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I have provided the patient report form to assist you on the information on the patient. Thank you. Concept Map NSG315 50 year old, female, English-Speaking; Admitted on date for dysuria secondary to vaginal yeast infection and SOB; Full code, Allergies: Cymbalta & Penicillin Doctor’s Orders: -Order for diabetes education classes post discharge -Patient to have vitals taken Q30 minutes after cardiac cath procedure for the first 2 hours then every hour after that -Release compression pump around right wrist 1 hour after procedure 2 ccs of air at a time every 30 minutes -Patient on normal diet post procedure Vaginal yeast infection is most commonly caused by Candida albicans. Main symptoms of this are burning, itching and dysuria. Typical Treatment is oral medication and also a topical cream to help with side effects (Ignatavicius & Workman, 2017, pg. 451-452). Type 2 Diabetes is a disease that is progressive and combines insulin resistance with decreased beta-cell secretion of insulin. This insulin resistance develops due to lack of physical activity as well as obesity to a genetically susceptible person. This is usually accompanied by hyperlipidemia, hypertension and clot formation. Symptoms include fatigue, polyuria and polydipsia. (Ignatavicius & Workman, 2017, pg. 1306). Treatment includes antidiabetic drugs, exercise and dietary modification (Ignatavicius & Workman, 2017, pg. 1310). Lab: Normal Range Results Why: WBC 4.4 – 11.0 15.7 Patient’s WBC is elevated due to the diagnosis of the yeast infection. The white blood cell count will be elevated in the presence of an infection due to the body trying to fight it off. This was ordered to see if an infection is still present. Hb 12.0 – 15.5 11.5 Hemoglobin is low due to the patient’s diabetes. The patient’s diabetes is not controlled which can damage the kidneys and cause the patient to be anemic due to lack of red blood cells. Patient also is also more susceptible to inflamed blood vessels due to the diabetes which can cause the signal from the kidneys to the bone marrow to not get through (“Diabetes and Anemia”). Patient is also given heparin which will cause anemia (Vallerand, Sanoski & Deglin, 2017, pg. 630). This was ordered to monitor the patient’s Hb due to diabetes and also patient has diastolic CHF. Hct 34.9 – 44.5 35.6 Patient’s hematocrit levels are normal. Hb A1C < 5.7 8.9 Patient’s hemoglobin A1C level is extremely high and is a good indicator of diabetes control. Patient is on metformin but does not take insulin at home. This was ordered to detect current control of the diabetes Platelet 150 - 450 300 Patient’s platelet level is within normal range. This was ordered to detect the patient’s ability to clot. Test: Results: Chest X-Ray (date) No evidence of acute cardiopulmonary disease CT angiogram (date) Showed a fatty liver; no signs of a pulmonary embolism Exercise Nuclear Stress Test date) Mid to distal anterior wall mild ischemia in mid to distal LAD (left anterior descending) artery territory Echocardiogram ejection fraction (date) 55-60% Cardiac catheterization date) No evidence of CAD ; stent was not placed. Pertinent medical history: Diastolic congestive heart failure, Type 2 Diabetes Rheumatoid Arthritis Hypertension Chest Pain Body System: Data: HEENT Obj: PERRLA Obj: Normal hearing, normocephalic Neurologic/Sensory/Mental Status Obj: Vital signs (0800) – 0/10 Obj: Vital signs (1200) – 3/10 in chest area, tightness Obj: A&O x4 Integument Obj: IV access left antecubital, 20g inserted 6/11/17 Obj: Puncture wound right radial artery Obj: vital signs (0800) – Temp 97.4 Obj: vital signs (1200) – Temp 97.7 Sub: “You have to check my feet because of my diabetes, right?” Cardiovascular Obj: Heart sounds present, Pulses +2, capillary refill <3 sec Obj: vital signs (0800) – BP 156/80, HR 66 Obj: vital signs (1200) – BP 153/90, HR 67, Respiratory Obj: vital signs (0800) – RR 18 and O2 97% on room air Obj: vital signs (1200) – RR 18 and 02 99% on room air Obj: breath sounds normal Sub: “When I take deep breaths, I feel tightness and I start to cough” GI Obj: patient NPO this morning before cardiac catheterization Obj: patient on regular diet after procedure Obj: Bowel sounds present Sub: “Coffee with sugar will make my blood sugar go up?” …Can I finish this cup?” Obj: vital signs (0800) BG 287 Obj: vital signs (1200) BG 235 GU Sub: “I can get up myself to use the bathroom” Obj: