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    Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

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    Mara Jon Ocden Casiben
    The nursing assessment identified a patient with impaired bowel elimination pattern related to decreased liver function as evidenced by changes in bowel habits and liver enzyme levels. The short term goal was to establish normal bowel pattern within 8 hours with nursing interventions like assessing bowel habits, administering oral rehydration and advising a low protein diet. The long term goal was to maintain normal bowel elimination in 3 days with continued interventions and advising on potential liver transplantation. The plan would be evaluated based on achieving normal bowel habits.

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    Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

    Uploaded by

    Mara Jon Ocden Casiben
    147 views4 pages
    The nursing assessment identified a patient with impaired bowel elimination pattern related to decreased liver function as evidenced by changes in bowel habits and liver enzyme levels. The short term goal was to establish normal bowel pattern within 8 hours with nursing interventions like assessing bowel habits, administering oral rehydration and advising a low protein diet. The long term goal was to maintain normal bowel elimination in 3 days with continued interventions and advising on potential liver transplantation. The plan would be evaluated based on achieving normal bowel habits.

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    NCP-Liver failure

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    The nursing assessment identified a patient with impaired bowel elimination pattern related to decreased liver function as evidenced by changes in bowel habits and liver enzyme levels. The short term goal was to establish normal bowel pattern within 8 hours with nursing interventions like assessing bowel habits, administering oral rehydration and advising a low protein diet. The long term goal was to maintain normal bowel elimination in 3 days with continued interventions and advising on potential liver transplantation. The plan would be evaluated based on achieving normal bowel habits.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    147 views4 pages

    Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

    Uploaded by

    Mara Jon Ocden Casiben
    The nursing assessment identified a patient with impaired bowel elimination pattern related to decreased liver function as evidenced by changes in bowel habits and liver enzyme levels. The short term goal was to establish normal bowel pattern within 8 hours with nursing interventions like assessing bowel habits, administering oral rehydration and advising a low protein diet. The long term goal was to maintain normal bowel elimination in 3 days with continued interventions and advising on potential liver transplantation. The plan would be evaluated based on achieving normal bowel habits.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

    DIAGNOSIS
    SUBJECTIVE DATA: Impaired bowel STG: Assess the frequency of bowel pattern Assessment aids in diagnosis & STG:
     Change in bowel elimination After 8 hours of nursing providing appropriate interventions
    habits like alternate pattern r/t change intervention, the patient will In case of diarrhea, asses the color, To replace the fluids according to the After 8 hours of nursing intervention,
    episodes of diarrhea in bowel habits as be able to: consistency & frequency of stools loss short term goal is fully achieved as
    & constipation alternate episodes  evidenced by:
     Hematemesis of constipation & Administer oral rehydration solution To replace the fluids & prevent
    diarrhea LTG: after every loose stools dehydration 
     Dyspepsia
     Abdominal bloating secondary to After 3 days of nursing Advice the client to take the fluids as To prevent constipation & dehydration
    decreased intervention the patient will be LTG:
    & pain advised
     Black & tarry stools metabolic function able to: After 3 days of nursing intervention,
    of the liver  Client will be able to Advice the client to take carbohydrate To treat constipation long term goal is fully achieved as
    OBJECTIVE DATA: maintain a normal & fiber rich foods like wheat bran &
    evidenced by:
     Fetor Hepaticus bowel elimination oranges as prescribed
    (Sweet odor of pattern with regular Administer dulcolax syrup or To increase peristalsis & aid in stool  Client maintained a normal
    breath) bowel habits suppositories as prescribed elimination bowel elimination pattern
     Distended abdomen Administer proctolysis enema as To eliminate the stools with regular bowel habits
     Pain in the right prescribed in case of constipation
    hypochondriac region Provide bowel wash with laxatives To eliminate the stools & prevent
    of abdomen once every 6 hours in case of sever hepatic encephalopathy
     Loose stools or black constipation
    & tarry stools/ Administer IV fluids like colloids To prevent dehydration & maintain
    straining at stools &crystalloids as prescribed fluid volume status
     Irregular bowel Advice to take low protein diet As the liver cannot metabolize the
    sounds protein they can build up the intestinal
     Stools for occult ammonia and cause encephalopathy
    Blood Positive Place the client on molecular To temporarily support the liver
     Abdominal palpation absorbent recirculating system if function and improve the bowel habits
    shows hepatomegaly needed of the client
     Presence of anal/ Advice the client on the need for liver To replace the liver function and aid in
    sacral edema transplantation and prepare for the metabolism of foods thereby improves
     Hypoalbuminemia surgical procedure, if indicated in end the bowel pattern
     Elevated liver of stage liver disease
    enzymes
     Liver ultrasound
    reveals fatty or
    fibrous scarring of the
    liver
     Liver Biopsy shows
    fibrosis & scarring of
    Liver tissue
    a

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