Nursing diagnosis (from NANDA-I)

Goal

Nursing interventions

Rationale

Evaluation/

expected outcome

Risk for infection

To eliminate the chances of infection at the wound site and promote complete recovery 

·      Infection control and aseptic procedures are to be adhered to

·      Review of laboratory studies are required for  chances of systematic infections

·      Carry out dressing under aspectic techniques and use of proper dressing materials for the process 

·      Examination of the skin for  signs of infection and irritation

·      Identification of signs of scratching and itching

·      Antibiotics might be applied as indicated

·      Identification of a plan for debridement in case of necrotic tissue is present

·      Teach patient about skin assessment and how to monitor for signs and symptoms of infection

·     Mechanisms for preventing infection  at surgery site

·     Increased count of WBC indicates an ongoing infection that could be due to infection at the wound site  (Nettina et al., 2013)

·     Chances of getting infected are high at the time  of wound dressing

·     Disruption of skin integrity near or at the surgery site are major sources of inection. Clipping to shaving with care is needed for preventing nicks and abrasions in the skin

·     Itching and scratching alleviate chances of infection (Ovaska et al., 2013)

·     Suspected infection can be treated

·     Healing is not appropriate if there is necrotic tissue

·     Early identification and intervention prevents severe complications ( Zaccagnini & White, 2015)

Maintainence of aseptic and safe environment

Absence of infection or complications at the surgery site 

Imbalanced nutrition: more than body requirements

To promote  functional and healthy eating patterns as per body requirement

·     Carry out and review the daily food intake

·     Exploration and discussion of emotions of the patient associated with eating

·     Formulation of eating plan  with engagement of the patient. Knowledge of the patient’s details and nutritional needs is necessary. The preferences of the patient is to be  known

·     The significance of consuming a healthy diet is to be emphasised onto

·     Strategies are to be  developed to deal with binge eating

·     Determination of the present activity  level of the patient and plan an exercise program

·     Development of an appetite reduction plan in collaboration with the patient

·     Create a safe and soothing environment at meal time

·   Identifies the patterns of eating on the basis of which dietary program can be outlined

·   Points out difference between eating due to body needs and emotional needs

·   A plan that is outlined keeping the preferences of the patient into consideration is more successful

·   Balanced diet leads  to  metabolic balances and reduces chances of headache, fatigue and weakness that are common after surgery ( Ceccarelli et al., 2017)

·   The patient is  feeling guilty about binge eating would not do it further

·   Exercises would help in weight loss and increase energy, enhance body functioning and promote overall well being

·   Signs of fullness to be recognised

·   Appropriate environment while eating promotes good eating habits (Chism, 2015)

Appropriate eating behaviours

Patient education

To educate patient and his family member about the  implications of laparotomy

·      Explain about the procedure of laparotomy and the patient benefit drawn from it

·      Conduct one-on-one session with Mrs. Jones to communicate the details of the surgery

·      An informal environment is to be created for this purpose

·      Communication needs to be clear and transparent and language must be that for a layman

·      Possible complications of laparotomy to be informed, such as haemorrhage and bowel blockages

·      The patient to be advised rest

·      The patient to be taught self-care strategies involving prevention of constipation

·      Dressing techniques to be taught to Mrs. Jones

·      Mrs. Jones  to  be encouraged to motivate the patient to quit smoking and  drinking through providing education on cessation strategies

·   Inform the patient and family member about what the surgery as about

·   Communication on a one-on-one process is useful in imparting education

·   Informal environment fosters patient education

·   Patient able to connect to what is being communicated to him 

·   Early detection of complications and subsequent interventions reduce the  chances of further adverse events

·   Adequate rest proves speedy patient recovery

·   Constipation increases the chances of post-surgical complications  (Potter et al., 2017)

·   She would be responsible for caring for the patient once he is discharged from the hospital

·   Smoking and drinking cessation would promote overall health (Kleinpell, 2013)

Mr. and Mrs. Jones well informed about the surgical procedure and the implications