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  • Nursing Care Plans for Pancreatitis – Best Nursing Care Plans(2022)

    This article discusses Nursing Care Plans for Pancreatitis plus its causes, symptoms, preventions, treatments, and interventions.

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    Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

    Introduction

    Pancreatitis is a condition where the pancreas becomes inflamed (swollen) over a short period of time. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

    Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Some people develop chronic pancreatitis, which is pancreatitis that occurs over many years.

    Mild cases of pancreatitis improve with treatment, but severe cases can cause life-threatening complications.

    Symptoms of Pancreatitis

    Signs and symptoms of pancreatitis may vary, depending on which type a patient experiences.

    Acute pancreatitis signs and symptoms include:

    • Upper abdominal pain
    • Abdominal pain that radiates to your back
    • Tenderness when touching the abdomen
    • Fever
    • Rapid pulse
    • Nausea
    • Vomiting

    Chronic pancreatitis signs and symptoms include:

    • Upper abdominal pain
    • Abdominal pain that feels worse after eating
    • Losing weight without trying
    • Oily, smelly stools (steatorrhea)

    Causes of Pancreatitis

    Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of the pancreas and causing inflammation.

    With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

    Conditions that can lead to acute pancreatitis include:

    • Gallstones
    • Alcoholism
    • Certain medications
    • High triglyceride levels in the blood (hypertriglyceridemia)
    • High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
    • Pancreatic cancer
    • Abdominal surgery
    • Cystic fibrosis
    • Infection
    • Injury to the abdomen
    • Obesity
    • Trauma
    • Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat gallstones, also can lead to pancreatitis.

    Risk factors for Pancreatitis

    Factors that increase the risk of pancreatitis include:

    Excessive alcohol consumption. Research shows that heavy alcohol users (people who consume four to five drinks a day) are at increased risk of pancreatitis.

    Cigarette smoking. Smokers are, on average, three times more likely to develop chronic pancreatitis compared with nonsmokers.

    Obesity. A person is more likely to get pancreatitis if you’re obese.

    Diabetes. Having diabetes increases your risk of pancreatitis.

    Family history of pancreatitis. The role of genetics is becoming increasingly recognized in chronic pancreatitis. If a person has family members with the condition, the chances increase — especially when combined with other risk factors.

    Complications of Pancreatitis

    Pancreatitis can cause serious complications, including:

    Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.

    Breathing problems. Acute pancreatitis can cause chemical changes in the body that affect lung function, causing the level of oxygen in the blood to fall to dangerously low levels.

    Infection. Acute pancreatitis can make the pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.

    Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cyst-like pockets in the pancreas. A large pseudocyst that ruptures can cause internal bleeding and infection complications.

    Malnutrition. Both acute and chronic pancreatitis can cause the pancreas to produce fewer enzymes needed to break down and process nutrients from the food eaten. This can lead to malnutrition, diarrhea, and weight loss, even though a person may be eating the same foods or the same amount of food.

    Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way the body uses blood sugar.

    Pancreatic cancer. Long-standing inflammation in the pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

    Diagnosis of Pancreatitis

    The diagnosis of pancreatitis is based on a history of abdominal pain, the presence of known risk factors, physical examination findings, and diagnostic findings.

    Serum amylase and lipase levels. Although their elevation can be attributed to many causes, these are used in making a diagnosis, and serum lipase remain elevated for a longer period than amylase.

    WBC count. The WBC count is usually elevated.

    X-ray studies. X-ray studies of the abdomen and chest may be obtained to differentiate pancreatitis from other disorders that can cause similar symptoms.

    Ultrasound. Ultrasound is used to identify an increase in the diameter of the pancreas.

    Blood studies. Hemoglobin and hematocrit levels are used to monitor the patient for bleeding.

    CT scan: Shows an enlarged pancreas pancreatic cysts and determines the extent of edema and necrosis.

    Ultrasound of abdomen: May be used to identify pancreatic inflammation, abscess, pseudocysts, carcinoma, or obstruction of biliary tract

    Endoscopic retrograde cholangiopancreatography: Useful to diagnose fistulas, obstructive biliary disease, and pancreatic duct strictures/anomalies (the procedure is contraindicated in an acute phase).

    CT–guided needle aspiration: Done to determine whether the infection is present.

    Abdominal x-rays: May demonstrate dilated loop of small bowel adjacent to the pancreas or another intra-abdominal precipitator of pancreatitis, presence of free intraperitoneal air caused by perforation or abscess formation, pancreatic calcification.

    Upper GI series: Frequently exhibits evidence of pancreatic enlargement/inflammation.

    Serum amylase: Increased because of obstruction of normal outflow of pancreatic enzymes (normal level does not rule out disease). It may be five or more times the normal level in acute pancreatitis.

    Serum lipase: usually elevates along with amylase but stays elevated longer.

    Serum bilirubin: Elevation is common (may be caused by alcoholic liver disease or compression of the common bile duct).

    Alkaline phosphatase: Usually elevated if pancreatitis is accompanied by biliary disease.

    Serum albumin and protein: Maybe decreased (increased capillary permeability and transudation of fluid into extracellular space).

    Serum calcium: Hypocalcemia may appear 2–3 days after onset of illness (usually indicates fat necrosis and may accompany pancreatic necrosis).

    Potassium: Hypokalemia may occur because of gastric losses; hyperkalemia may develop secondary to tissue necrosis, acidosis, renal insufficiency.

    Triglycerides: Levels may exceed 1700 mg/dL and may be a causative agent in acute pancreatitis.

    LDH/AST: May be elevated up to 15 times normal because of biliary and liver involvement.

    CBC: WBC count of 10,000–25,000 is present in 80% of patients. Hb may be lowered because of bleeding. Hct is usually elevated (hemoconcentration associated with vomiting or fluid effusion into the pancreas or retroperitoneal area).

    Serum glucose: Transient elevations of more than 200 mg/dL are common, especially during initial/acute attacks. Sustained hyperglycemia reflects widespread cell damage and pancreatic necrosis and is a poor prognostic sign.

    Partial thromboplastin time (PTT): Prolonged if coagulopathy develops because of liver involvement and fat necrosis.

    Urinalysis: Glucose, myoglobin, blood, and protein may be present.

    Urine amylase: Can increase dramatically within 2–3 days after the onset of an attack.

    Stool: Increased fat content (steatorrhea) indicative of insufficient digestion of fats and protein.

    Nursing Care Plans for Pancreatitis Based on Diagnosis

    Nursing Care Plan 1: Diagnosis – Acute Pain

    May be related to:

    • Obstruction of pancreatic biliary ducts
    • Chemical contamination of peritoneal surfaces by pancreatic exudate/autodigestion of the pancreas
    • Extension of inflammation to the retroperitoneal nerve plexus

    Possibly evidenced by:

    • Reports of pain
    • Self-focusing, grimacing, distraction/guarding behaviors.
    • Autonomic responses, alteration in muscle tone

    Desired Outcomes

    • Report pain is relieved/controlled.
    • Follow prescribed therapeutic regimen.
    • Demonstrate the use of methods that provide relief.

    Nursing Interventions

    Investigate verbal reports of pain, noting specific location and intensity (0–10 scale). Note factors that aggravate and relieve pain.

    Rationale: Pain is often diffuse, severe, and unrelenting in acute or hemorrhagic pancreatitis. Severe pain is often the major symptom in patients with chronic pancreatitis. Isolated pain in the RUQ reflects the involvement of the head of the pancreas. Pain in the left upper quadrant (LUQ) suggests an involvement of the pancreatic tail. Localized pain may indicate the development of pseudocysts or abscesses.

    Maintain bed rest during an acute attack. Provide a quiet, restful environment.

    Rationale: Decreases metabolic rate and GI stimulation and secretions, thereby reducing pancreatic activity.

    Promote position of comfort on one side with knees flexed, sitting up, and leaning forward.

    Rationale: Reduces abdominal pressure and tension, providing some measure of comfort and pain relief. Note: Supine position often increases pain.

    Provide alternative comfort measures (back rub), encourage relaxation techniques (guided imagery, visualization), quiet diversional activities (TV, radio).

    Rationale: Promotes relaxation and enables the patient to refocus attention; may enhance coping.

    Keep the environment free of food odors.

    Rationale: Sensory stimulation can activate pancreatic enzymes, increasing pain.

    Administer analgesics in a timely manner (smaller, more frequent doses).

    Rationale: Severe and prolonged pain can aggravate shock and is more difficult to relieve, requiring larger doses of medication, which can mask underlying problems and complications and may contribute to respiratory depression.

    Maintain meticulous skin care, especially in the presence of draining abdominal wall fistulas.

    Rationale: Pancreatic enzymes can digest the skin and tissues of the abdominal wall, creating a chemical burn.