urine yellow in color and clear Musculoskeletal Obj: Steady/balances gait Obj: ambulate without difficulty Sub: “I am a little stiff from laying down...probably my RA” Obj: full ROM except in right arm due to post procedure protocol Reproductive Obj: patient has had 3 children Social Obj: husband and daughters in the room Psychological Obj: patient calm, and cooperative Spirituality/Social/Emotional   Gordons’ Patterns: Data: Health Perception/Health Management “I do not know how to inject myself with insulin” Diabetes, HTN, diastolic CHF, Rheumatoid Arthritis Coping/Stress Tolerance “Can I stay here in the hospital while I start taking the new medication for my diabetes? Till I get used to it and to make sure nothing happens” Nutritional-Metabolic -” Coffee with sugar will make my blood sugar go up?” …Can I finish this cup?” “I’ll try to drink more water” Patient ate all of breakfast, including French toast and fruit “You have to check my feet because of my diabetes, right?” IV access in left antecubital Post Cardiac Catheterization, has small puncture to right radial artery Uncontrolled diabetes, Hb A1C 8.9 BG: 8am 287 and 12pm 235 Elimination “I can get up myself to use the bathroom” Admitting diagnosis: dysuria related to genital candidiasis Activity-Exercise “I don’t really exercise” “I can get up myself to use the bathroom” “I am a little stiff from laying down...probably my RA” BP 153/80, HR 67, RR 18, Temp 97.7, and SpO2 97 Easily palpated pulses, clear lung sounds, normal heart sounds “When I take deep breaths, I feel tightness and I start to cough” Mild ischemia in the mid to distal LAD territory of the heart Difficulty taking deep breaths Cough when taking a deep breath Role-Relationship Husband and daughters present in room Sleep-Rest “I slept pretty well last night” Medications: Class: Dose: Route: Side effects: Rationale: Aspirin NSAID 81mg PO Dyspepsia, nausea & epigastric distress (Vallerand, Sanoski & Deglin, 2017) Patient came in with chest tightness with SOB. Prophylaxis of TIA and MI. Folic acid Antianemic 1mg PO Fever, irritability & confusion (Vallerand, Sanoski & Deglin, 2017) Prevention and treatment of several types of anemias Hydroxychloroquine Antirheumatic 400mg PO Fatigue, headache & mood changes (Vallerand, Sanoski & Deglin, 2017) Management of Rheumatoid Arthritis. Metformin ER Antidiabetic 1000mg PO Abdominal bloating, diarrhea & N/V (Vallerand, Sanoski & Deglin, 2017) Management of Type 2 Diabetes Methylprednisolone Corticosteroid 40mg IV Hypertension, nausea & adrenal suppression (Vallerand, Sanoski & Deglin, 2017) Management of Rheumatoid Arthritis Metoprolol XL Antihypertensive 100mg PO Fatigue, weakness & erectile dysfunction (Vallerand, Sanoski & Deglin, 2017) Management of hypertension and prevention of MI Insulin Lispro Antidiabetic 1-50 units SubQ Hypoglycemia, headache & nausea (Vallerand, Sanoski & Deglin, 2017) Control of hyperglycemia in patients with T1D and T2D. Heparin Anticoagulant 5,000 units SubQ Anemia, bleeding & fever (Vallerand, Sanoski & Deglin, 2017) Prophylaxis and treatment of various thromboembolic disorders (Vallerand, Sanoski & Deglin, 2017) Assist the patient in identifying and avoiding triggers of SOB. EBP rationale: Irritants in the patient’s environment may decrease ability to take deep breaths (Ackley, Ladwig & Makic, 2017, pg. 406). Teach patient how to do pursed-lip breathing to help train the muscle. EBP rationale: studies have shown that this technique is effective in decreasing breathlessness and improving respiratory function (Ackley, Ladwig & Makic, 2017, pg. 406). Teach patient relaxation techniques to help reduce anxiety associated with shortness of breat. EBP rationale: relaxation therapy can help reduce dyspnea (Ackley, Ladwig & Makic, 2017, pg. 407). Evaluation: Patient will demonstrate pursed-lip breathing to assist in taking deep breaths and will verbalize decreased discomfort in chest Nursing Diagnosis #3: Knowledge deficient RT uncontrolled diabetes as evidence by not knowing how to inject insulin, not exercising and not know how coffee effects blood sugar (Doenges & Moorhouse, 2013). SMART Goal: Patient will demonstrate self insulin management and control of blood glucose levels and have an improved Hb A1C before her next follow up with doctor Nursing Diagnosis #2: Risk for situational low self-esteem RT physical illness as evidence by not having confidence in new medication, not being able to inject