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Hello Tutor, Please help me to do my Nursing Care Plan. I’m stuck… Thank you. Last Saturday, our clinical was in ICU. My pt was a 51 y.o. Female stabbed (3-4) by her son. He attacked his step dad and when she tried to stop him, he proceeded to stabbed her instead. Name: _______________________________________ Date ________________________________ Assessment findings (Only abnormal and critical assessment findings) 1. Pain 2. Infection 3. Nursing Interventions which relate to Assessment Findings (Basic Care & Comfort/Safety & Infection Control) 1. 2. 3. Risk Factors (Health Promotion & Maintenance/Reduction of Risk Potential) 1. 2. 3. Medications (include dosage, why are they on this medication). The meds listed here must be the 3 Medications used for Med Templates 1. Hydromorphone 0.5 mL, IV push, Injection Q 2hr, for 7 days, PRN pain breakthrough, First dose, Stop Date 05/08/22 2. Methocarbamol l 1,000 mg=2 tab, Oral, Tab, Qhr, for 14 days, First Dose 04/09/’22 3. Enoxaparin (Lovenox) 30=0.3 mL, Subcutaneous, Injection, Q 12 hr, for 30 days, First Dose: 04/08/’22, Stop Date 05/08/22 Psychosocial Concerns which relate back to the Assessment findings. 1. 2. 3. Specific Patient / Family Teaching related to Assessment findings (Health Promotion & Maintenance / Safety & Infection Control / Management of Care). 1. 2. 3. Labs & Diagnostics relate back to the Assessment findings. (Only abnormal findings – Also list reference range) 1. 2. 3. What labs, if any, were discussed with / or explained to the patient / family? 1. RBC 3.4 – L 2. Hgb 10.3 – L 3. Platelets 121 – L Potential & Actual Complications from treatments/procedures 1. 2. 3. What follow up visits will be required upon discharge? 1. Professional Skilled Services for Continues Care 2. Special Services 3. Community Residents Write 4 Diagnosis pertaining to your patient (in order of the highest priority first) 1. Impaired Gas Exchange 2. High Risk for bleeding 3. Chronic Pain 4. Risk for Infection ***Something similar to the pages below: With references (2-3) pls at least 5 years. Thanks again! Assessment findings (Only abnormal and critical assessment findings) 1. Pain 2. Headache 3. Neck Fracture Nursing Interventions which relate to Assessment Findings (Basic Care & Comfort/Safety & Infection Control) 1.Maintain immobilization of affected part using bed rest and neck braces to relieve pain and prevent bone displacement and extension of tissue injury. 2.Cover any breaks in the skin with clean or sterile dressing to prevent infection. 3.Teach the patient and significant others (SO) about the use of analgesics and instruct nonpharmacological pain management such as imagery, relaxation, and distractions. Effective pain intervention will enhance the patient’s ability to engage inappropriate activity and exercises. (https://www.heart.org, 3/2022) Risk Factors (Health Promotion & Maintenance/Reduction of Risk Potential) 1. Seizure 2.DVT 3.Bleeding (Auer, R., & Riehl, J. 2017) Medications (include dosage, why are they on this medication). The meds listed here must be the 3 Medications used for Med Templates 1. Morphine 2 mg = 1 mL, IV push Q 4-hour, PRN: Severe pain scale 7-10 out of 10 2. Hydrocodone-acetaminophen 7.5 mg-325mg/15 mL oral solution, PRN: moderate pain scale 4-6 out of 10 3.Odansetron 4 mg = 2 mL, IV push, Q 4-hour, PRN: nausea/vomiting Psychosocial Concerns which relate back to the Assessment findings. 1.Anxiety 2.Fearfulness 3.Loss of interest in usual activities Specific Patient / Family Teaching related to Assessment findings (Health Promotion & Maintenance / Safety & Infection Control / Management of Care). 1. Report headache/dizziness to Provider 2. Make sure to follow up on ortho for neck fracture 3. Perform and supervise active and passive ROM exercises to maintain strength and mobility of unaffected muscles and facilitates resolution of inflammation in injured tissues. (Desnita, O., Noer, R. M., & Agusthia, M. July 2021). Labs & Diagnostics relate back to the Assessment findings. (Only abnormal findings – Also list reference range) (Normal Range) 1.WBC Increase 16.3 4.5-11.0 2. Neutro Auto Increase 84.2 45-75% 3. Chloride Level Increase 112 96-106 What labs, if any, were discussed with / or explained to the patient / family? 1.CT scan 2.X-ray 3.Ultrasound Potential & Actual Complications from treatments/procedures 1.Arterial damage during treatment 2. Infection and possibly sepsis 3. Hemorrhage, possibly leading to shock What follow up visits will be required upon discharge? 1. Physical or occupational therapist 2. Rehabilitation specialist 3. Psychiatric clinical nurse specialist or therapist Write 4 Diagnosis pertaining to your patient (in order of the highest priority first) 1. Risk for Impaired Gas Exchange 2. Acute Pain related to fracture, soft tissue damage and muscle spasm 3. Impaired Physical Mobility 4. Risk for disturbed thought process related to stress of trauma, unfamiliar surroundings, and drug therapy

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