i can tell you are new at this! the process of writing a care plan involves 5 steps. they are (1) the collection of data or information about the patient, (2) grouping the abnormal assessment data items into nursing diagnoses, (3) planning the care which involves determining outcomes and nursing interventions, (4) putting the plan into action, and (5) evaluating the effectiveness of the plan. this is a cycle that repeats itself continually until a nursing diagnosis is resolved or abandoned and replaced with a new one.
the only abnormal assessment items you have given are abdominal pain and vomiting. however, from the four medical diagnoses you've listed i'm suspecting there is a lot more potentially going on with this patient. i would suggest that you review the signs and symptoms of an ileus, copd, diabetes and peptic ulcer disease. if your patient also has some of those same symptoms, you need to use them in supporting nursing diagnoses. doctors aren't the only ones who have exclusive use of symptoms in formulating their medical diagnoses. we can use them to formulate nursing diagnoses as well. i am, in particular, thinking about a possible connection between the diabetes and the ileus. diabetic patients sometimes have a complication called gastroparesis and i'm wondering if this patient might have had problems with that in the past, or currently, and if it might be contributing to the development of the ileus. you also need to look at the nursing implications and follow-up care for a colonoscopy. the bowel is often inflated with air during the procedure that contributes to abdominal cramping and pain. if biopsies were obtained, the patient might have some bloody rectal discharge. this carries a risk of developing an infection. all potential things that could contribute to nursing diagnoses. all of these factors carry potential symptoms that you may have missed picking up in the patient's chart or even noticing yourself. also, what kind of copd does the patient have: chronic bronchitis or emphysema? with one there will be more sputum production as opposed to the other. people with emphysema are more prone to be "pink puffers" where as those with chronic bronchitis are the "blue bloaters" and tend to get cyanotic. either way they may have problems with gas exchange in their lungs.
here are three possible nursing diagnoses. i would caution you to make sure you have patient assessment data to back them up if you use them. anything between brackets is just information i'm guessing at. i've also linked you into online information about each of these nursing diagnoses at two different websites.
deficient fluid volume r/t loss of fluids from vomiting and fluids segregated in the bowel aeb
acute pain r/t
[abdominal distension] aeb abdominal pain
risk for ineffective airway clearance r/t chronic obstructive pulmonary disease
[increased production of secretions, retained secretions, bronchospasm] aeb ????