insulin and not knowing about diet control Nursing Diagnosis #1: Impaired Gas Exchange RT abnormal breathing pattern as evidence by SOB and not being able to take deep breaths without feeling tightness (Doenges & Moorhouse, 2013). Assess the patient’s previous experiences with new medications and how she coped with that. EBP rationale: accessing illness self-concept may assist in development of a treatment plan Assist the patient in setting short-term goals and writing in a journal to keep track of achievements. Encourage family members to acknowledge strengths and achievement to help validate patients strengths. Educate patient on smart diet choices in relation to blood glucose control. EBP rationale: teaching the patient about carbohydrate intake will help control the diabetes (Ackley, Ladwig & Makic, 2017, pg. 417). Assist patient is picking meal options off menu in hospital. EBP rationale: weight loss in patients with diabetes will decrease the risk of diabetic complications (Ackley, Ladwig & Makic, 2017, pg. 417). Educate patient on why insulin is important for the body and how to inject it. EBP rationale: studies have shown that frequent and regular education sessions will improve self-care management in patients that have chronic conditions (Ackley, Ladwig & Makic, 2017, pg. 557). Evaluation: Patient’s journal will show that she has been keeping track of short-term goals and has met them and has set new ones as previous ones have been met Evaluation: Has the patient consistently given herself insulin, and has patient decreased her HbA1C levels SMART Goal: Patient will verbalize having a decreased tightness in chest and less SOB when taking deep breaths before her follow up appointment SMART Goal: Patient will be able to identify strengths and healthy coping skill before follow up appointment with doctor   Explain how the data clusters helped you to determine the Gordon’s Functional and Dysfunctional Patterns. The data clusters helped split everything into categories and organize the data. When splitting them into Gordon’s patterns, 5 patterns contained data that was considered dysfunctional; Health Perception/Health management, Coping/Stress Tolerance, Nutritional-Metabolic, Activity-Exercise and Elimination 2. Using Gordon’s as a guide, which nursing diagnoses are identified for this client? (Separate each Gordon’s pattern into a paragraph). Health Perception/Health Management: Knowledge deficient RT uncontrolled diabetes as evidence by not knowing how to inject insulin, not exercising and not know how coffee effects blood sugar Ineffective Health maintenance RT complexity of therapeutic regimen as evidence by multiple complex chronic diseases Coping/Stress Tolerance: Risk for Hopelessness RT new medication as evidence by wanting to stay in hospital to start new drug Risk for situational low self-esteem RT physical illness as evidence by not having confidence in new medication, not being able to inject insulin and not knowing about diet control Nutritional-Metabolic: Risk for impaired skin integrity RT uncontrolled diabetes as evidence by patient having to check feet, Hb A1C 8.9 and elevated blood glucose levels Impaired skin integrity RT cardiac procedure as evidence by post cardiac catheterization Risk for bleeding RT s/p cardiac procedure as evidence by post cardiac catheterization access through right radial artery Risk for Unstable Blood Glucose RT inadequate blood glucose monitoring as evidence by out of normal range BG, Hb A1C 8.9, and not proper diet choices Elimination: Impaired Urinary elimination RT yeast infection as evidence by dysuria, and elevated white blood cell count Activity-Exercise: Impaired Gas Exchange RT abnormal breathing pattern as evidence by SOB and not being able to take deep breaths Risk for Decreased Cardiac output RT altered contractility as evidence by hypertension, heart failure and stress test results List the identified nursing diagnoses in the: Impaired Gas Exchange RT abnormal breathing pattern as evidence by SOB and not being able to take deep breaths Risk for situational low self-esteem RT physical illness as evidence by not having confidence in new medication, not being able to inject insulin and not knowing about diet control Knowledge deficient RT uncontrolled diabetes as evidence by not knowing how to inject insulin, not exercising and not know how coffee effects blood sugar Which nursing diagnosis is most important to address with this