    Administer medication as indicated:

    Narcotic analgesics: meperidine (Demerol), fentanyl (Sublimaze), pentazocine (Talwin);

    Rationale: Meperidine is usually effective in relieving pain and may be preferred over morphine, which can have a side effect of biliary-pancreatic spasms. Paravertebral block has been used to achieve prolonged pain control. Note: Pain in patients who have recurrent or chronic pancreatitis episodes may be difficult to manage because they may become dependent on the narcotics given for pain control.

    Sedatives: diazepam (Valium);antispasmodics: atropine;

    Rationale: Potentiates action of narcotic to promote rest and to reduce muscular and ductal spasm, thereby reducing metabolic needs enzyme secretions.

    Antacids: Mylanta, Maalox, Amphojel, Riopan;

    Rationale: Neutralizes gastric acid to reduce pancreatic enzymes’ production and reduce the incidence of upper GI bleeding.

    Cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid)

    Rationale: Decreasing secretion of HCl reduces stimulation of the pancreas and associated pain.

    Withhold food and fluid as indicated.

    Rationale: Limits and reduces the release of pancreatic enzymes and resultant pain.

    Maintain gastric suction when used.

    Rationale: Prevents accumulation of gastric secretions, which can stimulate pancreatic enzyme activity.

    Prepare for surgical intervention if indicated.

    Rationale: Surgical exploration may be required in the presence of intractable pain and complications involving the biliary tract, such as pancreatic abscess or pseudocyst.

    Nursing Care Plan 2: Diagnosis – Risk for Deficient Fluid Volume

    Risk factors may include:

    • Excessive losses: vomiting, gastric suctioning
    • Increase in size of the vascular bed (vasodilation, effects of kinins)
    • Third-space fluid transudation, ascites formation
    • Alteration of the clotting process, hemorrhage

    Desired Outcomes

    Maintain adequate hydration as evidenced by stable vital signs, good skin turgor, prompt capillary refill, strong peripheral pulses, and individually appropriate urinary output.

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    Nursing Care Plans for Pancreatitis
    Nursing Care Plans for Pancreatitis

    Nursing Interventions

    Monitor BP and measure CVP if available.

    Rationale: Fluid sequestration (shifts into third space), bleeding, and release of vasodilators (kinins) and cardiac depressant factor triggered by pancreatic ischemia may result in profound hypotension. Reduced cardiac output and poor organ perfusion secondary to a hypotensive episode can precipitate widespread systemic complications.

    Measure I&O including vomiting, gastric aspirate, diarrhea. Calculate 24-hr fluid balance.

    Rationale: Indicators of replacement needs and effectiveness of therapy.

    Note the decrease in urine output (less than 400 mL per 24 hr).

    Rationale: Oliguria may occur, signaling renal impairment and acute tubular necrosis (ATN), related to an increase in renal vascular resistance or reduced and altered renal blood flow.

    Record color and character of gastric drainage, measure pH and note presence of occult blood.

    Rationale: The risk of gastric bleeding and hemorrhage is high.

    Weigh as indicated. Correlate with calculated fluid balance.

    Rationale: Weight loss may suggest hypovolemia; however, edema, fluid retention, and ascites may be reflected by increased or stable weight, even in the presence of muscle wasting.

    Note poor skin turgor, dry skin and mucous membranes, reports of thirst.

    Rationale: Further physiological indicators of dehydration.

    Observe and record peripheral and dependent edema. Measure abdominal girth if ascites are present.

    Rationale: Edema and fluid shifts occur as a result of increased vascular permeability, sodium retention, and decreased colloid osmotic pressure in the intravascular compartment.Note: Fluid loss (sequestration) of more than 6 L per 48 hr is considered a poor prognostic sign.

    Investigate changes in sensorium (confusion, slowed responses).

    Rationale: Changes may be related to hypovolemia, hypoxia, electrolyte imbalance, or impending delirium tremens (inpatient with acute pancreatitis secondary to excessive alcohol intake). The severe pancreatic disease may cause toxic psychosis.

    Auscultate heart sounds; note rate and rhythm. Monitor and document rhythm changes.

    Rationale: Cardiac changes and dysrhythmias may reflect hypovolemia or electrolyte imbalance, commonly hypokalemia, and hypocalcemia. Hyperkalemia may occur related to tissue necrosis, acidosis, and renal insufficiency and may precipitate lethal dysrhythmias if uncorrected. S3 gallop in conjunction with JVD and crackles suggest HF or pulmonary edema. Note: Cardiovascular complications are common and include MI, pericarditis, and pericardial effusion with or without tamponade.

    Inspect the skin for petechiae, hematomas, and unusual wound or venipuncture bleeding. Note hematuria, mucous membrane bleeding, and bloody gastric contents.

    Rationale: DIC may be initiated by a release of active pancreatic proteases into the circulation. The most frequently affected organs are the kidneys, skin, and lungs.

    Watch out for signs and symptoms of calcium deficiency. Observe and report coarse muscle tremors, twitching, positive Chvostek’s, Trousseau’s sign, tetany, cramps, carpopedal spasm, and seizures.

    Rationale: Symptoms of calcium imbalance. Calcium binds with free fats in the intestine and is lost by excretion in the stool.

    Keep airway and suction apparatus handy and pad side rails.

    Rationale: If you suspect hypocalcemia

    Administer fluid replacement as indicated (saline solutions, albumin, blood, blood products, dextran).

    Rationale: Choice of replacement solution may be less important than rapidity and adequacy of volume restoration. Saline solutions and albumin may be used to promote the mobilization of fluid back into vascular space. Low-molecular-weight dextran is sometimes used to reduce the risk of renal dysfunction and pulmonary edema associated with pancreatitis.

    Monitor laboratory studies (Hb and Hct, Protein, albumin, electrolytes, BUN, creatinine, urine osmolality, and sodium, potassium, coagulation studies).

    Rationale: Identifies deficits and replacement needs and developing complications (ATN, DIC).

    Replace electrolytes (sodium, potassium, chloride, calcium as indicated).

    Rationale: Decreased oral intake and excessive losses greatly affect electrolyte and acid-base balance, which is necessary to maintain optimal cellular and organ function.

    Prepare and assist with peritoneal lavage hemoperitoneum dialysis.

    Rationale: Removes toxic chemicals and pancreatic enzymes and allows for more rapid correction of metabolic abnormalities in severe and unresponsive cases of acute pancreatitis.

    Nursing Care Plan 3: Diagnosis – Imbalanced Nutrition: Less Than Body Requirements

    May be related to:

    • Vomiting decreased oral intake; prescribed dietary restrictions
    • Loss of digestive enzymes and insulin (related to pancreatic outflow obstruction or necrosis/autodigestion)

    Possibly evidenced by:

    • Reported inadequate food intake
    • Aversion to eating, reported altered taste sensation, lack of interest in food.
    • Weight loss
    • Poor muscle tone

    Desired Outcome

    • Demonstrate progressive weight gain toward the goal with normalization of laboratory values
    • Experience no signs of malnutrition.
    • Demonstrate behaviors lifestyle changes to regain and/or maintain an appropriate weight.

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    Nursing Care Plans for Pancreatitis
    Nursing Care Plans for Pancreatitis

    Nursing Interventions

    Assess abdomen, noting the presence and character of bowel sounds, abdominal distension, and reports of nausea.

    Rationale: Gastric distention and intestinal atony are frequently present, resulting in reduced and absent bowel sounds. Return of bowel sounds and relief of symptoms signal readiness for discontinuation of gastric aspiration (NG tube).

    Provide frequent oral care.

    Rationale: Decreases vomiting stimulus and inflammation and irritation of dry mucous membranes associated with dehydration and mouth breathing when NG is in place.

    Assist patient in selecting food and fluids that meet nutritional needs and restrictions when the diet is resumed.

    Rationale: Previous dietary habits may be unsatisfactory in meeting current tissue regeneration and healing needs. Use of gastric stimulants (caffeine, alcohol, cigarettes, gas-producing foods) or ingestion of large meals may result in excessive stimulation of the pancreas and recurrence of symptoms.

    Observe color, consistency, and amount of stools. Note frothy consistency and foul odor.

    Rationale: Steatorrhea may develop from incomplete digestion of fats.

    Note signs of increased thirst and urination or changes in mentation and visual acuity.

    Rationale: May warn of developing hyperglycemia associated with increased release of glucagon (damage to [beta] cells) or decreased release of insulin (damage to [beta] cells).

    Test urine for sugar and acetone.

    Rationale: Early detection of inadequate glucose utilization may prevent the development of ketoacidosis.

    Maintain NPO status and gastric suctioning in the acute phase.

