7 Nursing care plans for patient who has malignant neoplasm of stomach?

I need help with 7 nursing care plans already written its need just correction and some addition – its for hypothetical patient who has malignant neoplasm of stomach I need the the right objective and subjective assessment ,nursing diagnosis, goals, interventions with rationals and the evaluation.make sure to add the “interventions with rationals” because I didn’t add it before.I attached the file with my some of my teacher correction please check it out
_nursing_care_plans_.docx

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Assessment
Subjective:
Patient
report “he
has
abdominal
pain”
Objective:
Grimacing
Subjective:
Patient
report that
“he is
vomited
after each
meal”.
Objective:
Pale, dry
skin
Nursing
diagnosis
Pain related to
the presence of
abnormal
epithelial cells,
nerve impulse
disorders of the
stomach
evidenced by
patient Reports
of pain (5-10).
goal
Intervention
Relief of pain
1.Administer analgesic
agents as prescribed.
Deficient Fluid
Volume related
to bleeding
(loss of active)
and
hemoptysis.
Vomiting with
blood.
Fluid
requirements
are met.
Patient report
pain less than 5
on a rating
scale of 0 to 10.
Vital signs
within normal
limits, good
skin turgor,
moist mucous
membranes, the
production of
urine output is
balanced, not
vomiting blood
and stools are
not black
rationale
Patient reports
decreased pain.
2.Assess frequency,
intensity, and duration of
pain to determine
effectiveness of analgesic
agent.
3.Work with patient to
help manage pain by
suggesting nonpharmacologic methods
for pain relief, such as
position changes,
imagery, distraction,
relaxation exercises, back
rubs, massage, and
periods of rest and
relaxation.
1-Record the
characteristics of
vomiting and / or
drainage.
2-Monitor vital signs;
compared with normal
results of client / previous.
Measure blood pressure
with sitting, sleeping,
standing if possible.
3-Record patient’s
physiological response to
bleeding, such as mental
changes, weakness,
restlessness, anxiety, pale,
sweaty, tachypnea, the
increase in temperature.
4-Monitor input and
output and connect them
with changes in body
weight. Measure blood
loss / fluid through
vomiting and defecation.
5-Maintain bed rest;
prevent vomiting and
stress at the time of
defecation. Schedule of
activities to provide a rest
period without
interruption.
6-Elevate head of bed for
antacid drug
administration.
7-Give fluid as indicated.
evaluation
Assist in
distinguishing
gastric distress.
Postural hypotension
showed decreased
circulating volume.
Worsening of
symptoms may
indicate the
continued bleeding
or inadequate fluid
replacement.
Provide guidelines
for fluid
replacement.
Activities / vomiting
increased intraabdominal pressure
and can trigger
further bleeding.
Prevent gastric
reflux and aspiration
of antacids which
can cause serious
lung complications.
Replacement fluid
hypovolemia.
It may be used when
the infection causes
chronic gastritis.
A tool to determine
the need for blood
replacement and
8-Give antibiotics as
indicate.
Subjective:
Objective:
Ineffective
tissue perfusion
related to
hypovolemia
Maintain
effective tissue
perfusion
9-Supervise laboratory
examination; e.g. Hb / Ht.
1.Monitor changes in
level of consciousness,
dizziness complaints /
headaches.
2.Auscultation apical
pulse. Guard heart rate /
rhythm when there is a
continuous ECG.
3.Assess the skin to cold,
pale, sweating, slow
capillary filling, and
peripheral pulse is weak.
4.Note the
report abdominal pain,
especially sudden severe
pain or pain spreading to
shoulders.
5.Observations for pale
skin, reddish. Massage
with oil. Change positions
frequently.
6.Collaboration:
7-Provide supplemental
oxygen as indicated.
8-Give IV fluids as
indicated
oversee the
effectiveness of
therapy
The change may
indicate inadequate
cerebral perfusion
due to arterial blood
pressure.
Change
dysrhythmias and
ischemia can occur
as a result of
hypotension,
hypoxia, acidosis,
electrolyte
imbalance, or
cooling near the
heart area.
Vasoconstriction is a
sympathetic
response to the
decline in circulation
volume and / or may
occur as a side effect