client? Explain how this was determined. Impaired Gas Exchange RT abnormal breathing pattern as evidence by SOB and not being able to take deep breaths. This was determined because if there is an impaired gas exchange, oxygen and other nutrients can not get to the whole body. Which nursing diagnosis is second most important to address with this client? Explain how this was determined. Knowledge deficient RT uncontrolled diabetes as evidence by not knowing how to inject insulin, not exercising and not know how coffee effects blood sugar. This was determined as the second most important because the patient has uncontrolled diabetes which can lead to a great number of other issues. Which nursing diagnosis is least important to address with this client? Explain how this was determined. Risk for situational low self-esteem RT physical illness as evidence by not having confidence in new medication, not being able to inject insulin and not knowing about diet control. This was chosen as the least important because this will resolve as the patient gets better control over her diabetes References Diabetes and Anemia. (n.d.). Retrieved date, from http://www.webmd.com/diabetes/diabetes-and-anemia#1 Ignatavicius, D. D., Workman, M. L., Blair, M., Rebar, C., & Winkelman, C. (2017) Medical-Surgical Nursing: Patient Centered Collaborative Care. (8th ed.). St. Louis, MI: Elsevier. Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Davis's Drug Guide for Nurses (15th ed.). Philadelphia, PA: F.A. Davis Company. Ackley, B. J., Ladwig, G. B., & Makic, M. B. (2017). Nursing diagnosis handbook: an evidence-based guide to planning care (11th ed.). St. Louis, MO: Elsevier. Doenges, M. E., & Moorhouse, M. F. (2013). Application of nursing process and nursing diagnosis: An interactive text for diagnostic reasoning (6th ed.). Philadelphia, PA: F.A. Davis. Concept map template Nursing 240/245/430 Patient Situation: Medical Dx/pathophysiology List doctors order medications Labs/xrays Pertinent Medical History Nursing 240/245/430 Page 1 Assessment Subjective /objective data Body Systems Gordon Pattern and cluster data Gordon Pattern and cluster data Gordon Pattern and cluster data Patient Gordon Pattern and cluster data Gordon Pattern and cluster data Nursing 240/245/430 Page 2 Intervention and rationale Evaluation Educational Nsg Dx Goal/outcome Psychosocial Nsg Dx Physiological Nsg Dx Goal/outcome Goal/outcome Intervention and rationale Intervention and rationale Evaluation Evaluation Nursing 240/245/430 Page 3   Write about what you just did and how you thought about it. Each Gordon’s Patterns set shall be a paragraph. Tell me about all the thinking you did to develop the associated nursing diagnoses for that data cluster set. Then, move on to the next data cluster and make that a new paragraph. Don’t assume your instructor knows anything about your thought process, because they don’t. Show your instructor how you are thinking! How to begin…………….   On a separate page: Include ALL of the questions with the Answers of the questions:   In separate paragraphs, explain the data clusters and which Gordon’s pattern is represented by each data cluster. Which Gordon’s patterns are Functional or Dysfunctional? (Take each of the data clusters and discuss how they helped you.) Using Gordon’s as a guide, Explain which nursing diagnoses are identified for this client? (Separate each Gordon’s pattern into a paragraph). List the identified nursing diagnoses in priority order the: “Problem” Related to “_____ “ Evidenced by “____” format. Which nursing diagnosis is most important to address with this client? Explain how this was determined. Which nursing diagnosis is second most important to address with this client? Explain how this was determined. Which nursing diagnosis is least important to address with this client? Explain how this was determined. Describe the evaluation of the client for each nursing diagnosis? Answer questions Nursing 240/245/430 Page 4 References (all in APA format) Nursing 240/245/430 Page 5 School of Nursing Care Mapping (Attachment 7) Building upon the learning process for planning care through care mapping in NSG 110 and NSG 120, each student will create at least one care map in each clinical. Select the patient from the clinical rotation and obtain approval from your clinical instructor to assure this patient is appropriate for the care mapping assignment. Using the Care Map Template create a plan of care