    Rationale: Prevents stimulation and release of pancreatic enzymes (secretin), released when chyme and HCl enter the duodenum.

    Administer hyperalimentation and lipids, if indicated.

    Rationale: IV administration of calories, lipids, and amino acids should be instituted before nutrition and nitrogen depletion are advanced.

    Resume oral intake with clear liquids and advance diet slowly to provide a high-protein, high-carbohydrate diet, when indicated.

    Rationale: Oral feedings given too early in the course of illness may exacerbate symptoms. Loss of pancreatic function and reduced insulin production may require the initiation of a diabetic diet.

    Provide medium-chain triglycerides (MCTs) (MCT, Portagen).

    Rationale: MCTs are elements of enteral feedings (NG or J-tube) that provide supplemental calories and nutrients that do not require pancreatic enzymes for digestion and absorption.

    Administer medications as indicated:

    Vitamins: A,D,E,K;

    Rationale: Replacement is required because fat metabolism is altered, reducing absorption and storage of fat-soluble vitamins.

    Replacement enzymes: pancreatin (Dizymes) pancrelipase (Viokase, Cotazym).

    Rationale: Used in chronic pancreatitis to correct deficiencies to promote digestion and absorption of nutrients.

    Monitor serum glucose.

    Rationale: Indicator of insulin needs because hyperglycemia is frequently present, although not usually in levels high enough to produce ketoacidosis.

    Provide insulin as appropriate.

    Rationale: Corrects persistent hyperglycemia caused by injury to cells and increased release of glucocorticoids. Insulin therapy is usually short-term unless permanent damage to the pancreas occurs.

    Nursing Care Plan 4: Diagnosis – Risk for Infection

    Risk factors may include:

    • Inadequate primary defenses: stasis of body fluids, altered peristalsis, change in pH of secretions
    • Immunosuppression
    • Nutritional deficiencies
    • Tissue destruction, chronic disease

    Desired Outcomes

    • Achieve timely healing be free of signs of infection.
    • Be afebrile
    • Participate in activities to reduce the risk of infection.

    Nursing Interventions

    Use strict aseptic techniques when changing surgical dressings or working with IV lines, indwelling catheters and tubes, drains. Change soiled dressings promptly.

    Rationale: Limits sources of infection, which can lead to sepsis in a compromised patient. Note: Studies indicate that infectious complications are responsible for about 80% of deaths associated with pancreatitis.

    Stress the importance of good handwashing.

    Rationale: Reduces risk of cross-contamination.

    Observe the rate and characteristics of respirations breath sounds. Note the occurrence of cough and sputum production.

    Rationale: Fluid accumulation and limited mobility predispose to respiratory infections and atelectasis. Accumulation of ascites fluid may cause elevated diaphragm and shallow abdominal breathing.

    Encourage frequent position changes, deep breathing, and coughing. Assist with ambulation as soon as stable.

    Rationale: Enhances ventilation of all lung segments and promotes mobilization of secretions.

    Observe for signs of infection:

    Fever and respiratory distress in conjunction with jaundice;

    Rationale: Cholestatic jaundice and decreased pulmonary function may be the first sign of sepsis involving Gram-negative organisms.

    Increased abdominal pain, rigidity, and rebound tenderness diminished and absent bowel sounds;

    Rationale: Suggestive of peritonitis.

    Increased abdominal pain and tenderness, recurrent fever (higher than 101°F), leukocytosis, hypotension, tachycardia, and chills.

    Rationale: Abscesses can occur 2 wk or more after the onset of pancreatitis (mortality can exceed 50%) and should be suspected whenever a patient is deteriorating despite supportive measures.

    Obtain culture specimens (blood, wound, urine, sputum, or pancreatic aspirate).

    Rationale: Identifies presence of infection and causative organism.

    Administer antibiotic therapy as indicated: cephalosporins, cefoxitin sodium (Mefoxin); plus aminoglycosides: gentamicin (Garamycin), tobramycin (Nebcin).

    Rationale: Broad-spectrum antibiotics are generally recommended for sepsis; however, therapy will be based on the specific organisms cultured.

    Prepare for surgical intervention as necessary.

    Rationale: Abscesses may be surgically drained with resection of necrotic tissue. Sump tubes may be inserted for antibiotic irrigation and drainage of pancreatic debris. Pseudocysts (persisting for several weeks) may be drained because of the risk and incidence of infection and rupture.

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    Nursing Care Plans for Pancreatitis
    Nursing Care Plans for Pancreatitis

    Nursing Care Plan 5: Diagnosis – Acute pain

    It is related to inflammation of the pancreas and surrounding tissue, biliary tract disease, obstruction of pancreatic ducts, and interruption of the blood supply.

    Possibly evidenced by:

    • Observed evidence of pain
    • Guarding behavior
    • Protective gestures
    • Positioning to avoid pain
    • Sleep disturbances (eyes lackluster, beaten look, fixed or scattered movement
    • Expressive behavior (restlessness, moaning, crying, vigilance, irritability, sighing)
    • Distraction behavior (pacing, seeking out other people)
    • Change in muscle tone
    • Diaphoresis

    Desired Outcomes

    • A patient will report pain is relieved/controlled.
    • A patient will follow the prescribed pharmacological regimen.
    • Verbalize nonpharmacologic methods that provide relief.
    • Demonstrate use of relaxation skills and diversional activities, as indicated, for an individual situation

    Nursing Interventions

    Note client’s locus of control (internal/external)

    Rationale: Individuals with an external locus of control may take little or no responsibility for pain management.

    Accept client’s description of pain.

    Rationale: Pain is a subjective experience that others cannot feel.

    Note when pain occurs.

    Rationale: To medicate prophylactically, as appropriate.

    Provide comfort measures.

    Rationale: To promote nonpharmacological pain management.

    Encourage adequate rest periods.

    Rationale: To prevent fatigue

    Administer analgesics as indicated to maximum dosage, as needed.

    Rationale: To maintain an acceptable level of pain.

    Evaluate and document client’s response to analgesia and assist in transitioning or changing drug regimen based on individual needs.

    Rationale: Increasing or decreasing dosage, stepped program (switching from injection to oral route, increased time span as the pain lessens) helps in self-management of pain.

    Related FAQs

    1. What is the plan of care for pancreatitis?

    Maintain bedrest during acute attack. Provide quiet, restful environment. Decreases metabolic rate and GI stimulation and secretions, thereby reducing pancreatic activity. Promote position of comfort on one side with knees flexed, sitting up and leaning forward.18 Mar 2022

    2. What is the nursing diagnosis for pancreatitis?

    Nursing Diagnosis: Imbalanced Nutrition: Less Than the Body Requirements related to poor oral intake, secondary to pancreatitis, as evidenced by stable weight loss, lack of interest in food, impaired muscle tone, inadequate food consumption, intolerance to food, and reported changes in taste sensations.

    3. What is the most important nursing intervention for pancreatitis?

    The following are their recommendations for caring for these patients: – Offer regular analgesia to promote comfort. Anti-emetics may be needed to control nausea and vomiting; – Give prescribed intravenous fluids and other products to correct hypovolaemia, and keep the patient well hydrated.

    4. What is the goal for acute pancreatitis?

    The goals of treatment of acute pancreatitis are to alleviate pancreatic inflammation and to correct the underlying cause. Treatment usually requires hospitalization for at least a few days. (See “Management of acute pancreatitis”.)

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  • Nursing Care Plans for Osteoporosis – Best Nursing Care Plans(2022)

    This article discusses Nursing Care Plans for Osteoporosis plus its causes, symptoms, preventions, treatments, and interventions.

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    customnursingassignments.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us.(Nursing Care Plans for Osteoporosis)

    Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

    Introduction

    Osteoporosis is a disease that thins and weakens the bones. The bones become fragile and fracture (break) easily, especially the bones in the hip, spine, and wrist. Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine.

    Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.

    Symptoms of Osteoporosis

    There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

    1. Back pain, caused by a fractured or collapsed vertebra
    2. Loss of height over time
    3. A stooped posture
    4. A bone that breaks much more easily than expected

    Causes of Osteoporosis

    Doctors have identified several risk factors for osteoporosis. Some are modifiable, but it is not possible to avoid others. The body continually absorbs old bone tissue and generates new bone to maintain bone density, strength, and structural integrity.

    Bone density peaks when a person is in their late 20s, and it starts to weaken at around 35 years of age. As a person grows older, bone breaks down faster than it rebuilds. Osteoporosis may develop if this breakdown occurs excessively.

    It can affect both males and females, but it is most likely to occur in women after menopause because of the sudden decrease in estrogen. Estrogen protects typically women against osteoporosis.

