Nursing Care Plan for Esophagitis (Achalasia)

Esophagitis is the inflammation of the esophagus caused by physical or chemical trauma. Reflux esophagitis is the reflux of gastric contents into the esophagus caused by an incompetent lower esophageal sphincter or a sliding hiatal hernia. Achalasia (cardiospasm) is the dilatation of the lower esophagus caused by a decrease in motility in the lower two thirds of the esophagus and ineffective peristalisis. This results in a sphincter that does not relax in response to swallowing causing an obstruction as food and fluid accumulate in the lower esophagus.

Nursing Diagnoses: Pain related to physical injuring agents caused by esophageal spasm, distention of lower portion of esophagus from food and fluid accumulation. Altered nutrition less than body requirements related to inability to ingest foods and fluids caused by dysphagia, reflux of gastric contents.

Expected Outcomes: Adequate nutritional intake with minimal or absence of discomfort evidenced by verbalization that eating 6 small meals/day without discomfort.

Nursing Intervention with Rationale:
I. Assess for:
A. Substernal pain, bloated or full feeling, heartburn.
Rationale: Symptoms associated with esophagitis caused by reflux of gastric contents.

B. Halitosis, regurgitation, dysphagia, retrosternal pain after meals.
Rationale: Signs and symptoms associated with achalasia.

II. Administer:
A. Antacid (magaldrate, aluminum hydroxide)
Rationale: Acts to reduce acid concentration in stomach and increase lower esophageal sphincter.

B. Anticholinergic (propatheline bromide, bethanechol chloride)
Rationale: Acts to relax smooth muscle and prevent spasms; improves strength of esophageal sphincter.

III. Perform/Provide
A. Oral care before and after meals and as needed.
Rationale: Prevents halitosis.

B. Small frequent meals instead of 3 meals/daily.
Rationale: Prevents overdistention of lower esophagus and obstruction.

C.Sitting position for meals and avoid lying position for 2-3 hours after meals.
Rationale: Prevents regurgitation.

D. Bland diet.
Rationale: Prevents irritation to esophagus.

E. Sleep with head elevated.
Rationale: Prevents gastric juices from entering esophagus and irritating mucosa by promoting gastric emptying.

F. Eat slowly, take fluids with food.
Rationale: Dysphagia occurs more frequently when liquids are taken.

G. Fluids following eating.
Rationale: Cleanses esophagus to prevent irritation in esophagitis.

IV: Teach Patient/Family:
A. Avoid coughing, straining at defecation, bending at waist, wearing tight clothing at waist.
Rationale: Prevents gastric reflux.

B. Avoid sucking on candy, chewing gum, smoking, using straw.
Rationale: Reduces chance of swallowing air.

C. Avoid foods such as hot/cold, caffeine, alcohol, spices, fruit juices, carbonated drinks.
Rationale: Irritating to esophagus.

Nursing Care Plan Schizophrenia | Social Isolation

This care plan is designed for patients with schizophrenia with a nursing diagnosis of social isolation may be related to disturbed thought processes that result in mistrust of others/delusional thinking; and environmental deprivation, institutionalization (as a result of long-term hospitalization) possibly evidenced by difficulty in establishing relationships with others; social withdrawal/isolation of self, expressions of feelings of rejection, and dealing with problems using anger/hostility and violence.

Desired Outcomes: (1) Verbalize willingness to be involved with others; (2) Participate in activities/programs with others; and (3) Develop 1:1 trust-based relationship.

Nursing intervention with rationale:
1. Assess presence/degree of isolation by listening to client’s comments about loneliness.
Rationale: Mistrust can lead to difficulty in establishing relationships, and client may have withdrawn from close contacts with others.

2. Spend time with client. Make brief, short interactions that communicate interest, concern, and caring.
Rationale: Establishes a trusting relationship. Consistent, brief, honest contact with the nurse can help the client begin to reestablish trusting interactions with others.

3. Plan appropriate times for activities (by limiting withdrawal, varying daily routine only as tolerated).
Rationale: Consistency in 1:1 relationship and sameness of milieu are required initially to enable client to decrease withdrawn behavior. Motivation is stimulated by the humanistic sharing of a 1:1 experience.

