Richard J. Daley College Nursing 101 Data Collection for Care Plan Section I – Demographic Data: Patient Initials: K. J. Sex: Female MSWD: Married Age: 44 No. of children: 1 Occupation: Disabled Section II- Admission Data 1. Date admitted: 10/19/2007 2. Admitting diagnosis: Hematomesis‚ melanotic stools‚ cirrhosis‚ hepatorenal syndrome. 3. Allegries: Codiene 4. Signs and symptoms on admission: jaundice appearance‚ lethargic‚ oriented x 1‚ vomiting bright red blood‚ has had
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Vbg Intensive and Critical Care Nursing Article in Press‚ Corrected Proof - Note to users http://www.sciencedirect.com/science doi:10.1016/j.iccn.2011.01.001 | How to Cite or Link Using DOI Copyright © 2011 Elsevier Ltd All rights reserved. | Permissions & Reprints | Original article The experiences of patients and their families of visiting whilst in an intensive care unit – A hermeneutic interview study References and further reading may be available for this article
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ASSESMENT | GOAL OF CARE | PLAN OF ACTIONS | RATIONALE | IMPLEMENTATION | DOCUMENTATION | Subjective:“Daghan man na siya samad ug hubag sa iyang lawas”(She has many wounds and bruises on her body) as verbalized by the mother.Objective:-Presence of lesions and abrasions on the patient’s body.-greenish violet discolorated patches-soaked dressingNursing Diagnosis:Risk for impaired skin integrity related to superficial factors. | At the end of 8 hours nursing interventions‚ the client will be able
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PATIENT CENTERED NURSING CARE PLAN STUDENT NAME: _________________________ CLIENT’S AGE: ___________ SEX: MALE FEMALE DATE: _________________________________ DIAGNOSIS: __________________________________ Assessment (Subjective and Objective Data‚ Fundamental Needs) Nursing Diagnosis (NANDA) Planning Intervention Evaluation Analysis Statement… Related to… As Evidenced by… Need Specific Goal (RUMBA‚ SMART) Source
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it is compulsory that we‚ as social care practitioners‚ design a practical intervention which is useful to the service users in our own individual placements. In order to complete this intervention successfully it is essential that each student follow a set of given guidelines. Under these guidelines are three main headings: planning‚ doing and reviewing. Following these headings correctly will enable us to go through‚ step by step‚ how and why the intervention came about. In particular‚ this essay
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Medical Diagnosis #1: Multiple coronary artery disease Chief Complaint #1 Use Quotes: ”Shortness of breath and chest pain for over a month now” on 2/6/13 on day of Admission Chief Complaint #1 Use Quotes: “Pain 8/10” on day of your nursing care Prior Illnesses Hypertension‚ coronary artery disease‚ obesity‚ angina Family History Father passed away from a heart attack; Mother had a stroke General Survey Sex M Race Caucasian Age 74 Height 175cm Weight 90.7 kg
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Schizophrenia and Nursing Interventions Schizophrenia‚ a chronic and immobilizing condition defined as a psychiatric disease affects approximately 1% of the world’s population (Harris‚ Nagy & Vargaaxis‚ 2011). It is known to decrease the standard life expectancy by ten years due to its dire effects on morbidity and mortality‚ ranking it to be among the ‘top ten causes of disability adjusted life years” (Zigmond‚ Rowland & Coyle‚ 2015). The disease presents itself most commonly in young adults‚ and
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CUES/ CLUES |DIAGNOSIS |OBJECTIVES |INTERVENTIONS |EVALUATION | |SUBJECTIVE: ➢ “I ALWAYS EXPERIENCED CHEST PAIN AND DIFFICULTY OF BREATHING” As verbalized by the patient. OBJECTIVE: ➢ Weak and pale in appearance ➢ Difficulty of breathing ➢ Poor skin turgor ➢ Clutching of hands to chest ➢ Shortness of breath ➢ Restlessness VITAL SIGNS: ➢ BP- 130/90 mmHg ➢ T- 37.5 C ➢ PR- 98 BPM ➢ RR-25BPM ➢ PAIN SCALE- 8 | ➢ ACUTE PAIN RELATED TO MYOCARDIAL ISCHEMIA. |SHORT
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Student Name: Date: February 25‚ 2006 Nursing Diagnosis Outcome Criteria (Goal) Evaluation of Outcome Criteria (Goal) PC: Postpartum Hemorrhage Patient will develop no complications related to excessive bleeding‚ will maintain normal vital signs of express understanding of her condition‚ its management‚ and discharge instructions‚ identify and use available support systems. R/T‚ RTRF and secondary to: Pathophysiology Supporting Nursing Diagnosis Statement (cite source) Uterine atony
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DEGREE NURSING NURSING PROCESS FORM: PART I – ASSESSMENT Student: Date of Care: 3/4/13 Client’s Initial: WB Room # 1011 Occupation: Teacher Age: 59 Sex: F Race: Black Religion: Christian Admission Date: 3/1/13 Primary Language: English Role in family: Widowed from husband Stage in Life Cycle: Generativity vs. Stagnation Surgery date(s) this admission: N/A Chief complaint: Brain Dysfunction/Traumatic‚ closed injury Admission Diagnosis: Post Blunt
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