    The IOF advises that once people reach 50 years of age, 1 in 3 women and 1 in 5 men will experience fractures due to osteoporosis.

    Risk Factors of Osteoporosis

    Several factors can increase the likelihood that you’ll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments.

    Unchangeable risks

    Some risk factors for osteoporosis are out of your control, including:

    Gender. Women are much more likely to develop osteoporosis than are men.

    Age. The older you get, the greater your risk of osteoporosis.

    Race. You’re at the most significant risk of osteoporosis if you’re white or of Asian descent.

    Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.

    Body frame size. Men and women with small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.

    Hormone levels

    Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

    Sex hormones. Lowered sex hormone levels tend to weaken bone. The fall in estrogen levels in women at menopause is one of the most vital risk factors for developing osteoporosis. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss.

    Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid.

    Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.

    Dietary factors

    Osteoporosis is more likely to occur in people who have:

    Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss, and an increased risk of fractures.

    Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.

    Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help you lose weight and for other gastrointestinal disorders.

    Steroids and other medications

    Long-term use of oral or injected corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:

    • Seizures
    • Gastric reflux
    • Cancer
    • Transplant rejection
    • Medical conditions

    The risk of osteoporosis is higher in people who have some medical issues, including:

    1. Celiac disease
    2. Inflammatory bowel disease
    3. Kidney or liver disease
    4. Cancer
    5. Multiple myeloma
    6. Rheumatoid arthritis
    7. Lifestyle choices

    Some bad habits can increase your risk of osteoporosis. Examples include:

    • Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing, and weightlifting seem particularly helpful.
    • Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
    • Tobacco use. The exact role tobacco plays in osteoporosis isn’t clear, but it has been shown that tobacco use contributes to weak bones.

    Complications of Osteoporosis

    How osteoporosis can cause vertebrae to crumble and collapse

    Compression fractures

    Bone fractures, particularly in the spine or hip, are the most severe complications of osteoporosis. Hip fractures are often caused by a fall and can result in disability and an increased risk of death within the first year after the injury.

    In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine (vertebrae) can weaken to the point of collapsing, resulting in back pain, lost height, and a hunched forward posture.

    Prevention of Osteoporosis

    Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.

    Calcium

    Men and women between 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

    Good sources of calcium include:

    • Low-fat dairy products
    • Dark green leafy vegetables
    • Canned salmon or sardines with bones
    • Soy products, such as tofu
    • Calcium-fortified cereals and orange juice

    If you find it challenging to get enough calcium from your diet, consider taking calcium supplements. However, too much calcium has been linked to kidney stones. Although yet unclear, some experts suggest that too much calcium, especially in supplements, can increase the risk of heart disease.

    The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine recommends that total calcium intake from supplements and diet combined should be no more than 2,000 milligrams daily for people older than 50.

    Vitamin D

    Vitamin D improves the body’s ability to absorb calcium and improves bone health in other ways. People can get some of their vitamin D from sunlight, but this might not be a good source if you live in a high latitude, if you’re housebound, or if you regularly use sunscreen or avoid the sun because of the risk of skin cancer.

    Dietary sources of vitamin D include cod liver oil, trout, and salmon. Many types of milk and cereal have been fortified with vitamin D.

    Most people need at least 600 international units (IU) of vitamin D a day. That recommendation increases to 800 IU a day after age 70.

    People without other sources of vitamin D and especially with limited sun exposure might need a supplement. Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

    Exercise

    Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life.

    Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing, and impact-producing sports — affect mainly the bones in your legs, hips, and lower spine. Balance exercises such as tai chi can reduce your risk of falling, especially as you get older.

    Nursing Care Plans for Osteoporosis Based on Diagnosis

    Nursing Care Plans 1: Diagnosis- Impaired Physical Mobility

    May be related to:

    • Bone loss
    • Pain
    • Fracture
    • Inability to bear weight

    Possibly evidenced by Spontaneous fracture.

    Desired Outcomes

    1. Patient will maintain functional mobility as long as possible within the limitations of the disease process.
    2. A patient will have a few, if any, complications related to immobility as the disease condition progresses.

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    Nursing Care Plans for Osteoporosis
    Nursing Care Plans for Osteoporosis

    Nursing Interventions

    Assess the patient’s functional ability for mobility and note changes.

    Rationale: Identifies problems and helps to establish a plan of care.

    Provide a range of motion exercises every shift. Encourage an active range of motion exercises.

    Rationale: Helps to prevent joint contractures and muscle atrophy.

    Reposition patient every 2 hours and prn.

    Rationale: Turning at regular intervals prevents skin breakdown from pressure injury.

    Apply trochanter rolls and pillows to maintain joint alignment.

    Rationale: Prevents musculoskeletal deformities.

    Assist patient with walking if at all possible, utilizing sufficient help. A one or two-person pivot transfer utilizing a transfer belt can be used if a patient has a weight-bearing ability.

    Rationale: Preserves patient’s muscle tone and helps prevent complications of immobility.

    Use mechanical lift for patients who cannot bear weight, and help them out of bed at least daily.

    Rationale: Provides change of scenery movement and encourages participation in activities.

    Avoid restraints as possible.

    Rationale: Inactivity created by the use of restraints may increase muscle weakness and poor balance.

    Instruct family regarding ROM exercises, methods of transferring patients from bed to wheelchair, and turning at routine intervals.

    Rationale: Prevents complications of immobility, and knowledge assists family members in being better prepared for home care.

    Assess the degree of immobility produced by injury or treatment and note the patient’s perception of immobility.

    Rationale: Patient may be restricted by self-view or self-perception out of proportion with actual physical limitations, requiring information or interventions to promote progress toward wellness.

    Encourage participation in diversional or recreational activities. Maintain stimulating environment (radio, TV, newspapers, personal possessions, pictures, clock, calendar, visits from family and friends).

    Rationale: Provides an opportunity to release energy, refocuses attention, enhances patient’s sense of self-control and self-worth, and aids in reducing social isolation.

    Instruct patient or assist with active and passive ROM exercises of affected and unaffected extremities.

    Rationale: Increases blood flow to muscles and bone to improve muscle tone, maintain joint mobility, prevent contractures or atrophy, and calcium resorption from disuse.

    Encourage the use of isometric exercises starting with the unaffected limb.

    Rationale: Isometrics contract muscles without bending joints or moving limbs and help maintain muscle strength and mass. Note: These exercises are contraindicated while acute bleeding and edema are present.

    Provide footboard, wrist splints, trochanter, or hand rolls as appropriate.

    Rationale: Useful in maintaining the functional position of extremities, hands, and feet and preventing complications (contractures, footdrop).

    Place in supine position periodically if possible, when traction is used to stabilize lower limb fractures.

    Rationale: Reduces risk of flexion contracture of hip.

    Instruct and encourage the use of trapeze and “postposition” for lower limb fractures.

    Rationale: Facilitates movement during hygiene or skincare and linen changes; reduces the discomfort of remaining flat in bed. “Post position” involves placing the uninjured foot flat on the bed with the knee bent while grasping the trapeze and lifting the body off the bed.

    Assist with self-care activities (bathing, shaving).

    Rationale: Improves muscle strength and circulation, enhances patient control in the situation and promotes self-directed wellness.

    Provide and assist with mobility by means of wheelchair, walker, crutches, canes as soon as possible. Instruct in the safe use of mobility aids.

    Rationale: Early mobility reduces complications of bed rest (phlebitis) and promotes healing and normalization of organ function. Learning the correct way to use aids is important to maintain optimal mobility and patient safety.

    Monitor blood pressure (BP) with a resumption of activity. Note reports of dizziness.

    Rationale: Postural hypotension is a common problem following prolonged bed rest and may require specific interventions (tilt table with gradual elevation to an upright position).

    Reposition periodically and encourage coughing and deep-breathing exercises.

    Rationale: Prevents or reduces the incidence of skin and respiratory complications (decubitus, atelectasis, pneumonia).

    Auscultate bowel sounds. Monitor elimination habits and provide for a regular bowel routine. Place on bedside commode, if feasible, or use fracture pan. Provide privacy.

    Rationale: Bed rest, use of analgesics, and changes in dietary habits can slow peristalsis and produce constipation. Nursing measures that facilitate elimination may prevent or limit complications. Fracture pan limits flexion of hips and lessens the pressure on lumbar region and lower extremity cast.

    Encourage increased fluid intake to 2000–3000 mL per day (within cardiac tolerance), including acid or ash juices.

    Rationale: Keeps the body well hydrated, decreasing the risk of urinary infection, stone formation, and constipation

    Provide a diet high in proteins, carbohydrates, vitamins, and minerals, limiting protein content until the first bowel movement.

