Question

Write nursing care plan one from any renal diagnoses , one from any GI diagnoses and one from musculoskeletal diagnoses

Answer 1

ASSESMENT	NURSING DIAGNOSIS	GOAL	PLANNING	INTERVENTIONS
Subjective data: Patient says he is having decreased urinary output and edema on ankles Objective data: Edema Hypertension Weight gain Shortness of breath Oliguria Distended juggular vein	Fluid volume exess related to decreased glomerular filtration rate and sodium retention	Reduce the fluid volume excess	SHORT TERM: after 4--8 hours of nursing intervention patient will demonstrate behaviours to monitor fluid status and reduce reccurence of fluid excess LONG TERM After 3 days of nursing intervention the patient will manifest stability in fluid volume and stable weightand free from signs of edema	1 Asses the level of patient condition 2 Establish rapport 3 Monitor and record vitals 4 Asses the possible risk factors 5 Provide comfortable position 6 Asses the patient appetite

RATIONAL	EVALUATION
TO asses precipitating and causative risk factors To obtain baseline data To obtain base line data To note for the precense of nausea and vomiting To prevent fluid overload and monitor intake and output To monitor fluid retention and evaluate degree of excess For the presence of crackles or congestion	SHORT TERM Patient demonstrated behaviours to monitor fluid status and reduce recurrence of fluid excess LONG TERM The patient shall have manifested stabilized fluid volume stable weight and free from signs of edema