This is assignment that I submitted while ago and I failed the…

Question Answered step-by-step This is assignment that I submitted while ago and I failed the… This is assignment that I submitted while ago and I failed the most. Can you assist me and help me understand where was I wrong and how do you do for your care plan especially goals & outcome for the patient, Assessment Data and intervention/rational? The most difficult part of my assignment and I am still struggling was the outcome evaluation & replanning. Can you help please? Here are the instructor’s comment/feedback for this assignment: Assignment Feedback from instructor:There should be 6 interventions if you have 2 goals, you should have 6 to rationalize your interventionsWhat are the 2 goals for this PT and when will they be achieved?This would be a good goal if it had a time framed. This does not appear to be an outcome.These are all nursing diagnosis and don’t belong here. The question wants 3-5 subjective/objective data on the pt that leads to your nursing diagnosis of nausea.Unneeded information for this question.GI bleed is a medical diagnosis and lack of fluids is not a nursing diagnosis.  Patient Medical Diagnosis: GI bleed Nursing Diagnosis: Nausea/EmesisAssessment Data (Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)Goals & Outcome (Two statements are required for each nursing diagnosis.   Must be Patient and/or family focused; measurable; time-specific; and reasonable.) Nursing Interventions (List at least three nursing or collaborative interventions with rationale for each goal & outcome.)Rationale (Provide reason why intervention is indicated/therapeutic; provide references.)Outcome Evaluation & Replanning(Was goal met?  How would you revise the plan of care according the patient’s response to current plan ?)1. Imbalanced Nutrition: Less Than Body Requirements related to GI bleeding as evidenced by Inadequate dietary intake (NPO status) and malabsorption of irons, minerals, and vitamins 2. Risk for Deficient Fluid Volume as evidenced by GI bleeding 3. Risk for injury related to changes in cognitive function as evidenced by patient unable to identify place during orientationpatient confused on location of bathroom 4. Activity Intolerance related toImbalance between oxygen supply and demandas evidence byGeneralized weaknessDeconditioned stateSedentary lifestyle 5. Deficient KnowledgeMay be related to:(1) Lack of recall of previously learned informationNew condition, treatmentRecurrent episodes of GI bleedingas evidenced by inaccurate follow-through with treatment regimen and lifestyle modifications Patient Medical Diagnosis: Acute Gastrointestinal BleedingNausea/Emesis Patient is resting in bed with her TV on, she is requesting to watch a movie. Denies any pain currently. Tuesday, the patient respirations are even and unlabored. Will continue to monitor. Subjective Data:WeaknessDizzinessAbdominal pain Objective Data:Patient is on NPO statusPt unable to identify place during orientationPt confused on location of bathroom Statements Client will be normovolemic as evidenced by systolic BP greater than or equal to 90 mm Hg (or client’s baseline), absence of orthostasis, HR 60 to 100 beats/minute, urine output greater than 30 ml/hr., and normal skin turgor. Nursing Diagnosis:Risk for Deficient Fluid Volume as related to GI bleeding as evidenced by weakness, dizziness, and dry oral mucosa. 1. Monitor and document vital signs, especially BP and HR. Assess for the signs of hematemesis or melena.Rationale (R) The client with a bleeding ulcer may vomit bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper GI tract. A decrease in circulating blood volume can cause hypotension and tachycardia. Alteration in HR is a compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and irregular if electrolyte imbalance also occurs. Hypotension is evident in hypovolemia. 2. Assess alteration in mentation/sensorium (confusion, agitation, slowed responses).R: Alteration in mentation/sensorium may be caused by abnormally high or low glucose, electrolyte abnormalities, acidosis, decreased cerebral perfusion, or developing hypoxia. Impaired consciousness can predispose a patient to aspiration regardless of the cause. 3. Assess color and amount of urine. Report urine output less than 30 ml/hr. for two (2) consecutive hours.R: Normal urine output is considered normal, not less than 30ml/hour. Concentrated urine denotes fluid deficit.Emphasize the importance of oral hygiene.A fluid deficit can cause a dry, sticky mouth. Attention to mouth care promotes interest in drinking and reduces the discomfort of dry mucous membranes. 4. Provide a comfortable environment by covering the patient with light sheets.R: Drop situations where patients can experience overheating to prevent further fluid loss. 5. Plan daily activities.1. Administer parenteral fluids as prescribed. R: Consider the need for an IV fluid challenge with an immediate infusion of fluids for patients with abnormal vital signs.Fluids are necessary to maintain hydration status. Determination of the type and amount of fluid to be replaced and infusion rates will vary depending on clinical status. 2. Administer blood products as prescribed.R. Blood transfusions may be required to correct fluid loss from active gastrointestinal bleeding. 3. Maintain IV flow rate. Stop or delay the infusion if signs of fluid overload transpire, refer to physician respectively.Most susceptible to fluid overload are elderly patients and require immediate attention. 4. Assist the physician with inserting the central venous line and arterial line, as indicated.R: central venous line allows fluids to be infused centrally and for monitoring of CVP and fluid status. An arterial line allows for the continuous monitoring of BP. 5. Provide measures to prevent excessive electrolyte loss (e.g., resting the GI tract, administering antipyretics as ordered by the physician).R: Fluid losses from diarrhea should be concomitantly treated with antidiarrheal medications, as prescribed. Antipyretics can decrease fever and fluid losses from diaphoresis. Outcome #1 After 8 hours of nursing shift patients’ vital signs is normal with BP of 115/80 mmHg, with adequate urine output, moist oral mucosa and with good skin turgor.  