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A"er 3 hours of nursing intervention the patien…

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Original Title
Ncp Format
NURSING PROBLEM: NAUSEA AND VOMITTING

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ASSESSMENT NURSING
DIAGNOSIS
PLANNING IMPLEMENTATION RATIONALE EVALUATION

© “Medyo
Attribution
Subjective:
nahihilo ako
Non-Commercial (BY-NC)
Nausea related to
hypertensive and
Short term:
After 3 hours of
1. Assess GI tract 1. To ensure that
there is no
After the nursing
intervention the
at di makakain ng antibiotic agent or nursing problem that will patient was:
maayos dahil manifested of intervention the cause vomiting.

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napapasuka ako pag aversion towards patient will: 2. Identify situations 2. To decreased the 1. Been freed
napasobra” as food and increased the client possibility of or
verbalized by the gagging sensation. 1. Be free or perceived as nausea episodes decreased

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patient will have “nauseatic” upon meals. nausea
decrease situation. sensation
Objective: nausea 3. Promote comfort 3. Increased nutrients 2. Had
1. Vomitting 2. Have a and enhance intake. decreased
after eating decreased intake. episodes

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2. Dizziness episode of 4. Encouraged dry 4. Dry and ice chips of
upon standing vomiting. foods and ice have natural vomiting.
3. Slight Long term: chips during tendencies to 3. Able to
dehydration After 2 days of episodes of decrease nausea. take
upon skin nursing nausea. acceptable

! "
turgor test intervention the 5. Advise to drink 5. Fluids stimulate level of
4. Increased RR patient will: fluid 30 min increased gastric dietary
after episodes before or 30mins secretion thereby intake.
of vomiting 1. Manage after the meal increasing the
5. V/s as chronic instead with meal. chance of
follows: nausea as 6. Provide bland diet vomiting.

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! BP: evidence if it is not 6. Decrease gastric
130/110 by indicated. acidity and
! RR: 22 acceptable increased nutrients
! Temp: level of 7. Avoid dairy intake.
37.1 dietary products, 7. The foods
! PR: 88 intake. increased sweet, mentioned

$
2. Maintain fried or fatty increases the
and regain foods, gas- possibility of

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weight as forming vegetable. nausea.

appropriate
8. Encouraged to eat 8. Big meals put too
in frequent small much pressure in
meals through the the stomach and
day instead of 3 stimulating gastric
full meals acidity.
9. Frequent oral care 9. Decrease “bad
taste”
10. Administer anti 10. To decrease the
emetics to deter side effect of some
side effect of medications
medications.
11. Suggest wearing 11. Decreasing
loose clothes pressure on the
abdomen to allow
good intake of
foods.
12. Encouraged to eat 12. Chewing allows
food slowly. the food to be
degenerated
before ingestion.

13. Monitor v/s

14. Monitor I & O.

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