Fluid Volume Deficit and Imbalanced Nutrition - NCP for Bowel Obstruction

Nursing Care Plan for Bowel Obstruction

Nursing Diagnosis : Fluid Volume Deficit related to inadequate intake and absorption ineffectiveness of the small intestine

characterized by nausea, vomiting, fever and diaphoresis.

Goal:

• Fluid and electrolyte needs are met,
• Maintaining adequate hydration with evidence of mucous membranes moist, good skin turgor, and capillary refill good, stable vital signs, and individually passing urine properly.

Expected outcomes:

• Normal vital signs.
• Fluid intake and output balance.
• Elastic skin turgor.
• Mucosa moist.
• Electrolytes are within normal limits.

Interventions:

• Assess the patient's fluid needs.
• Observation of vital signs: pulse, temperature, blood pressure, respiration.
• Observation level of consciousness and signs of shock.
• Observation bowel sounds every 1-2 hours.
• Monitor intake and output closely.
• Monitor the laboratory results of serum electrolytes, hematocrit.
• Give an explanation to the patient and family about the actions taken: NGT, and fasting.
• Collaboration with medical therapy for intravenous administration.

Rationale:

• Knowing the patient's fluid needs.
• Drastic changes in vital signs is an indication of lack of fluids.
• fluid and electrolyte deficiency can affect the level of consciousness and lead to shock.
• Assess bowel function.
• Assessing fluid balance.
• Assessing fluid and electrolyte balance.
• Increasing knowledge of the patient and family, and co-operation between the nurse-patient-family.
• Meet the patient's fluid and electrolyte needs.

Nursing Diagnosis : Imbalanced Nutrition Less than Body Requirements related to impaired absorption of nutrients.

Goal:
Stable weight and nutrition resolved.

Expected outcomes:

• No signs of mal nutrition.
• Stable weight.
• Patients do not experience nausea and vomiting.

Interventions :

• Review the individual factors that affect the ability to digest food, eg fasting status, nausea, paralytic ileus after the hose is removed.
• Auscultation bowel sounds; palpation of the abdomen; record the passage of flatus.
• Identification of the likes and dislikes of the patient's diet. Encourage selection of high protein foods and vitamin C.
• Observations on the occurrence of diarrhea; foul odor and oily food.
• Collaboration in the provision of drugs as indicated.

Rationale:

• Influence the choice of intervention.
• Determining the return of peristalsis (usually within 2-4 days).
• Improving patient cooperation with the dietary rules. Protein / vitamin C is a contributor utuma for tissue maintenance and repair. Malnutrition is a factor in the lowering of defense against infection.
• Malabsorption syndrome may occur after surgery small intestine, require further evaluation and changes in diet, eg, low-fiber diet.
• Prevent vomiting. Neutralize or reduce the formation of acid to prevent erosion and possible mucosal ulceration.