Help again. Nursing health problem peptic ulcer perforation

[marilyn1711]

I need help with my nursing diagnosis #1 problem. My patient is a 63 year old male. history of smoking, diabetes mellitus, pancreatitis, alcoholism, hypertension and hyperlipidemia. He was admitted with acute abdominal pain. diagnosed with peptic ulcer perforation. underwent laparaotomy of the abdomen and graham patch repair. he is now post op, midline abdominal incision with wound vac. jp drains in llq and rlq. He has an ng tube on low intermittent suction. he is npo receiving TPN and LR. His labs show increased wbc, low h&H, low sodium, low calcium and high triglycerides. I chose weakness and pain for my second and third problems and i wanted to use impaired nutrition less than body requirements for my number one problem but none of the interventions seem to go with my patient. I am not sure what to use now, or how to make what I did choose work. I do believe his nutrition is impaired, but the interventions in my book list things like provide company for the patient while eating....this does not relate. any suggestions? TIA

[srobb11]

There are several things that take priority over impaired nutrition for a post-surgical patient. Come on....think....surgery...what do you think is going to be his #1 complaint after surgery? Think...you can get this...

[Esme12, ASN, BSN, RN]

Think hierarchy of needs. If it were you what would be important to you right now as a post op patient

http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs

http://www.pterrywave.com/nursing/care%20plans/Nursing%20Care%20Plans%20TOC.aspx

The Hierarchy from most important to least important is as follows:

1. Physiological needs (in the following order)
   
   • the need for oxygen and to breathe
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort
     

[*]Safety and security needs (in the following order)

• safety from physiological threat
  
• safety from psychological threat
  
• protection
  
• continuity
  
• stability
  
• lack of danger
  

[*]Love and belonging needs

• affiliation
  
• affection
  
• intimacy
  
• support
  
• reassurance
  

[*]Self-esteem needs

• sense of self-worth
  
• self-respect
  
• independence
  
• dignity
  
• privacy
  
• self-reliance
  

[*]Self-actualization

• recognition and realization of potential
  
• growth
  
• health
  
• autonomy
  

https://allnurses.com/general-nursing-student/help-care-plans-286986.html

[dmw2489]

here is something that i see, his H&H is low, what does that effect? to add to that what meds is he on? and what are some of the side effects of the meds? (I am thinking of some specific class that there is a possibility he is on) also in his hx he is a smoker.... There are also some huge red flags that come up in his history for me.... 1 being DM- what type and is it pharmacologically treated?? (adding to the pharm portion, what med is he on for the HTN?) 2 being the alcoholism hmmmm... there are alot of high priority dx in this pt. start with your ABC's, are there any deficits in airway? breathing? or circulation? these should be addressed first. always remember to that safety is huge in nursing! and the final thought would be think about what things are currently in his body that ARENT normally there... what is a big risk after surgery? You are thinking and that is good but go by priority! ABC's!!!!!

[EricJRN, MSN, RN]

The post doesn't have a lot of information about a hands-on physical assessment of the patient. Your assessment data can often lead you right to a nursing diagnosis.