Question

r. J.S. is a 66-year-old man who just arrived on the medical surgical unit following an appendectomy. He is complaining of pain. You are the nurse assigned to care for Mr. J.S.

1. What critical assessment data do you need to identify and collect?

2. Formulate a nursing diagnosis based on your assessment data.

3. Describe two nursing interventions to assist the patient.

4. What criteria would you use to evaluate the effectiveness of the nursing interventions?

Answer 1

Mr. J.S. is a 66-year-oldman who just arrived an medical surgical unit following an appendectomy.He is complaining of pain.You are the nurse assigned to care for Mr. J.S.

Question 1. What critical assessment data do you need to identify and collect?

Answer:

• The patient received the amount and the type of the last pain medication.
• Identify and collect the physical examination data which includes assessment of the surgical site.
• Identify and collect the data about a complete set of vital signs which includes heart rate,blood pressure,respiratory rate and also a pain assessment.

Question 2. Formulate a nursing diagnosis based on your assessment data.

Answer:

• Nursing disgnosis is that the pain which is related to the surgical incision.
• Surgical incision refers to a pocedure in which cut made through the skin to facilitate an operation.
• The size of incision fully depend upon the kind of surgery you had.

Question 3. Describe two nursing interventions to the patient.

Answer:

Nursing interventions include

• After checking the MAR (Medication Administration Record) for the last dose of the patient, then the administer physician- ordered pain medication and also administer the drug after using two patients identifiers.
• After receiving pain medication , then the patient will state pain which is level 1 on a pain scale varies from 0 to 10 within 30 minutes.

Question 4. What criteria would you use to evaluate the effectiveness of nursing interventions?

Answer:

I used to evaluate the criteria of following effectiveness of nursing interventions:

• Vital signs are in the normal range.
• The patient is resting in a physically relaxed way without any pain as evidence by peaceful sleep.
• After the nursing intervention, the patient state that the pain has been relieved.