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Medical Surgical Nursing Assignment

   

Added on  2021-04-21

11 Pages3325 Words74 Views
Medical Surgical Nursing1Double click here to fill in this footerLast name__ _student number_NUR251 S1 2018 Assessment 1

Task 1 :John should be assessed for blood pressure, wound assessment and infection for providingnursing intervention to John. Blood pressure assessment is necessary for John becauseprovided data indicates hypertensive condition in John. Infection in John can be assessed bycounting white blood cells (WBC). Increase in WBC indicate infection because in response toinfection there can be increase in neutrophils and lymphocytes. WBC count also indicate,there is infection in John. Moreover, John is not responding to oral antibiotics. Woundassessment and pain assessment is also required in John. Blood pressure assessment isnecessary in John because due to wound and its pain there might be augmented restlessnessin John. This increased restlessness can lead to increased hypertension in John. Sustainedhypertension can lead to reduced physical activity which can lead to either anxiety ordepressive state. Moreover, John has past history of anxiety (Dewit, Stromberg, and Dallred2016). Assessment of infection is important in John because uncontrolled infection can resultin reduced chances of wound healing and augmented pain sensation in John. Woundassessment and its pain assessment is necessary in John because wound can increase chancesof infection. Wound also can increase pain sensation in John. If these conditions would nothave assessed accurately in John, there would have been increased chances of infection, delayin wound healing and more painful condition for John. Infection, wound healing and painshould be assessed in John collectively because all these conditions can exaggerate eachother. Assessment of these conditions is necessary in John because these conditions can haveinfluence on physical, physiological and psychological aspects of John (Berman, et al., 2014).2Double click here to fill in this footerLast name__ _student number_NUR251 S1 2018 Assessment 1

Task 2 ANursing Care Plan: John DoeNursing problem: InfectionRelated to: John cut his foot on Oyster shell. Due to this, he got injury and consequently Infection.Goal of careNursing interventionsRationaleEvaluationThere should not bespread of infection.Infection should becontrolledordiminished. Wound should be regularly cleaned withantiseptic solution and it should be coveredwith sterile dressing. Antibiotic should be administered throughsuitable route of like oral, preantral ortopical. Cleaning of wound with antisepticsolution would result in bactericidal orbacteriostatic action at wound placeRidley, 2015). Based on the suitability andresponsiveness of antibiotic, route ofantibiotic administration should beselected. In case of John, oral antibioticis not exhibiting positive responsehence antibiotic should be administeredthrough intravenous route (Ridley,2015). White blood cell count should be determinedin John.Specimens should be submitted for theidentification of bacteria. Nursing problem: Wound Related to: John cut his foot on Oyster shell. Due to this, he got injury and results in the wound.Goal of careNursing interventionsRationaleEvaluationComplete healing of thewound and preventionof injury.Color, temperature, edema, moisture andappearance of the skin around the woundshould be monitored. Integrity of inured tissue should bemonitored for signs of infection.Systematic inspection can be helpful inidentifying potential problems due toinfection (Martin and Nunan, 2015;Berg, Fleischer, Kuss et al., 2012).Area around skin remain intact withoutinflammation.3Double click here to fill in this footerLast name__ _student number_NUR251 S1 2018 Assessment 1

No sensations of paindue to injury andwound.Assessment of John for heightenedsensation of pain. Nurse should monitor wound care practicesby monitoring cleansing agent used andtemperature of water used for cleaning. Topical application should be used to keepwound area moist and also exudate shouldbe allowed to absorb and fill the deadspaces. Foot elevationEarly interventions can be provided forJohn for pain due to injury, wound anddressing change (Atkin et al., 2014). Sensitivity of injured skin in the woundvaries from individual to individual.Hence, cleaning process of wound inJohn should be optimized (Martin andNunan, 2015)Dressing should be chosen which cankeep environment dry and also keep thewound surrounding moist so thatexudate can be controlled and deadspaces can be eliminated (Berg,Fleischer, Kuss et al., 2012).Foot elevation can be used to reduceoedema. Gravity can be useful to lowerdown the swelling (Martin and Nunan,2015; Berg, Fleischer, Kuss et al.,2012). Wound is without signs of infection. John is educated about the importance ofwound cleaning and cleaning procedure ofthe wound. John should be capable ofcleaning his wound on himself at the time ofdischarge. Applied both wet and dry dressing and thisdressing changed twice a day. Nursing problem: PainRelated to: Pain secondary to injury, wound and dressing change.Goal of careNursing interventionsRationaleEvaluationPain sensation shouldbe reduced in John.John should not feelQuality, severity, location, onset andduration of pain should be assessed.Detailed assessment of pain would behelpful in planning early painmanagement interventions. Patient, inthis case John, can be used as mostreliable source of pain. Application ofPain sensation reduced in case of John.4Double click here to fill in this footerLast name__ _student number_NUR251 S1 2018 Assessment 1

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