map of a select patient. Students’s name must be on the care map and the write up of the questions. Steps in care mapping (each section shall include the complete and accurate patient information): 1. Identify the patient’s medical diagnosis, problem, or reason for seeking health/medical care. (By week 4) Medical Diagnosis A description of the problem or reason for seeking care. This portion should include: · pathophysiology-include a description of what the disease process is, who does it affect and when, where does it affect them and why it affects them (risk factors) · signs and symptoms of the disease/disorder · how the disease/disorder is diagnosed · and typical treatment (medical and surgical) 2. Nursing Assessment. This is the patient assessment by the student nurse and it comes from a variety of sources: History and Physical Assessment Findings: History: Genitourinary: Neuro/Sensory/Mental Status: Gastrointestinal: HEENT: Integumentary: Cardiac: Musculoskeletal: Respiratory: Reproductive: Emotional/Social/Spiritual: ***Physical assessment should involve inspection, auscultation, palpation & percussion. Laboratory and diagnostic tests Pharmacologic therapies in a table: (Medication name, individualized indications, dose, route, frequency, time, top three side effects pertinent to the medication, contraindications, if any) 3. Assessment Analysis - Analyze the data gathered (learned in NSG 110): · Cluster the data into patterns and identify the Gordon’s Functional Health Patterns. Indicate whether the pattern is functional or dysfunctional. · Determine Associate Nursing Diagnoses based upon the Selected Gordon’s Patterns 4. Identify nursing diagnoses (problems that represent the patient’s responses to the medical diagnosis). · Nursing Diagnosis (NANDA) · Related to (what factors are causing the problem) _______________________________ · As evidenced by (assessment findings- the evidence that a problem is occurring) ***Reminder to review the parts of a Problem-Oriented diagnosis, a Risk diagnosis, and a Health Promotion diagnosis. 5. Select the Priority Problems in each Category : Physiological, Psychosocial and Educational needs (only NSG 315 and NSG 430) 6. Develop plans of care in the appropriate template to alleviate the problems Each plan must have the following: a. an appropriate nursing diagnosis, b. patient-centered goal statement, c. Patient-centered SMART outcomes, d. evidence-based interventions, e. and evaluation criteria. ***Reminder about steps in the nursing process as learned in NSG 110: · Goals are broad, measurable, patient-centered statement. · Outcomes are specific, measurable, realistic and concise steps that the patient must accomplish to achieve the general goal. Outcomes should flow from the nursing diagnosis. The student should aim to alleviate the problems identified in the “As Evidenced By” portion of the nursing diagnosis. · Each Nursing Intervention shall include evidence-based rationale with citation in APA format. Interventions should be individualized to the patient’s needs. · Patient education and discharge planning should be included in the interventions. · Evaluation criteria should state whether the outcomes are met. If outcomes have not been met, how are you going to revise the plan of care? 7. Students shall answer the questions at the end of the care map template using appropriate grammar, spelling, syntax. Additional instructions for writing the paper are on the template and below: Write about what you just did and how you thought about it. Each Gordon’s Functional Pattern set shall be a paragraph. Describe the thinking you did to develop the associated nursing diagnoses for that data cluster set. Then, move on to the next data cluster and make that a new paragraph. Don’t assume your instructor knows anything about your thought process, because they don’t. Show your instructor how you are thinking! How to begin…………….   On a separate page: Name and date; Include ALL of the questions with the Answers of the questions:   1. In separate paragraphs, explain the data clusters and which Gordon’s pattern is represented by each data cluster. Which Gordon’s Patterns are Functional or Dysfunctional? (Take each of the data clusters and discuss how they helped.) 2. Using Gordon’s as a guide, which nursing diagnoses are identified for this client? (Separate each Gordon’s pattern into a paragraph). 3. List the identified nursing diagnoses in the: “Problem” Related to “_____ “ Evidenced by “____” format. 