of vasopressin.
Pain caused by
gastric ulcer, often
disappear after acute
hemorrhage due to
buffer the effects of
blood.
Disturbances in
peripheral
circulation increases
the risk of skin
damage.
Treat hypoxemia and
lactic acidosis during
acute hemorrhage.
Maintain circulating
volume and
perfusion.
Subjective:
Objective:
Tiredness;
drowsiness;
apathy;
insufficient
energy and
impaired
competence
to maintain
the usual
level of
Fatigue related
to
physiological
condition,
malnutrition,
negative life
event and sleep
deprivation
improved sense
of energy.
1. To orient for more
frequently rest throughout
the day.
2. To recommend
avoiding excessive
physical effort, to not
waste energy.
3. To monitor blood count
to assess the presence of
major anemia.
4. To refer for medical
evaluation if necessary.
promote rest
and restore
energy
physical
activity.
Subjective:
Objective:
Pale, dry
skin
Poor muscle
tone
Unbalanced
nutrition: less
than the body
Requirements,
related to
gastric injury.
Patient displays
nutritional
ingestion
sufficient to
meet metabolic
needs.
1. Assess the patient’s
knowledge on the
importance and benefits
of maintaining the normal
nutritional body
requirements.
Patient takes
adequate
amount of food
with the
appropriate
calories.
2. Explain to the patient
and significant others the
importance of maintaining
proper nutrition.
3.Suggest eating preferred
and well tolerated by the
patients, better food with
high content of calories /
protein.
4.Encourage small,
frequent feedings of
nonirritating food to
decrease gastric irritation;
encourage fluid
consumption between
meals rather than with
meals.
5.Schedule rest periods
before meals and open
packages and cut up food
for patient.
6.facilitate tissue repair by
ensuring food supplement
8. Record intake, output,
and daily weights.
9.Assess sign of
dehydration (thirst, dry
mucous membranes, poor
skin turgor, tachycardia,
deceased urine output).
10.Review results of daily
laboratory studies to note
any metabolic
abnormalities (sodium,
potassium, glucose, blood
urea nitrogen).
Risk of
bleeding
Risk of
bleeding
related to
advanced
gastric lesion
Patient does not
experience
bleeding as
evidenced by
normal blood
pressure, stable
hematocrit and
hemoglobin
11.Administer antiemetic
agents as prescribed.
1.Monitor patient’s vital
signs, especially BP and
HR. Look for signs of
orthostatic hypotension.
2.Evaluate the patient’s
use of any medications
that can affect hemostasis
Patient shows
no sign of
bleeding.
Maintained
normal blood
pressure, stable
hematocrit and
levels and
desired ranges
for coagulation
profiles.
(e.g, anticoagulants,
salicylates, NSAIDs, or
cancer chemotherapy).
3.Monitor platelet count
and coagulation test
results.
hemoglobin
levels and
desired ranges
for coagulation
profiles.
4. Check stool and urine
for occult blood.
5. Educate the patient
about over-the-counter
drugs and avoid products
that contain aspirin or
NSAIDs such as
ibuprofen and naproxen.
6.Provide psychological
and emotional support to
the patient.
Subjective:
Objective:
Impaired skin
integrity related
to low fluid
intake and poor
nutrition.
Regains
integrity of
skin.
7. Keep in touch with
blood transfusion center.
1-Assess changes in body
temperature, specifically
increased in body
temperature.
2-Assess the patient’s
level of distress.
3-Assess patient’s
nutritional status; refer for
a nutritional consultation
and/or institute dietary
supplements.
4-Monitor site of impaired
tissue integrity at least
once daily for color
changes, redness,
swelling, warmth, pain, or
other signs of infection.
5-Provide tissue care as
needed.
6- Monitor patient’s skin
care practices, noting type
of soap or other cleansing
agents used, temperature
of water, and frequency of
skin cleansing.
7-Encourage a diet that
meets nutritional needs.
8-Educate patient about
proper nutrition,
hydration, and methods to
maintain tissue integrity.
Demonstrates
understanding
of plan to heal
skin and prevent
injury.
Describes
measures to
protect the skin.
9-Encourage use of
pillows, foam wedges,
and pressure-reducing
devices.

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