4. Assist client to participate in diversional activities and limited/planned interaction situations with others in group meeting/unit party, etc.
Rationale: With toleration of 1:1 relationship and strengthened ego boundaries, client will be able to increase socialization and enter small-group situations. Brief encounters can help the client to become more comfortable around others and provide an opportunity to try out new social skills.

5. Identify support systems available to the client (e.g., family, friends, coworkers).
Rationale: Support is an important part of the client’s rehabilitation, providing a network to assist in social recovery.

6. Assess family relationships, communication patterns, knowledge of client condition.
Rationale: Problems within family (poor social/relationship skills, high expressed emotion) may interfere with client’s progress and indicate need for family therapy.

7. Note client’s sense of self-worth and belief about individual identity/role within milieu and setting.
Rationale: When client feels good about self and own value, family interactions with others are enhanced.

Nursing Care Plan for Laminectomy

The surgical removal of a portion of a vertebra (posterior arch) is called laminectomy. It is done to remove a herniated nucleus pulposus, tumor, bone fragments that cause pressure and chronic pain. It may be performed on the cervical or lumbar region. Fusion is the removal of bone fragments from the iliac crest or tibia and implantation of the fragments at the surgical site to treat instability of the spine resulting from degenerative processes, and fractures.

Nursing Diagnoses: Pain related to physical injuring agents caused by surgical trauma resulting in irritated spinal nerves, edema. Impaired physical mobility related to musculoskeletal impairment caused by spinal surgery, pain and imposed restriction of movements.

Expected Outcomes: Pain relieved or controlled, progressive return of mobility evidenced by verbalizations that pain decreased or absent, and ambulation and self-care activities resumed.

Nursing Intervention with Rationale:
I. Assess for:
A. Burning, numbness, tingling in legs, muscle spasms.
Rationale: Results from spinal nerve root irritation.

B. Ability to or fear of movement in bed.
Rationale: Indicates for complications of immobility.

II. Monitor, Describe, Record:
A. Neurological signs every 4 hours.
Rationale: Possibility of spinal fluid leakage and infection.

B. Vital signs every 4 hours, peripheral pulses and capillary refill time every 4 hours.
Rationale: Indicates changes caused by ineffective ventilation if cervical approach is done or respiratory distress; circulatory disturbance in extremities.

III. Perform or Provide
A. Flat in bed for 24 hours in spinal proper alignment; 10 days to 2 weeks if fusion done
Rationale: Promotes comfort and proper alignment until healed; raising head of bed puts strain on or may be dislodge bone graft.

B. Logroll when turning, avoid twisting; instruct to fold arms on chest and use turning sheet with staff assisting.
Rationale: Maintains body alignment and prevents twisting of trunk.

C. Position in supine or side-lying with pillow to back, under, or between legs; sitting should be in straight-bak chair.
Rationale: Provides comfort and support.

D. Ambulate with assistance after 24 hours or as appropriate.
Rationale: Promotes circulation and breathing post-operatively.

E. Apply brace, cast, or collar before ambulation to stabilize surgical site.
Rationale: Brace may be used if a fusion is done, cervical collar immobilizes neck if cervical laminectomy done.

IV. Teach Patient or Family
A. Proper body mechanics and alignment for lying, standing, stooping or bending, walking, sitting.
Rationale: Prevents injury to spine or recurrent spinal problems or pressure on spinal nerves.

B. Use of straight-back chair and straight-back seat for driving.
Rationale: Maintains proper back alignment.

C. How to roll out of bed while pushing on mattress and splint the back when sitting or rising from a chair.
Rationale: Prevents back injury.

D. Application of cervical brace or cast, brace to lumbar region.
Rationale: Immobilized neck if cervical approach done.

Nursing Care Plan for Penile Implantation

The surgical insertion of a penile prosthesis performed to treat erectile dysfunction to allow for the maintenance of an erect penis for sexual function. Penile implantation may be semi-rigid resulting in a permanent semi-erection or inflatable, which is filled with fluid pumped into cylinders placed in the penis resulting in lengthening and firming of the organ (fluid released when activity completed). Impotency may be caused by spinal cord trauma, diabetes mellitus, atherosclerosis, surgery, or radiation of area, or psychological conditions. This plan, which includes interventions specific to this procedure, may be used in association with preoperative care, postoperative care, spinal cord trauma, and diabetes mellitus care plan.