4. Which nursing diagnosis is most important to address with this client? Explain how this was determined. 5. Which nursing diagnosis is second most important to address with this client? Explain how this was determined. 6. Which nursing diagnosis is least important to address with this client? Explain how this was determined. 7. Describe the evaluation of the client for each nursing diagnosis? · Care maps are due in week 6 and student must earn ≥ 80% (within two attempts) to pass the care map and clinical portion of the course. · Should a revision of the clinical care map be required, the revision is due in week 8. Be prepared to present your concept map to your fellow students during post conference the last week time permitting. All material that is not original work shall be referenced in APA format with appropriate in-text citations. Work that is not original and not referenced will not be graded and could result in a grade of zero. The concept map is supporting documentation for you to use to develop a plan of care specific to your patient and justifies everything you do for your patient. It should be specific enough that you could hand it to another nurse so the care for your patient could be continued. The concept map is a written version of the nursing process and it is “used to organize patient data, analyze relationships in the data, establish priorities, build on previous knowledge, identify what you do not understand, and enable you to take a holistic view of the patient’s situation (Schuster, 2002).” The nursing process involves critical thinking and is the foundation of what nurses do. The steps are: · Assessment- gathering clinical data from a variety of sources to support the decisions you make about the patient. · Diagnosing- identifying problems that represent the patient’s responses to the medical diagnosis, problem, or reason for seeking care. · Planning- developing a plan, with goals, to alleviate the problems. · Implementing- providing the care based on the plan you created. · Evaluating- reviewing the care you provided and determining whether the care provided has alleviated the patient’s problems and that the goals you set have been reached. Concept map template DAMILOLA OLOYEDE Nsg 240/245/430 Assessment Subjective: complain of pain upon admission objective data: leg edema, stage 2 pressure injury, right heel, right leg tear Vital signs: BP 112/63, HR 69, RR 18, Temp 97.7. pulse ox 68, pain 8 on a scale of 0 to 10 Body Systems Respiration; 18, clear lung sound Cardiovascular; BP 112/63, HR 69, pulse palpation and +2 heart sound s1s2 and regular. Integumetary; leg edema, stage 2 pressure injury right heel, right leg tear. Urinary; condom catheter, orange clear. Neuro/Sensory/Mental alert; alert and oriented x3 HEENT; hearing adequate, eyes PERRLA GI; Abdomen is soft, symmetric, and non tender without distention. Gordon Pattern and cluster data Patient is confused and very forgetful Relevant Gordon Pattern: Self-Perception/Self-Concept Definition: A person’s behavior about self, viewpoint of abilities, body image, recognition, general sense of value, and emotional patterns style (Doenges et. Al. , 2013, p. 17). Dysfunctional Gordon Pattern and cluster data Patient is stressed and in acute pain Relevant Gordon Pattern: Coping/Stress Definition: Universal coping style, stress tolerance, support systems, and perceive ability to control and manage issues (Doenges et. Al. , 2013, p. 17). Dysfunctional Gordon Pattern and cluster data Patient has diarrhea and incontinence Relevant Gordon Pattern: Nutrition/Metabolic Definition: Style of food and fluid consumption, fluid and electrolyte balance, overall capacity to recover (Doenges et. Al. , 2013, p. 17 Dysfunctional Patient JB 90yo Male Gordon Pattern and cluster data Patient has a condom catheter in place Relevant Gordon Pattern: Elimination Definition: Styles of excretory function (bowel, bladder, and shin) and client’s viewpoint (Doenges et. Al. , 2013, p. 17). Dysfunctional Gordon Pattern and cluster data Patient cannot walk without assistance and also needs assistance to be transferred from bed to his wheelchair Relevant Gordon Pattern: Activity/Exercise Definition: Pattern of training ,undertaking, spare time, relaxation, and activities of daily living; factors that impede with desired or expected individual style (Doenges et. Al. , 2013, p. 17). Dysfunctional Medications