NAME: MUNUNGA VIORA N

STUDENT NUMBER: 2021922029

MODULE: GENERAL NURSING SCIENCE 2

LECTURER: MR RUPANDE

NURSING INTEVENSION FOR POST OPERATIVE

DX; APPENDECTOMY

date time Nursing Nursing assessme evaluation goal signatu

diagnosis intervention nt re
09.10. 08h0 ACTUAL Encourage Monitor -after 8 gravity m.viora
23 0 PROBLEM early temperatu hours 0f localizes
Acute pain ambulation re from nursing inflammato
related to Encourage 37.3c and interventio ry exudate
surgical a patient to guarding n client’s into lower
procedure as sleep in a behavior pain scale abdomen
evidence by semi fowler pain is reduced or pelvis
facial position- while to4/10 relieving
grimaced Administer talking from 7/10 abdominal
and analgesic to pain scale and temp tension
guarding relief pain of 7/10 subsides to which is
behavior -Provide normal accentuate
diversional range d by supine
activities position
 -keep area
clean or dry
carefully
-impaired dress the -patient -healing of - to assess
skin wound appears to the skin the
integrity -determine be weak wound contributio
related to nutritional and without n factors
destruction status restlessne complicati -monitor
of skin layer potential ss due to on by progress of
or tissue as for delayed pain manifestin wound
evidence by healing g intact healing
acute exacerbate sutures -a patient
appendecto by and dry to be free
my malnutritio wound from pain
n- dressing - patient
administer had a fair
antibiotics night
to prevent
infection
e.g.
amoxicillin

-clean the
wound with
bethadine
Potential solution -Sign of -no sign of - to prevent
problem and dress infection infection further
-risk of the wound of the observed spread of
infection with wound on the infection
bethadine appears wound
ointment redness
and pus

-monitor
vital signs
e.g. temp
hourly
-septicemia - administer -Patient is -patient is -temp
related to antibiotics in a feeling subsides to
uncontrolled to prevent severe better normal
infection infection pain range m.viora
due to high e.g. -assess -no
temperature metronidaz for tachycardia
ole tachycard or
-administer ia and tachypnea
analgesics tachypnea observed
to relieve -assess -blood
pain e.g. the blood pressure is
ibuprofen pressure on normal
-administer range
oxygen
when a
patient has
difficulty in
breathing