ADS

3 Nursing Diagnosis for Epistaxis with Interventions and Rational

This article 3 Nursing Diagnosis for Epistaxis with Interventions and Rational is one of the articles you were looking for? If true, you are very right here. OK here's the information on the article 3 Nursing Diagnosis for Epistaxis with Interventions and Rational.

3 Nursing Diagnosis for Epistaxis with Interventions and Rational

Nursing Diagnosis

1. Risk for Bleeding

Goal: minimize bleeding

Expected Outomes: No bleeding, vital signs within normal limits, no anemis.

Interventions:
  • Monitor the patient's general condition
  • Monitor vital signs
  • Monitor the amount of bleeding patients
  • Monitor the event of anemia
  • Collaboration with the doctor about the problems that occur with bleeding: transfusion, medication.
(Diagnosis NANDA, NIC, NOC)


2. Ineffective airway clearance

Goal: to be effective airway clearance

Expected Outcomes: Frequency of normal breathing, no additional breath sounds, do not use additional respiratory muscles, dyspnoea and cyanosis does not occur.

Independent
  • Assess the sound or the depth of breathing and chest movement.
    Rational: Decreased breath sounds may lead to atelectasis, Ronchi, and wheezing showed accumulation of secretions.
  • Note the ability to remove mucous / coughing effectively
    Rational: bright lumpy or bloody sputum may result from damage to lungs or bronchial injury.
  • Give Fowler's or semi-Fowler position.
    Rational: Positioning helps maximize lung expansion and reduce respiratory effort.
  • Clean secretions from the mouth and trachea
    Rational: To prevent obstruction / aspiration.
  • Maintain a fluid inclusion at least as much as 250 ml / day unless contraindicated.
    Rational: Helping dilution of secretions.

Collaboration
  • Give medication in accordance with the indications mucolytic, expectorant, bronchodilator.
    Rational: Mucolytic to reduce cough, expectorant to help mobilize secretions, bronchodilators reduce bronchial spasms and analgesics are given to reduce discomfort.

3. Acute pain

Goal: pain diminished or disappeared

Expected Outcomes:
  • Clients express the pain diminished or disappeared
  • Clients do not grimace in pain

Interventions:
  • Assess client's level of pain
    Rational: Knowing the client's level of pain in determining further action.
  • Explain the causes and consequences of pain to the client and his family.
    Rational: The causes and consequences of pain the client is expected to participate in treatment to reduce pain.
  • Teach relaxation and distraction techniques.
    Rational: The client knows the distraction, and relaxation techniques can be practiced so as if in pain.
  • Observation of vital signs and client complaints.
    Rational: Knowing the prevailing circumstances and conditions of client development.

Thank you for reading the article 3 Nursing Diagnosis for Epistaxis with Interventions and Rational.We sincerely hope you can understand that our article 3 Nursing Diagnosis for Epistaxis with Interventions and Rational is taken from various sources. If the article useful 3 Nursing Diagnosis for Epistaxis with Interventions and Rational don't forget to share. Thank You.

1 komentar:

  1. HOW I GOT CURED OF HERPES VIRUS.

    Hello everyone out there, i am here to give my testimony about a herbalist called dr imoloa. i was infected with herpes simplex virus 2 in 2013, i went to many hospitals for cure but there was no solution, so i was thinking on how i can get a solution out so that my body can be okay. one day i was in the pool side browsing and thinking of where i can get a solution. i go through many website were i saw so many testimonies about dr imoloa on how he cured them. i did not believe but i decided to give him a try, i contacted him and he prepared the herpes for me which i recieved through DHL courier service. i took it for two weeks after then he instructed me to go for check up, after the test i was confirmed herpes negative. am so free and happy. so, if you have problem or you are infected with any disease kindly contact him on email--- drimolaherbalmademedicine@gmail.com. or / whatssapp --+2347081986098.
    This testimony serve as an expression of my gratitude. he also have herbal cure for COLD SORE, SHINGLES, CANCER, HEPATITICS A, B. DIABETES 1/2, HIV/AIDS, CHRONIC PANCERATIC, CHLAMYDIA, ZIKA VIRUS, EMPHYSEMA, LOW SPERM COUNT, ENZYMA, COUGH, ULCER, ARTHRITIS, LEUKEMIA, LYME DISEASE, ASTHMA, IMPOTENCE, BARENESS/INFERTILITY, WEAK ERECTION, PENIS ENLARGEMENT. AND SO ON.

    BalasHapus