Postoperative NCP for MI and Pneumonia

Solutions

Expert Solution

# MI

Acute pain related to coronary artery occlusion.

- Assess the pain level.

- Provide calm and quiet environment.

- lnstruct the patient to do relaxation techniques .

- Provide medications as per order.

Activity intolerance related to imbalance between myocardial oxygen supply and demand .

-Document the heart rate and rhythm.

- Instruct the patient to avoid vulselva maneuver.

Risk for excess fluid volume .

- Assess for jugular vein distension.

- Measure input and output.weigh daily .

- Provide low sodium diet.

# Pneumonia

Ineffective airway clearance related to inflammation.

- Assess the rate, rhythm and depth of respiration.

- Assess the cough and hydration status.

- Auscultate the lungs .

- Teach the client deep breathing exercises.

Impaired gas exchange related to collection of mucus in airways.

- Assess respiration.

- Observe colour of skin , mucous membrane , and nail beds for noting cyanosis.

- Assess the anxiety level.

- Monitor ABG 's and pulse oxymetry .

- Administer oxygen.

- Elevate head end .

Hyperthermia related to infection.

- Monitor vital signs.

- Monitor input and output chart.

- Give antipyretics

Nightingale answered 2 years ago

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