use of pulse oximetry which provides an estimate of oxygenating the blood in the arteries and arterioles. During the post-surgery period, in case the patient is not able toward meeting the demands of the body to raise the oxygenation, failure of the respiratory system may occur. This may be gauged in the sampling of the blood in arteries as a reduction in the Ph of the blood and curtailed oxygen pressure usually levels and increase in partiality.