Escitalopram 10mg/PO/Selective Serotonin Reuptake Inhibitor SSRI. Side effect; coma, confusion, decreased urine output. Pantoprazole/40mg/ IV/proton-pump inhibitor. Side effects joint pain, gas Metoprolol 25mg/PO/Beta blocker. Side effect; dry mouth, depression, bloating List doctors order Blood work Clear liquid diet Condom catheter Fall risk precaution Labs/xrays WBC 10.52 abnormal (high) indicating an infection Hgb 8.6 abnormal (low) CBC test showed Hematocrit 29.8 abnormal (low) anemia Nursing 240/245/430 Page 1 Pathophysiology Abdominal pain due to Gastrointestinal bleeding. This is a common problem encountered in the emergency department and in the primary care setting. Acute or overt gastrointestinal bleeding is visible in the form of hematemesis, melena or hematochezia. Chronic or occult gastrointestinal bleeding is not apparent to the patient and usually presents as positive fecal occult blood or iron deficiency anemia. Intervention and rational Assess vital signs, particularly blood pressure level: Hypovolemia due to GI bleeding may lower pressure levels and put the patient at risk for hypotensive episodes that can lead to shock. Evaluation Goals were met Patient report no pain upon discharge Goal/outcome Patient will have a blood pressure level within range Psychosocial Nsg Dx Ineffective health maintenance related to lack of knowledge about signs and symptoms of GI bleed stating, “visible blood in stool and rectal bleeding”. Physiological Nsg Dx Acute abdominal pain related to patient holding abdomen due to GI bleed as evidenced by patient stating pain level is 10 on a scale of 0-10, 10 being worse Goal/outcome Patient will have an absence of GI bleeding and a hemoglobin level of over 13 Goal/outcome Pain management Patient reports 0 level of pain on a scale of 0-10 Intervention and rational Commence a fluid balance chart monitoring the input and output of the patient: To monitor patient’s fluid volume. Intervention and rational Educate the patient on how to fill out a fluid balance: To encourage the patient to drink more fluid as needed or report any changes to the nursing team Evaluation At the time of the evaluation, there was increase in the patients overall well being. Nursing 240/245/430 Page 2   Write about what you just did and how you thought about it. Each Gordon’s Patterns set shall be a paragraph. Tell me about all the thinking you did to develop the associated nursing diagnoses for that data cluster set. Then, move on to the next data cluster and make that a new paragraph. Don’t assume I know anything about your thought process, because I don’t. Show me how you are thinking! How to begin…………….   Include ALL of the questions with the Answers of the questions:   Explain how the data clusters helped you to determine the Gordon’s Functional and Dysfunctional Patterns. Using Gordon’s as a guide, which nursing diagnoses are identified for this client? (Separate each Gordon’s pattern into a paragraph). List the identified nursing diagnoses in the: “Problem” Related to “_____ “ Evidenced by “____” format. Which nursing diagnosis is most important to address with this client? Explain how this was determined. Which nursing diagnosis is second most important to address with this client? Explain how this was determined. Which nursing diagnosis is least important to address with this client? Explain how this was determined. Select the priority physiological and psychosocial (NSG240) and educational (NSG245 and NSG430) Nursing diagnoses. Complete the Nursing process by answering the questions below and including the information in the explanation paper for each priority nursing diagnosis: What is the goal for the client to show that the priority problem is reduced or resolved? What would a nurse (you) need to do for the client to help the client meet the goal? How would you know that the client has met the goal? Answer questions Nursing 240/245/430 Page 3 References Doenges, E. M. ,Moorhouse, F. M. (2013). Application of nursing process and nursing diagnosis (6th ed.). DavisPlus Kim, B. S., Li, B. T., Engel, A., Samra, J. S., Clarke, S., Norton, I. D., & Li, A. E. (2014). Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World journal of gastrointestinal pathophysiology, 5(4), 467–478. https://doi.org/10.4291/wjgp.v5.i4.467 DiGregorio AM, Alvey H. Gastrointestinal Bleeding. [Updated 2020 Aug 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537291/ Nursing 240/245/430 Page 4