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NCP For Case Study
NCP For Case Study
Teach patient
adaptive
behavior
This
compensates for
actual changed
Help patient body structure
identify ways of and function.
coping that have
been useful in Asking patients
the past. to remember
other body
image issues
and how they
were managed
may help patient
adjust to the
current issue.
Date done: July 5 2010
Problem Occurred: July 5 2010
Assessment Diagnosis Planning Implementation Evaluation
Subjective: The Acute pain After 2 hours of Intervention Rationale Goal met. After 2
patient verbalized related to post nursing hours of nursing
“masakit ang surgical incision intervention the Independent: intervention the
tyan ko noon pa at the left lower patient will Observe or Some people patient verbalized
hangang ngayon” abdomen as verbalized relieve monitor signs deny the relieved of pain
on a pain scale of manifested by a to pain and will and symptoms experience of and described a
7/10 pain scale of 7/10 describe a associated with pain when it is reduction of
reduction of pain pain, such as present. painscale from
scale from 7/10 BP, heart rate, Attention to 7/10 to 3/10.
to 3/10. temperature, associated signs
color and may help the
moisture of nurse in
skin, evaluating pain.
restlessness,
Objective: and ability to
Restless focus.
Reduce Different
interaction Assess for etiological
with people probable cause factors respond
Guarding of pain. better to
behavior different
Grimacing therapies.
face
Uncooperati Some
ve Assess patients may be
Presence of patient’s unaware of the
post operative knowledge of effectiveness of
incision at the or preference nonpharmacolo
lower for the array of gical methods
abdomen pain-relief and may be
With VS of strategies willing to try
BP-110/80 mmHg available. them, either
RR-19 Bpm with or instead
PR-79 Bpm of traditional
CR-75 Bpm analgesic
Temp.-36 0C medications.
Often a
combination of
therapies (e.g.,
mild analgesics
with distraction
or heat) may
prove most
effective.
It is important
Evaluate to help patients
patient’s express as
response to factually as
pain and possible (i.e.,
medications or without the
therapeutics effect of mood,
aimed at emotion, or
abolishing or anxiety) the
relieving pain. effect of pain
relief measures.
Discrepancies
between
behavior or
appearance and
what patient
says about pain
relief (or lack of
it) may be more
a reflection of
other methods
patient is using
to cope with
than pain relief
itself.
One can
Anticipate need most effectively
for pain relief deal with pain
by preventing it.
Early
intervention
may decrease
the total
amount of
analgesic
required.
Dependent: Pain
Give medications are
analgesics absorbed and
(Ketorolac) as metabolized
ordered, differently by
evaluating patients, so
effectiveness their
and observing effectiveness
for any signs must be
and symptoms evaluated from
of untoward patient to
effects. patient.
Ketorolac
Inhibits
prostaglandin
synthesis,
producing
peripherally
mediated
analgesia
and also has
antipyretic and
anti-
inflammatory
properties.