    Rationale: In the presence of musculoskeletal injuries, nutrients required for healing are rapidly depleted, often resulting in a weight loss of as much as 20 to 30 lb during skeletal traction. This can profoundly affect muscle mass, tone, and strength. Note: Protein foods increase contents in the small bowel, resulting in gas formation and constipation. Therefore, gastrointestinal (GI) function should be fully restored before increased protein foods.

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    Nursing Care Plans for Osteoporosis
    Nursing Care Plans for Osteoporosis

    Nursing Care Plans2: Diagnosis- Imbalanced Nutrition

    May be related to inadequate calcium and vitamin D

    Possibly evidenced by:

    • Deformity
    • Kyphosis
    • Loss of height
    • Fractures

    Desired Outcomes

    • A patient will demonstrate adequate intake of calcium and vitamin D.

    Nursing Interventions

    Instruct recommended daily intake for calcium.

    Rationale: Premenopausal women (19-50 years old) need 1,500 mg of calcium daily. After menopause, the requirement is 1,200 mg daily. Getting enough vitamin D is equally important as getting enough calcium because vitamin D aids in absorbing calcium and improves muscle strength.

    Instruct on the importance of adequate exposure to sunlight to prevent vitamin D deficiency.

    Rationale: The patient should be outside for 15 minutes daily.

    If a patient has limited exposure to sunlight, encourage vitamin D supplementation.

    Rationale: Supplementation will ensure adequate vitamin D intake.

    Instruct patient to perform gentle exercises.

    Rationale: Exercise can help build strong bones and slow bone loss. Strength-training exercises should be combined with weight-bearing exercises. Strength training helps in bone and muscle strength.

    Limit alcohol intake

    Rationale: Consuming more than two alcoholic drinks a day may decrease bone formation and reduce the body’s ability to absorb calcium.

    Provide a balanced diet.

    Rationale: A diet high in nutrients that support skeletal metabolism: vitamin D, calcium, and protein.

    Limit caffeine intake

    Rationale: Limit the amount of caffeinated beverages to about two to three cups of coffee a day. As long as the diet contains adequate calcium, moderation in caffeine consumption won’t harm the patient. Note also caffeine-containing beverages like colas and some teas.

    Nursing Care Plans3: Diagnosis- Risk for Poisoning

    May be related to:

    • Drug toxicity, interactions with prescribed medications
    • Polypharmacy
    • Analgesic abuse
    • Physiologic changes associated with the aging process
    • Cognitive limitations

    Possibly evidenced by:

    • Usage of numerous medications
    • Adverse medicine effects
    • Drug toxicity levels
    • Inability to take medication correctly
    • Pain
    • Use of analgesic in doses sufficient to cause toxicity or interact with other medicines
    • Disorientation
    • Impaired vision
    • Multiple health care providers
    • Multiple pharmacies
    • Inability to understand drug interactions or usage

    Desired Outcomes

    1. A patient will
    2. accurately verbalize understanding of the need for one medical provider to control care.
    3. Patient and family will accurately verbalize understanding of all medications, their effects, side effects, and potential drug interactions.
    4. A patient and family will be compliant with providing a safe environment by keeping medications in a secure location.
    5. A patient will be able to accurately verbalize understanding of appropriate medication administration.
    6. The patient will exhibit no signs or symptoms of drug toxicity or suffer problems with drug interactions.

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    Nursing Care Plans for Osteoporosis
    Nursing Care Plans for Osteoporosis

    Nursing Interventions

    Evaluate the patient’s entire collection of medications, including over-the-counter drugs, vitamin and mineral supplements, herbal remedies, and dietary regimens.

    Rationale: Provides information as to what drugs and substances are being utilized concurrently and what drug interactions may occur with concurrent use, as well as with dietary consumption. Incorrect administration of medications to be taken on an empty stomach may cause inhibition of the appropriate action of the drug. Concurrent use of other medications can result in potentiation of action and create drug toxicity.

    Encourage patient and family to utilize one primary doctor to coordinate care.

    Rationale: Prevents utilization of several physicians who are unaware of each other’s treatment regimens and may duplicate medication or prescribe medication that may affect other drugs.

    Administer drugs as ordered, being cognizant of any interactions that might be possible.

    Rationale: Most of the time, elderly patients are on several medications, and the medicines used in the treatment of osteoporosis can interact with other drugs, causing either a decrease or potentiation of other actions.

    Provide instructions for the use of medications, quantity, frequency, number of doses and times, and under what conditions they are to be taken.

    Rationale: Facilitates understanding of medication regimen and provides reference material once a patient is discharged.

    Ensure medication labels are inscribed in large print with dosage instructions.

    Rationale: Prevents medication errors for patients with visual impairments.

    Assist patient and family to establish a system of following medication regimen accurately, such as the use of calendars, charts, medication boxes that are labeled for each day of the week, and so forth.

    Rationale: Assists in the reduction of medication errors and assists families to be involved in patient care.

    Discuss medications with a physician about the potential for using alternative long-acting drugs that require only one daily dosage.

    Rationale: May help to decrease the number of medications per day, simplify the patient’s regimen and facilitate compliance.

    Monitor lab work for toxicity levels, imbalances of electrolytes, and other factors pertinent to the patient’s medication profile.

    Rationale: Helps to reduce the risk of toxicity. Age-related changes in the body, such as renal or liver impairment, decrease the metabolism of drugs, so what may be considered a normal dosage may become toxic for patients with impaired function.

    Instruct patient/family regarding all medications, their use, effects and side-effects, and adverse reactions that should be reported to the physician.

    Rationale: Helps to promote knowledge and facilitates compliance.

    Instruct patient and family to store drugs in a secure area away from the bedside.

    Rationale: Elderly patients may have some memory loss, forgetting that they’ve already taken medicine and double the dose taken. Frequently, elderly patients keep their medications at their bedside table to prevent the need to get up at night.

    Instruct patient and family regarding interactions that may occur with concurrent medication usage.

    Rationale: SERMS decreases the action of anticoagulants and ampicillin; bisphosphonates can result in hypercalcemia; estrogens can decrease the action of anticoagulants and oral hypoglycemics, and other drugs; calcium can decrease the action of estrogens.

    Nursing Care Plans 4: Diagnosis-Deficient Knowledge

    It may be related to a lack of exposure to information regarding medications, dietary modifications, or a safe activity program.

    Possibly evidenced by:

    • Verbalization of the problem and request for information
    • Fear of further bone loss and fractures
    • Presence of preventable complication

    Desired Outcomes

    1. A patient will achieve increased knowledge and compliance with a medical regimen to minimize bone demineralization and injury.
    2. A patient will be compliant with medication and dietary instructions.
    3. The patient will be able to perform daily exercises within identified limitations and to prevent further bone loss or deterioration.
    4. The patient will exhibit no injury, fall, or trauma that might predispose to a fracture.
    5. A patient will be independent in performing ADLs with modifications.
    6. Patient and family will be able to accurately verbalize understanding of medications and methods of administration.

    Nursing Interventions

    Assess patient’s knowledge of disease, diet, medication, and exercise program to arrest the progression of bone deterioration.

    Rationale: Provides a basis for teaching and techniques to promote compliance. The disease is not usually detected until 24-40% of the calcium in bone is lost.

    Assess the patient’s understanding of osteoporosis.

    Rationale: Most individuals with osteoporosis are not diagnosed until an acute fracture occurs.

    Provide support for body image and lifestyle changes.

    Rationale: Assists patient to cope with chronicity of the disease and potential fractures causing pain and immobility.

    Assist in planning exercise program according to capabilities; to avoid flexion of the spine and wear a corset if appropriate (walking is preferred to jogging).

    Rationale: Exercise will strengthen the bone. Vertebral collapse is common, and a corset provides support.

    Teach the patient about nutrition and calcium intake.

    Rationale: Adequate calcium helps to prevent osteoporosis in women with a small frame, increased age, Asians, and Caucasians.

    Teach the patient that calcium carbonate is the most effective form of calcium.

    Rationale: Calcium carbonate is best absorbed in an acidic stomach. Adults 19-50 years of age should take 1000mg of elemental calcium daily, and individuals 51 years above should take 1,200 mg daily.

    Instruct patient that vitamin D supplementation is indicated for patients with limited sun exposure.

    Rationale: Vitamin D supplements are needed for people living in the extreme northern or southern latitudes with limited sun exposure. Recommended vitamin D is 200 IU through age 50; 400 IU for 51-70-year-olds, and 600 IU for >70 yr.

    Instruct patient in methods to perform activities of daily living and to avoid lifting, to bend, or carrying heavy objects.

    Rationale: Prevents injury that can occur with osteoporosis with minimal trauma.

    Instruct patient and family in administration of calcium, vitamin D, estrogens, and other drug therapy for osteoporosis.