Nursing Diagnoses: Body image disturbance related to biophysical factor of change of sexual activity, appearance and embarrassment of permanent erection of semi-rigid prosthesis. Altered sexuality patterns related to altered structure and functions caused by surgical implantation of penile prosthesis resulting in changes in sexual behaviors and activity.

Expected Outcomes: Progressive adaptation to change in sexual activity and pattern evidenced by verbalization of feeling of improved sexual performance and ability to conceal semi-rigid prosthesis, improved relationship with sexual partner.

Nursing Intervention with Rationale:
I. Assess for:
A. Feelings associated with implant and change in functioning of penis, sexual adequacy.
Rationale: Provides data revealing effect of change in body image, self-worth, sexuality.

II. Perform or Provide:
A. Encourage expression of feelings in attentive, non-judgmental environment.
Rationale: Provides venting of feelings and opportunity to externalize feelings in response to implant.

B. Encourage expression of how implant will affect lives of self and partner.
Rationale: Identifies positive behaviors and willingness to adapt to change in function.

C. Privacy during self-care; offer pajama bottoms.
Rationale: Prevents embarrassment of exposure of penal erection.

D. Inclusion of partner in content of instruction and demonstrations.
Rationale: Maintain relationship with sexual partner.

III. Teach Patient or Partner:
A. Operation of pump, using models, to inflate or deflate daily for 4-6 weeks.
Rationale: Promotes acceptance and satisfactory use of prosthesis; will maintain pump position and promote fibrous tissue growth around implant.

B. Amount of pressure to use for inflation.
Rationale: Pressure that is excessive will obstruct fluid flow.

C. Inform that adaptation to implant takes time.
Rationale: Promotes patience and acceptance of change in function.

D. Suggest wearing snug fitting underwear with penis placed in upward position on abdomen, loose trousers.
Rationale: Assists to conceal semi-rigid prosthesis.

E. Begin sexual activity 6-8 weeks after surgery with physician's permission; use adequate lubrication.
Rationale: Allows for healing; prevents undue trauma to penis after surgery.

Nursing Care Plan for Peptic Ulcer

Peptic ulcer is an acute or chronic ulcertation of the mucosa and deeper structures of the stomach, duodenum, lower esophagus, or jejunum. Chronic type may cause erosion followed by fibrosis of tissue over long periods of time. Causes may be an imbalance in acid and enzyme secretion that affects the protective barrier of the tract, drug ingestion that disrupts the protective barrier, severe emotional or prolonged stress. This plan may be used in association with gastrectomy care plan.

Nursing Diagnosis: Pain related to physical injuring agents of ingestion of irritants, increased gastric secretions, and effect on ulcerated area.

Expected Outcomes: Pain episodes reduced and controlled evidenced by verbalizations that pain is alleviated.

Nursing intervention with rationale:
I. Assess for:
A. Epigastritic pain following ingestion of irritating foods, time of onset after meals, other factors that increase or decrease pain.
Rationale: Symptoms of ulcer depending on site (pain 1-2 hours after meals in gastric ulcer; 2-4 hours in duodenal ulcer).

B. Bloated or gaseous feeling.
Rationale: Occurs with gastric ulcer.

II. Administer:
A. Antacid (aluminum hydroxide, magaldrate).
Rationale: Acts to relieve pain and enhance healing by protecting mucosa by neutralizing acid.

B. H2 Antagonist (cimetidine, ranitidine).
Rationale: Acts to decrease HCL secretion.

C. Anticholenergic (propantheline, belladona, and phenobarbital).
Rationale: Acts to decrease hypermotility and acid secretion.

D. Protective agent (sucralfate).
Rationale: Acts to coat and protect mucosa and inhibit pepsin activity on mucosa.

E. Gastric motility and emptying agent (metoclopramide).
Rationale: Acts to prevent retention of contents in stomach that stimulated acid production.

III. Teach patient or family:
A. Avoid raw, spicy, hot or cold foods, coffee, tea, cola drinks, alcoholic beverages.
Rationale: Increase acid production.

B. Avoid smoking, taking aspirin or other over-the-counter medications.
Rationale: Increases acid production and bleeding tendency of stomach mucosa.

C. Stress reduction techniques.
Rationale: Reduces acid production when relaxed; prevents pain.

D. Proper administration of medications including dose, time, frequency, side effects, expected outcomes.
Rationale: Promotes healing and prevents recurrence of ulcer or continued erosion of mucosa.