Nursing Diagnosis 1-Impaired Tissue Integrity, R/T surgical intervention, hysterectomy, and decreased sensation AEB: abdominal incision

areas with oozing moderate amounts of serous and minimal amount purulent drainage, (Doenges& Murr, 2008) 2-Acute Pain R/T surgical intervention AEB: prescribed Hydromorphone 0.2 mg-0.5 mg PRN Q4H as needed subcutaneous [opioid agonist analgesic], (Adams et al, 2010) 3. Fluid volume deficit and inbalance, R/T small bowel obstruction, Dehydration, AEB excessive fluid losses from NGT drainage, and inadequate po fluid intake, TNA (Total Nutrient Admixture) 28 ml/hr QD, Dry mouth, Chloride (Cl) - 109 H high Bicarbonate (HCO3) 20 L low, (Doenges& Murr, 2008,Kozier et al,2010) 4 .Knowledge deficit R/T nature of condition, nutritional and fluid needs and reason of hospitalization, AEB: Dehydration and coming to the emergency to check her wound after few days. (Doenges& Murr, 2008, Kozier et al, 2010 ) 5-Altered nutrition, less than body requirements, limited carbohydrate intake, R/T decreased ability to eat, AEB: staying NPO after the surgery, Needs for TPN TNA (Total Nutrient Admixture) 28 ml/hr QD, (Doenges& Murr, 2008) 6- Infection, R/T Foley catheter insertion, Surgical incision, PICC line insertion, 2 JPs , AEB: Leukocyte count (WBC) 11.5 H high, Purulent drainage from the surgical incision, Cipro 400 mg/200 ml D5W BID [antibacterial], Metronidazole 500mg/100ml BID [antibacterial], (Adams et al, 2010, Doenges& Murr, 2008, Karch, A. (2010) 7- Social isolation, R/T, being MRSA positive patient, AEB: keeping the patient on contact precautions, (Doenges& Murr, 2008, )

8- Unstable blood glucose level, R/T lack of adherence to diabetes management and lack of exercise and inadequate blood glucose monitoring, being a house wife, limited mobility and activity (knitting and Sewing), AEB: Fasting glucose - 12.5 HH high, Regular Novolin GE Toronto according to Insulin sliding scale. QID [antidiabetic], (Adams et al, 2010, Doenges & Murr, 2008, Karch, 2010) 9- Activity intolerance, R/T, pain, AEB: prescribed Hydromorphone 0.2 mg-0.5 mg PRN Q4H as needed subcutaneous [opioid agonist analgesic], (Adams et al, 2010), (Doenges& Murr, 2008) 10- Ineffective Airway Clearance, R/T, anesthesia during the surgery, AEB: prescribed Salbutamol 5 mg/1ml and Ipratropium Bromide 0.25 mg/1ml mixed with 0.45% NACL to a combined volume of approx 3 ml QID [bronchodilator],(Adams et al,2010), and, (Rhonchi) On expiration the patient had a rumbling sound. The ct. used the spirometer and was taught DB&C, (Doenges& Murr, 2008, Karch, 2010, Kozier et al,2010 ) 11- Risk for Aspiration, R/T, sedation/anesthesia, (Doenges& Murr, 2008) 12- Impaired attachment, R/T, Contact isolation, hospitality, AEB: partners anxiety,( Doenges & Murr, 2008, Kozier et al,2010) 13- Risk for autonomic dysreflexia, R/T, bowel distention, catheter insertion, bowel obstruction, ( Doenges & Murr, 2008) Based on the case study, the patient is post-op day four and five. I choose these three nursing diagnoses as the most important diagnoses: 1-Impaired attachment, R/T, Contact isolation, hospitality, AEB: partners anxiety,( Doenges & Murr, 2008, Kozier et al,2010) 2- Ineffective Airway Clearance, R/T, anesthesia during the surgery, AEB: prescribed Salbutamol 5 mg/1ml and Ipratropium Bromide 0.25 mg/1ml mixed with 0.45% NACL to a

combined volume of approx 3 ml QID [bronchodilator],(Adams et al,2010), and, (Rhonchi) On expiration the patient had a rumbling sound. The ct. used the spirometer and was taught DB&C, (Doenges& Murr, 2008, Karch, 2010, Kozier et al,2010 3-Infection, R/T Foley catheter insertion, Surgical incision, PICC line insertion, 2 JPs , AEB: Leukocyte count (WBC) 11.5 H high, Purulent drainage from the surgical incision, Cipro 400 mg/200 ml D5W BID [antibacterial], Metronidazole 500mg/100ml BID [antibacterial], (Adams et al, 2010, Doenges& Murr, 2008, Karch, A. (2010)

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References: Adams ,M.P., Holland, L.N., Bostwick, P.M., & King, S.L. (2010). Pharmacology for nurses: A pathophysiologicial approach (Canadian ed.). Toronto, ON: Doenges, M., Moorehouse, M., & Murr, A. (2008). Nurses pocket guide:

Diagnoses, prioritized interventions, & rationales (12th ed.). Philadelphia, PA: F.A. Davis. Karch, A. (2010). Lippincotts nursing drug guide. Ambler, PA: Lippincott, Williams & Wilkins. Kozier, B., Erb, G., Berman, A., Snyder, S.J., Raffin Bochal, D.S., Hirst, S., et al (2010). Fundamentals of Canadian nursing: Concepts, process and practice (2nd Canadian ed.). Toronto, ON: Pearson Canada.