    Rationale: Provides replacement of calcium and helps to decrease bone loss.

    Instruct patient about medication for osteoporosis, adverse effects, administration, and need for follow-up tests.

    Rationale: An informed patient is likely to adhere to the medication regimen and report adverse effects.

    Instruct patient and family regarding potential referrals to therapy as warranted.

    Rationale: May help to provide exercise and the development of an activity program to maintain the bone condition and encourage independence in ADLs.

    Teach patient and family regarding the use of assistive devices and safety precautions that are available to maintain mobility.

    Rationale: Prevents further trauma or fractures from falls resulting from lack of support.

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    Nursing Care Plans for Osteoporosis
    Nursing Care Plans for Osteoporosis

    Related FAQs

    1. What is the main cause of osteoporosis?

    A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures. Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.

    2. Can a person be cured of osteoporosis?

    The short answer is no, osteoporosis cannot be completely reversed and is not considered curable, but there are a number of health and lifestyle adjustments you can make to improve bone loss. Your provider may also prescribe you medications to help rebuild and slow down bone loss.

    3. What is the best treatment for osteoporosis?

    Bisphosphonates are usually the first choice for osteoporosis treatment. These include: Alendronate (Fosamax), a weekly pill. Risedronate (Actonel), a weekly or monthly pill.

    4. What is the life expectancy of a person with osteoporosis?

    This excess risk is more pronounced in the first few years on treatment. The average life expectancy of osteoporosis patients is in excess of 15 years in women younger than 75 years and in men younger than 60 years, highlighting the importance of developing tools for long-term management.

    Read More:

    https://customnursingassignments.com/nursing-care-plans-for-osteoarthritis/
    https://customnursingassignments.com/nursing-care-plans-for-obesity/

  • Nursing Care Plans for Osteoarthritis – Best Care Plans(2022)

    This article discusses Nursing Care Plans for Osteoarthritis plus its causes, symptoms, preventions, treatments, and interventions.

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    Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

    Introduction

    Osteoarthritis (OA) is the most common chronic joint condition. Osteoarthritis is also called wear-and-tear arthritis, degenerative arthritis, and degenerative joint disease.

    A joint is where two bones come together. Cartilage is the protective tissue that covers the ends of the bones. With osteoarthritis, this cartilage breaks down, causing the bones within the joint to rub together. This can cause pain, stiffness, and other symptoms.

    Osteoarthritis can occur in any joint. However, the most commonly affected body areas include the: hands, fingers, shoulder, spine, typically at the neck or lower back, hips, and knees. Osteoarthritis occurs most often in older people, although it can occur in adults of any age.

    Symptoms of Osteoarthritis

    The most common symptoms of Osteoarthritis include:

    • Joint pain
    • Stiffness in the joint
    • Loss of flexibility and reduced range of motion
    • Tenderness or discomfort when pressing on the affected areas with fingers
    • Inflammation
    • Crepitus, or grating, crackling, clicking, or popping sounds when you move joints.
    • Bone spurs, or extra lumps of bone, which are typically painless

    As Osteoarthritis becomes more advanced, the pain associated with it may become more intense. Over time, swelling in the joint and surrounding area may also occur. Learn how to recognize the early symptoms of Osteoarthritis, which can help you to manage the condition better.

    Causes of Osteoarthritis

    Osteoarthritis is caused by joint damage. This damage can have a cumulative effect over time, which is why age is one of the main causes of joint damage leading to Osteoarthritis. The older you are, the more repetitive stress you’ve had on your joints.

    Other causes of joint damage include:

    • Past injury, such as torn cartilage, dislocated joints, or ligament injuries
    • Joint malformation
    • Obesity
    • Poor posture

    Risk Factors of Osteoarthritis.

    1. Having family with the condition, particularly parents or siblings
    2. Gender, with women having higher rates of osteoarthritis than men
    3. Being at least 50 years old, according to the arthritis foundation
    4. Having undergone menopause
    5. Having an occupation that involves kneeling, climbing, heavy lifting, or similar actions
    6. A history of injury
    7. Being overweight or having obesity
    8. Poor posture
    9. Having another medical condition that affects your joint health, such as diabetes or a different type of arthritis
    10. Having osteoarthritis in one part of your body also increases the risk of developing osteoarthritis in other parts of the body.

    Osteoarthritis Treatment

    Osteoarthritis treatment is centered upon symptom management. The type of treatment that will help you the most will largely depend on the severity of your symptoms and their location.

    Often, over-the-counter (OTC) medications, lifestyle changes, and home remedies will be enough to provide you with relief from pain, stiffness, and swelling.

    Medications

    Several different types of Osteoarthritis medications can help provide relief. They include:

    Oral pain relievers. Acetaminophen (Tylenol) and other pain relievers help reduce pain but not swelling.

    Topical pain relievers. These OTC products are available as creams, gels, and patches. They help numb the joint area and provide pain relief, especially for mild arthritis pain.

    Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) help reduce swelling as well as pain.

    Corticosteroids. These prescription medications are available in oral form. They may also be given by injection directly into a joint. Examples include cortisone and triamcinolone acetonide (Kenalog-40, Zilretta).

    Weight management

    Being overweight can put a strain on your joints and cause pain. Shedding some pounds helps relieve this pressure and reduces pain. A moderate weight can also lower your risk of other health problems, such as diabetes and heart disease.

    Adequate sleep

    Resting the muscles can lower swelling and inflammation.

    Exercise

    Physical activity strengthens the muscles around the joints and may help relieve stiffness. A patient should aim for at least 20 to 30 minutes of physical movement every other day. They should choose gentle, low-impact activities, such as walking or swimming. Tai chi and yoga can also improve joint flexibility and help with pain management.

    Complications of osteoarthritis

    It’s well known that arthritis, including Osteoarthritis, can cause physical complications. Osteoarthritis can cause emotional complications too.

    Physical complications include:

    • Poor sleep
    • Weight gain as a result of pain or limited mobility
    • Osteonecrosis, or bone death
    • Erosion of the ligaments and tendons
    • Hairline (stress) fractures
    • Hemarthrosis, or bleeding near the joints
    • Emotional complications include anxiety and depression brought on by the loss of function. Discover other complications of osteoarthritis.

    Diagnosis of Osteoarthritis

    Osteoarthritis is a disease that often develops slowly. It can be hard to diagnose until it starts to cause painful or debilitating symptoms. Early Osteoarthritis is often diagnosed after an accident or other incident that causes a fracture requiring an X-ray.

    In addition to X-rays, a doctor may use an MRI to diagnose Osteoarthritis. This imaging test uses radio waves and a magnetic field to create bone and soft tissue images.

    Other diagnostic tests include a blood test to rule out other conditions that cause joint pain, such as RA. A synovial (joint) fluid analysis can also help determine whether gout or infection is the underlying cause of your inflammation.

    Types of Osteoarthritis

    Osteoarthritis of the hands

    Osteoarthritis can affect one or several areas of your hands. These areas often include the following:

    • Distal interphalangeal joint, which is the joint closest to the nail
    • Proximal interphalangeal joint, which is the middle joint of each finger
    • Joint connecting the thumb and the wrist
    • Wrist

    The joints that are affected largely determine the symptoms that occur. These symptoms often include:

    1. Stiffness
    2. Pain
    3. Swelling
    4. Redness
    5. Weakness
    6. Trouble moving your fingers
    7. Reduced range of motion
    8. Crepitus when you move your fingers
    9. Trouble gripping or holding onto objects

    Osteoarthritis of the Hips

    Osteoarthritis can occur in one or both hips. Hip Osteoarthritis is a slowly degenerative condition. Many people find that they’re able to manage their symptoms for many years by using medications, exercise, and physical therapy. Supports, such as canes, can also help.

    If the condition worsens, steroid injections, other medications, or surgery can help provide relief. Alternative therapies can also help, and new technologies are on the horizon. Here’s what you need to know about the many treatment options for hip Osteoarthritis.

    Osteoarthritis of the knees

    Like hip Osteoarthritis, knee Osteoarthritis can occur in one or both knees. Age, genetics, and knee injury may all play a role in knee Osteoarthritis.

    Athletes who concentrate solely on one sport that involves extensive, repetitive motion, such as running or tennis, may be at increased risk of Osteoarthritis. Likewise, if you pursue only one type of physical activity, this may overuse some muscles and underuse others.

    Overuse causes weakness and instability in the knee joint. Varying your activities helps to work for different muscle groups, allowing all the muscles around your knee to be strengthened.

    Treatment for knee Osteoarthritis depends on the stage of the condition.