Outcome #2The patient will maintain an elastic skin turgor and moist mucous membranes    List patient mediations, indications, and nursing considerations for this patientMedication, Dose, RouteIndications for MedicationNursing Consideration for Patient/ Side EffectsPantoprazole (Protonix) 40 mg vial (Q12h)Short-Term Treatment of Erosive Esophagitis Associated with Gastroesophageal Reflux Disease (GERD) …1.2 Maintenance of Healing of Erosive Esophagitis. …1.3 Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome. Pantoprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.Spironolactone (Aldactone) 25 mg TAB dailySpironolactone is in a class of medications called aldosterone receptor antagonists.It causes the kidneys to eliminate unneeded water and sodium from the body into the urine but reduces the loss of potassium from the body.Multivitamins (TAB-A-VITE) TAB 1 dailyMultivitamins are used to provide vitamins that are not taken in through the diet. Multivitamins are also used to treat vitamin deficiencies caused by GI bleedingConstipation, diarrhea, or upset stomach may occur. These effects are usually temporary and may disappear as your body adjusts to this medication. Lactulose 10gm/15ml Oral susp (Q8h)Lactulose belongs to a class of drugs called laxatives. In order to have a smooth bowel movement especially in elderly. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. Lactulose is a synthetic (man-made) sugar.Side effects of lactulose include:dehydrationdiarrheaexcessive bowel activityhigh blood sodium levelslow blood sodium levelsnauseavomitingabdominal crampingabdominal distentionburping (belching)gas (flatulence)NF-Sodium Bicarbonate Tablet 325MGIs under drug class alkalinizing agents. Sodium bicarbonate reduces stomach acid. It is used as an antacid to treat heartburn, indigestion, and upset stomach. Sodium bicarbonate is a very quick-acting antacid. It should be used only for temporary relief.Side effects:Frequent urge to urinateheadache (continuing)loss of appetite (continuing)mood or mental changesmuscle pain or twitchingnausea or vomitingnervousness or restlessnessslow breathingswelling of feet or lower legsunpleasant tasteunusual tiredness or weaknessXifaxan (Rifaximin)TAB 550MGIs class of medications called antibiotics. Rifaximin treats traveler’s diarrhea and irritable bowel syndrome by stopping the growth of the bacteria that cause diarrhea. Rifaximin treats hepatic encephalopathy by stopping the growth of bacteria that produce toxins and that may worsen liver disease.Side effects of Xifaxan include:nausea,vomiting,constipation,bloating,gas,stomach pain,feeling like you need to urgently empty your bowel,feeling your bowel is not completely emptyFurosemide (Lasix) 20MG TAB Daily.Furosemide is in a class of medications called diuretics (‘water pills’). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.Side effects of Lasix include: increased urination,thirst,muscle cramps,itching or rash,weakness,dizziness,spinning sensation,diarrhea,   List Patient abnormal lab values, normal ranges, and why they are altered.Abnormal Lab ValueNormal RangeCause of Abnormal Lab ValueBlood tests include a complete blood cell (CBC) countNot normal rangeA complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide range of disorders, including anemia and infection caused by GI bleeding. A complete blood count test measures several components and features of your blood, including: Red blood cells, which carry oxygen.Serum electrolyte levels (e.g., sequential multiple analysis 7 [SMA7])AbnormalAn electrolyte test can help determine whether there’s an electrolyte imbalance in the body. Electrolytes are salts and minerals, such as sodium, potassium, chloride, and bicarbonate, which are found in the blood. They can conduct electrical impulses in the body.Coagulation profile:Abnormalincluding activated partial thromboplastin time (aPTT), prothrombin time (PT), manual platelet count, and bleeding time.A coagulation profile may be performed to confirm normal clotting function before a procedure which may cause bleeding, or in conditions associated with bleedingBlood Urea Nitrogen (BUN)BUN 22 mg/dL A blood urea nitrogen (BUN) test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is made when protein is broken down in your body. Urea is made in the liver and passed out of your body in the urine. A BUN test is done to see how kidneys are working and damaged caused by chronic dehydration.          List all Patients Nursing Diagnosis in priority Order and explain why.Nursing DiagnosisExplanationLack of fluidRisk for Deficient Fluid Volume as related to GI bleeding as evidenced by weakness, dizziness, and dry oral mucosa. GI Bleedingis characterized by the sudden onset of bleeding from the GI tract at a site (or sites) proximal to the ligament of Treitz. Most upper GI bleeds are a direct result of peptic ulcer erosion, stress related- mucosal disease, that may evidence as superficial erosive gastric lesion to frank ulcerations, erosive gastritis (secondary to use or abuse of NSAIDs, oral corticosteroids, or alcohol) or esophageal varices (secondary to hepatic failure). In addition to these, Mallory-Weiss tears can cause gastroesophageal bleeding as a result of severe retching and vomiting, but the bleeding tends to be less severe than in other types. ReferenceAckley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby.Docherty, B., & McIntyre, L. (2002). Nursing considerations for fluid management in hypovolaemia. Professional nurse (London, England), 17(9), 545-549.  Health Science Science Nursing NURSING 6531 Share QuestionEmailCopy link Comments (0)