Risk for bleeding outcomes? help please!!!
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hello guys,
i am working in a nursing care plan and i am having hard time to define my goals:
my patient had an abdominal surgery and my nursing diagnosis is :
risk for bleeding: complications of gi bleedingrelated to exploratory laparotomy surgery.
but i can not think of any good outcomes to reduce the risk... .
i thought that one outcome will be teaching the parents the signs and symtoms of bleeding so they can report it and reduce the risk of bleeding but i do not have idea how i can prevent patient from star to bleed. any suggestions please!!!!!
Feb 16, '121. Teaching the parents the s/s of bleeding is not an outcome, it's an intervention. If your diagnosis is risk for bleeding then your outcome is that the patient will not experience bleeding, lab values related to bleeding (be specific) will remain normal. Remember that your outcomes, or goals, need to be specific, measurable and have a time frame.
2. As far as preventing bleeding goes, first think about what can cause bleeding in that situation? What sort of things are you going to instruct the patient to do (or not to do) in order to protect the incision site from injury? What lab results can you monitor that might indicate the patient is having bleeding or is at increased risk? What are you going to look for in the patient's incision and how often are you going to check?
Think about what could cause bleeding and then you can target your interventions towards those possible complications.
Feb 16, '12"risk for bleeding" is defined as " at risk for a decrease in blood volume that may compromise health (domain 11: safety/protection, class 2: physical injury)" what features put this patient at risk? just having had surgery isn't really enough support for this, imho.
how would bleeding affect the person, specifically?
do you own a nursing diagnosis book? it's helpful
nanda-i 2012-2014 is the current definitive resource, available at your online bookstore. among other nursing diagnoses you could find there, depending on your assessment of the actual patient:
disturbed sleep pattern: time–limited interruptions to sleep amount and quality due to external factors (domain 4, activity/rest; class 1, sleep/rest)
dysfunctional gastrointestinal motility: increased, decreased, ineffective, or lack of peristaltic activity within the gastrointestinal system (domain 3, elimination and exchange; class 2, gastrointestinal function) (common after any abdominal surgery)
risk for dysfunctional gastrointestinal motility: risk for increased, decreased, ineffective, or lack of peristaltic activity within the gastrointestinal system (domain 3, elimination and exchange; class 2, gastrointestinal function)
readiness for enhanced self-health management:a pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is sufficient for meeting specific health-related goals and can be strengthened (domain 1, health promotion; class 2, health management) (applies to parents)
impaired comfort: perceived lack of ease, relief, and transcendence in physical psychospiritual, environmental, and social dimensions (domain 12: comfort, class 1: physical comfort; class 2, environmental comfort; class 3, social comfort)
nausea: a subjective phenomenon of an unpleasant feeling in the back of the throat and stomach that may or may not result in vomiting (domain 12: comfort, class 1: physical comfort)
acute pain: unpleasant sensory or emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months (domain 12: comfort, class 1: physical comfort)
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