    Cervical osteoarthritis

    Cervical Osteoarthritis is also referred to as cervical spondylosis or neck Osteoarthritis. According to the American Academy of Orthopaedic Surgeons, it’s an age-related condition that affects more than 85 percent of people over 60 years old.

    The cervical spine is located in the neck and contains facet joints. These joints help to maintain flexibility in the spine, allowing for a full range of motion when the cartilage around the facet joints starts to wear away, cervical Osteoarthritis results.

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    Nursing Care Plans for Osteoarthritis
    Nursing Care Plans for Osteoarthritis

    Cervical Osteoarthritis doesn’t always cause symptoms. If it does, symptoms can range from mild to severe and include:

    • Pain in your shoulder blade, down your arm, or in your fingers
    • Muscle weakness
    • Stiffness in your neck
    • Headache, mostly in the back of your head
    • Tingling or numbness down your arms or legs

    Occasionally, more serious symptoms can occur, such as the loss of bladder control, bowel control, or balance. If you have these symptoms, get immediate medical help. Check out the risk factors and treatment options for cervical Osteoarthritis.

    Osteoarthritis of the Spine

    If you have back pain, it may indicate that you have spinal Osteoarthritis. This condition affects the facet joints located throughout the spine.

    Age and trauma to the spine are both potential risk factors for spinal Osteoarthritis. A person who is overweight or whose job requires squatting and sitting may also be at increased risk.

    Spinal Osteoarthritis’s symptoms can vary in severity. They include:

    • Stiffness or tenderness in the joints in your back
    • Weakness, numbness, or tingling in your arms or legs
    • Reduced range of motion

    It’s important to pay attention to these symptoms. Without treatment, spinal Osteoarthritis can worsen, causing more severe symptoms and disability. Get the facts on Osteoarthritis of the spine.

    Nursing Care Plans for Osteoarthritis Based on Diagnosis

    Nursing Care Plan 1: Diagnosis – Deficient Knowledge 

    It is related new diagnosis of Osteoarthritis, as evidenced by the patient’s verbalization of “I want to know more how to manage my illness.”

    Desired Outcome

    At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of their acute pain and its management.

    InterventionsRationales
    Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., denial of diagnosis or poor lifestyle habits).To address the patient’s cognition and mental status towards disease management and to help the patient overcome blocks to learning.
    Explain what their pain management program entails (e.g., medications, relaxation techniques, diet, and related physiotherapy or exercises). Avoid using medical jargon and explain in layman’s terms.To provide information on their pain management program for OA.
    Inform the patient of the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) to treat acute pain. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
    Educate the patient about non-pharmacological methods for acute pain such as imagery, distraction techniques, recommended exercises, and relaxation techniques.To reduce stress and to promote optimal pain relief without too much dependence on pharmacological means.
    If the patient is for surgery, explain the surgical procedure related to osteoarthritis to the patient and carer.The doctor may recommend surgery to resolve unbearable joint pain due to OA.

    Nursing Care Plan 2: Diagnosis – Activity intolerance

    It is related to joint inflammation and pain secondary to osteoarthritis, as evidenced by a pain score of 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness, and generalized weakness.

    Desired Outcome

    The patient will demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.

    InterventionsRationales
    Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that they used to do or want to try.To create a baseline of activity levels and mental status related to chronic pain, fatigue, and activity intolerance.
    Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent triggering pain by allowing the patient to pace activity versus rest.
    Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
    Refer the patient to physiotherapy / occupational therapy team as required.To provide more specialized care for the patient in terms of helping them build confidence in increasing daily physical activity.
    If the patient is overweight or obese, create a weight loss plan with the patient, career, physiotherapy/occupational therapy, doctors, and dietitian.Obesity is one of the most common risk factors for osteoarthritis, thus, a crucial part of the treatment is to lose weight through diet and exercise.

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    Nursing Care Plans for Osteoarthritis
    Nursing Care Plans for Osteoarthritis

    Related FAQs

    1. What are nursing interventions for osteoarthritis?

    The major goals of the nursing intervention are pain management and optimal functional ability. Weight loss. Weight loss is an important approach to pain and disability improvement. Assistive devices.

    2. What are the 4 main parts of a nursing care plan?

    Nursing care plan formats are usually categorized or organized into four columns: (1) nursing diagnoses, (2) desired outcomes and goals, (3) nursing interventions, and (4) evaluation.

    3. How do you diagnose osteoarthritis?

    X-rays of the affected joints are the main way osteoarthritis is identified. The common X-ray findings of osteoarthritis include loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.

    4. What is the most effective treatment for osteoarthritis?

    Pills. NSAIDs are the most effective oral medicines for OA. They include ibuprofen (Motrin, Advil) naproxen (Aleve) and diclofenac (Voltaren, others). All work by blocking enzymes that cause pain and swelling.

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  • Nursing Care Plans for Obesity – Best Nursing Care Plans(2022)

    This article discusses Nursing Care Plans for Obesity plus its causes, symptoms, preventions, treatments, and interventions.

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    Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

    Introduction

    Obesity is defined as a complex, chronic disorder of having an excessive fat accumulation of approximately 20% above the baseline weight associated with gender, age, and height.

    Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure, and certain cancers.

    There are many reasons why some people have difficulty losing weight. Usually, obesity results from inherited physiological and environmental factors, combined with diet, physical activity, and exercise choices.

    A healthier diet, increased physical activity, and behaviour changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity.

    Symptoms of Obesity

    Body mass index (BMI) is often used to diagnose obesity. To calculate BMI, multiply weight in pounds by 703, divide by height in inches, and then divide again by height in inches. Or divide weight in kilograms by height in meters squared.

    BMI   Weight status

    Below 18.5    Underweight

    18.5-24.9      Normal

    25.0-29.9     Overweight

    30.0 and higher      Obesity

    For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn’t directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don’t have excess body fat.

    Many doctors also measure a person’s waist circumference to help guide treatment decisions. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters) and in women with a waist measurement over 35 inches (89 centimeters).

    Causes of Obesity

    Although there are genetic, behavioral, metabolic, and hormonal influences on body weight, obesity occurs when people take in more calories than they burn through normal daily activities and exercise. The body stores these excess calories as fat.

    In the United States, most people’s diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

    Many people who live in Western countries now have much less physically demanding jobs, so they don’t tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping, and drive-through banks.

    Risk Factors of Obesity

    Obesity usually results from a combination of causes and contributing factors:

    Family inheritance and influences

    The genes inherited from parents may affect the amount of body fat stored and distributed that fat. Genetics may also play a role in how efficiently the body converts food into energy, how the body regulates appetite, and how the body burns calories during exercise.

    Obesity tends to run in families. That’s not just because of the genes they share. Family members also tend to share similar eating and activity habits.

    Lifestyle choices

    Unhealthy diet. A diet that’s high in calories lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.

    Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages can contribute to significant weight gain, such as sugared soft drinks.

    Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet, and phone screens is a passive activity. The number of hours spent in front of a screen is highly associated with weight gain.

    Certain diseases and medications

    In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome, and other conditions. Medical problems, such as arthritis, can also lead to decreased activity, resulting in weight gain.

    Some medications can lead to weight gain if you don’t compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids, and beta-blockers.

    Social and economic issues

    Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don’t have safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have access to healthier foods. In addition, the people you spend time with may influence your weight — you’re more likely to develop obesity if you have friends or relatives with obesity.

    Age

    Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. Generally, lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.

    Other factors

    Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.

    Quitting smoking. Quitting smoking is often associated with weight gain. It can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. However, in the long run, quitting smoking is still a greater benefit to your health than continuing to smoke. Your doctor can help you prevent weight gain after quitting smoking.

    Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase appetite. You may also crave foods high in calories and carbohydrates, contributing to weight gain.

    Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food when experiencing stressful situations.

    Microbiome. Your gut bacteria are affected by what you eat and may contribute to weight gain or difficulty losing weight.

    Complications of Obesity

    People with obesity are more likely to develop several potentially serious health problems, including:

    Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes.

    Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.

    Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney, and prostate.

    Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease, and liver problems.

    Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.

    Osteoarthritis. Obesity increases the stress placed on weight-bearing joints and promotes inflammation within the body. These factors may lead to complications such as osteoarthritis.

    Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019 (COVID-19). People who have severe cases of COVID-19 may require treatment in intensive care units or even mechanical assistance to breathe.

    Quality of life

    Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

    Other weight-related issues that may affect your quality of life include:

    • Depression
    • Disability
    • Shame and guilt
    • Social isolation
    • Lower work achievement

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    Nursing Care Plans for Obesity
    Nursing Care Plans for Obesity

    Diagnosis of Obesity

    • Measurement of body mass index
    • Review the patient’s medical and family history – to determine the cause of obesity, whether it is organic (presence of chromosomal aberrations, insulin resistance, etc.)
    • Physical examination and assessment – the attending physician may implement measurements in the waist circumference to aid with diagnosis. The patient’s status is usually included (e.g., blood pressure, heart rate, and temperature).
    • Blood tests to evaluate cholesterol or triglyceride level.

