# data[].attributes.body
Electrolyte imbalance: decreased oral intake, nausea/vomiting. administer fluids.

Educate: nutrition and fluid intake

# data[].attributes.headline
Risk for fluid volume deficit as evidenced by nausea/vomiting

# data[].attributes.subject
Risk for fluid volume deficit as evidenced by nausea/vomiting

# data[].attributes.body
Obtain patient's vitals and determine electrolyte values. Provide fluids as needed. Provide possible antiemetics.

# data[].attributes.headline
At risk for impaired nutritional status as evidenced by 5 days of N/V.     Check electrolytes!

# data[].attributes.subject
At risk for impaired nutritional status as evidenced by 5 days of N/V.     Check electrolytes!

# data[].attributes.body
Get vitals
Check electrolytes
Make him show his butt for skin breakdown (liability)

RN dx: Deficient Fluid Volume related to dehydration as evidenced by nausea and vomiting.

# data[].attributes.body
Administer IV fluids, patient teaching for adequate nutrition, patient teaching for stoma care

# data[].attributes.headline
Fluid volume deficit as evidence by vomiting

# data[].attributes.subject
Fluid volume deficit as evidence by vomiting

# data[].attributes.body
Get vitals
Administer Fluid
Monitor weight
Patient education on drinking and diet
Assess colostomy
Pain management

# data[].attributes.body
Make sure to have 2 liters of water daily
Daily multi Vitamin: Calcium
Diet: Low fiber, High proteins/calories
Administer analgesics
Avoid alcohol

# data[].attributes.headline
Imbalanced nutrition related to n/v as evidence by decrease oral intake x 5 days and weight loss

# data[].attributes.subject
Imbalanced nutrition related to n/v as evidence by decrease oral intake x 5 days and weight loss

# data[].attributes.body
NANDA: Risk for imbalanced nutrition
fluid volume deficit
check vitals
check ABGs
check electrolytes
promote fluid intake

# data[].attributes.body
Risk of dehydration
- Provide fluids

# data[].attributes.body
fluid volume deficient related to vomiting as evidence by patient vomiting and weight loss

# data[].attributes.body
ineffective coping ..

# data[].attributes.headline
Risk for electrolyte imbalance related to weakness as evidence by nausea.  

# data[].attributes.subject
Risk for electrolyte imbalance related to weakness as evidence by nausea.  

# data[].attributes.body
Plan of care: IV fluids, administer antiemetic. Vitals signs are needs.
Fall risk related to weakness as evidence by nausea. Bed alarm and call light withing reach when needing to get out of bed.

# data[].attributes.body
Nursing Diagnosis: Risk for electrolyte imbalance
Care Plan: Ausculate and palpate Addomin,  Iv fluids , pain management

# data[].attributes.body
NV, weakness, decreased oral intake 3 days, 15 days p/o, UC, drinks alcohol. Abd Pain, emptied mult x day.

Fluids, pain meds

Increase fluids
Monitor Electrolytes
Vitals

# data[].attributes.body
As evidence by nausea vomiting.
Ensure patient is getting the proper fluids as he is already showing signs of dehydration.
Patient teaching ensure the patient understands the importance of getting the proper amount of fluids and nutrition to help with the healing process.

# data[].attributes.headline
Risk of infection as evidenced by chronic non-healing sacral ulcer.

# data[].attributes.subject
Risk of infection as evidenced by chronic non-healing sacral ulcer.

# data[].attributes.body
Impaired skin integrity
risk for infection
risk for ineffective health maintenance

# data[].attributes.body
Nursing Diagnosis: Risk for Sensory Perception
Diagnosis: Sensory Processing Disorder
Intervention: Joint compression, Repositioning

# data[].attributes.body
maintain wound dryness/cleaniness
maintain pain medication, provide IV fluids
determine if she is potentially diabetic, or what could be the cause of the wound healing delay. Obtain a blood culture for the wound and assess if antibiotics are needed

# data[].attributes.headline
Impaired skin tissue as evidence by non healing  pressure wound. 

# data[].attributes.subject
Impaired skin tissue as evidence by non healing  pressure wound. 

# data[].attributes.body
Focused care: Wound care and pain medication.

# data[].attributes.body
Care plan: skin assessment, wound care, high protein diet to increase wound healing. pain medication. Wound cleaning if needed/ antibiotics

# data[].attributes.headline
impaired skin integrity related to impaired healing related to stage 2 ulcer

# data[].attributes.subject
impaired skin integrity related to impaired healing related to stage 2 ulcer

# data[].attributes.body
Evidence by non healing pressure ulcer.
Patient is running a low grade fever.
Care Plan: Ensure wound is clean and does not have any discharge or drainage.
See if patient can start an antibiotic to help the ulcer heal.

# data[].attributes.body
Administer oxygen, assist with ambulating, assess skin around ulcer site, maintain fluid balance

# data[].attributes.body
Impaired skin integrity
Pain meds
wound care
Education wound cleaning

# data[].attributes.body
Pain medications, ambulation, O2 therapy, wound care, fall risk, Iv fluids, impaired skin/tissue integrity

# data[].attributes.body
Nursing Diagnosis: Risk for skin breakdown
Care Plan: Reposition, fluids, assess skin for pressure injury, pain meds

# data[].attributes.body
Nursing diagnosis: Risk for infection
Care Plan: Focused Skin assessment, Pain meds, wound care, antibiotics, IV fluids, frequent repositioning, bed alarm, fall risk

# data[].attributes.headline
Impaired tissue integrity related to dehydration, prolonged immobility, and poor nutrition.

# data[].attributes.subject
Impaired tissue integrity related to dehydration, prolonged immobility, and poor nutrition.

# data[].attributes.body
Care plan: Administering IV fluids and adequate nutrition to prevent infection and promote healing. Pain medications. Prioritizing ambulation and repositioning.

# data[].attributes.body
Impaired skin integrity related to immobility as evidenced by stage 3 ulcer.

# data[].attributes.body
Nursing Diagnosis: Dehydration (Fluid Deficient)
Care Plan:
- Provide IV fluids

# data[].attributes.body
Nursing Diagnosis: Risk for site infection at TPN site, Risk for abnormal serum electrolyte levels
Maintain adequate hydration
Manage pain with pain medication, manage nausea and vomiting with antiemetic medications
Assess IV insertion site at the start and end of each shift

# data[].attributes.body
Pain management
Reposition every 2hours
Request assistive device/equipment such as specialty bed to relieve pressure.
Moisturize skin
Risk for infection as evidence by stage 3 non-healing pressure ulcer
Assist with ambulation

# data[].attributes.body
Chronic sacral ulcer:
pain, damaged tissue. Color changes. Swelling.

Patient reports pain level 5/10.
Wound Stage 3.

Pain meds
Wound debrid/Care

Decreased pain level within 1 hour.
Decreased wound size

# data[].attributes.headline
Click plus sign and type your 1 min care plan here.

# data[].attributes.subject
Click plus sign and type your 1 min care plan here.

# data[].attributes.headline
Click plus sign and type your 1 min care plan here.

# data[].attributes.subject
Click plus sign and type your 1 min care plan here.

# data[].attributes.headline
Click plus sign and type your 1 min care plan here. 

# data[].attributes.subject
Click plus sign and type your 1 min care plan here. 