    Nursing Care Plans for Obesity Based on Diagnosis

    Nursing Care Plan 1: Diagnosis – Imbalanced Nutrition: More Than Body Requirements

    May be related to:

    • Food intake that exceeds body needs
    • Psychosocial factors
    • Socioeconomic status

    Possibly evidenced by:

    • Weight of 20% or more over optimum body weight; excess body fat by skinfold/other measurements
    • Reported/observed dysfunctional eating patterns, intake more than body requirements

    Desired Outcomes

    • Identify inappropriate behaviors and consequences associated with overeating or weight gain.
    • Demonstrate change in eating patterns and involvement in an individual exercise program.
    • Display weight loss with optimal maintenance of health.
    Nursing InterventionsRationale
    Review individual causes for obesity (organic or nonorganic).Identifies and influences the choice of some interventions.
    Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits).Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring a change or a base on which to tailor the dietary program.
    Explore and discuss emotions and events associated with eating.Helps identify when a patient is eating to satisfy an emotional need rather than physiological hunger.
    Formulate an eating plan with the patient, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, energy, and nutrient requirements. Determine which diets and strategies have been used, results, individual frustrations, and factors interfering with success.Although there is no basis for recommending one diet over another, a good reducing diet should contain foods from all basic food groups focusing on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. Keeping the plan as similar to the patient’s usual eating pattern is helpful as possible. A plan developed with and agreed to by the patient is more likely to be successful.
    Emphasize the importance of avoiding fad diets.Elimination of needed components can lead to metabolic imbalances like excessive reduction of carbohydrates can lead to fatigue, headache, instability and weakness, and metabolic acidosis (ketosis), interfering with the effectiveness of the weight loss program.
    Discuss the need to give self permission to include desired or craved food items in the dietary plan.Denying self by excluding desired or favorite foods result in the sense of deprivation and feelings of guilt and failure when an individual “succumbs to temptation.” These feelings can sabotage weight loss.
    Be alert to binge eating and develop strategies for dealing with these episodes (substituting other actions for eating).The patient who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts.
    Identify realistic increment goals for weekly weight loss.Reasonable weight loss (1–2 lb per wk) results in more lasting effects. Excessive and rapid loss may result in fatigue and irritability and ultimately lead to failure to meet weight loss goals. Motivation is more easily sustained by meeting “stair-step” goals.
    Weigh periodically as individually indicated, and obtain appropriate body measurements.Provides information about the effectiveness of the therapeutic regimen and visual evidence of the success of the patient’s efforts. (During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.)
    Determine current activity levels and plan a progressive exercise program (walking) tailored to the individual’s goals and choice.Exercise furthers weight loss by reducing appetite; increasing energy; toning muscles; and enhancing cardiac fitness, sense of well-being, and accomplishment. Commitment on the part of the patient enables the setting of more realistic goals and adherence to the plan.
    Develop an appetite reeducation plan with the patient.Signals of hunger and fullness often are not recognized, have become distorted, or are ignored.
    Emphasize the importance of avoiding tension at mealtimes and not eating too quickly.Reducing tension provides a more relaxed eating atmosphere and encourages more leisurely eating patterns. This is important because a period of time is required for the appestat mechanism to know the stomach is full.
    Encourage the patient to eat only at a table or designated eating place and to avoid standing while eating.Techniques that modify the behavior may help avoid diet failure.
    Discuss restriction of salt intake and diuretic drugs if used.Water retention may be a problem because of increased fluid intake and fat metabolism.
    Reassess calorie requirements every 2–4 wk; provide additional support when plateaus occur.Changes in weight and exercise necessitate changes in plan. As weight is lost, changes in metabolism occur, resulting in plateaus when weight remains stable for periods of time. This can create distrust and lead to accusations of “cheating” on caloric intake, which is not helpful. A patient may need additional support at this time.
    Consult with a dietitian to determine caloric and nutrient requirements for individuals’ weight loss.Several different formulas can calculate individual intake, but weight reduction is based on the basal caloric requirement for 24 hr, depending on the patient’s sex, age, current and desired weight, and length of time estimated to achieve the desired weight. Note: Standard tables are subject to error when applied to individual situations, and circadian rhythms and lifestyle patterns need to be considered.
    Provide medications as indicated:
    Appetite-suppressant drugs like diethylpropion (Tenuate), mazindol (Sanorex), Sibutramine (Meridia);May be used with caution and supervision at the beginning of a weight loss program to support a patient during the stress of behavioral and lifestyle changes. They are only effective for a few weeks and may cause addiction problems in some people.
    Hormonal therapy like thyroid (Euthroid), levothyroxine (Synthroid);May be necessary when hypothyroidism is present. When no deficiency is present, replacement therapy is not helpful and may actually be harmful. Note: Other hormonal treatments, such as human chorionic gonadotropin (HCG), although widely publicized, have no documented evidence of value.
    Orlistat (Xenical);Lipase inhibitor blocks absorption of approximately 30% of dietary fat. Facilitates weight loss and maintenance when used in conjunction with a reduced-calorie diet. It also reduces the risk of regaining after weight loss.
    Vitamin, mineral supplements.Obese individuals have large fuel reserves but are often deficient in vitamins and minerals. Note: Use of Xenical inhibits the absorption of water-soluble vitamins and beta-carotene. Vitamin supplements should be given at least 2 hr before or after Xenical.
    Hospitalize for fasting regimen and stabilization of medical problems, when indicated.Aggressive therapy and support may be necessary to initiate weight loss, although fasting is not generally a treatment of choice. A patient can be monitored more effectively in a controlled setting to minimize complications such as postural hypotension, anemia, cardiac irregularities, and decreased uric acid excretion with hyperuricemia.
    Prepare for surgical interventions (gastric partitioning or bypass) as indicated.These interventions may be necessary to help the patient lose weight when obesity is life-threatening.

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    Nursing Care Plans for Obesity
    Nursing Care Plans for Obesity

    Nursing Care Plan 2: Diagnosis – Disturbed Body Image

    May be related to:

    • Biophysical/psychosocial factors such as patient’s view of self (slimness is valued in this society, and mixed messages are received when thinness is stressed)
    • Family/subculture encouragement of overeating
    • Control, sex, and love issues

    Possibly evidenced by:

    • Verbalization of negative feelings about the body (mental image often does not match physical reality)
    • Fear of rejection/reaction by others
    • Feelings of hopelessness/powerlessness
    • Preoccupation with change (attempts to lose weight)
    • Lack of follow-through with diet plan
    • Verbalization of powerlessness to change eating habits

    Desired Outcomes

    • Verbalize a more realistic self-image.
    • Demonstrate some acceptance of self as is, rather than an idealized image.
    • Seek information and actively pursue appropriate weight loss.
    • Acknowledge self as an individual who has responsibility for self.
    Nursing InterventionsRationale
    Determine the patient’s view of being fat and what it does for the individual.The mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications (compensation for lack of love and nurturing or defense against intimacy).
    Provide privacy during care activities.An individual usually is sensitive and self-conscious about their body.
    Promote open communication avoiding criticism and judgment about patient’s behavior.Supports patient’s own responsibility for weight loss, enhances the sense of control, and promotes the willingness to discuss difficulties and setbacks and problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.
    Outline and clearly state the responsibilities of patient and nurse.It is helpful for each individual to understand the area of their own responsibility in the program so that misinformation does not arise.
    Graph weight on a weekly basis.Provides ongoing visual evidence of weight changes (reality orientation).
    Encourage the patient to use imagery to visualize themself at the desired weight and to practice handling new behaviors.Mental rehearsal is very useful in helping the patient plan for and deals with anticipated changes in self-image or occasions that may arise (family gatherings, special dinners) where constant decisions about eating many foods will occur.
    Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.Enhances feelings of self-esteem; promotes improved body image.
    Encourage buying clothes instead of food treats as a reward for weight loss.Properly fitting clothes enhance the body image as small losses are made, and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.
    Suggest the patient dispose of “fat clothes” as weight loss occurs.Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that weight loss will not occur and be maintained.
    Have the patient recall food-related coping patterns in the family of origin and explore how these may affect the current situation.Parents act as role models for the child. Maladaptive coping patterns (overeating) are learned within the family system and are supported through positive reinforcement. The parent may substitute food for affection and love, and eating is associated with a feeling of satisfaction, becoming the primary defense.
    Determine relationship history and the possibility of sexual abuse.May contribute to current issues of self-esteem and patterns of coping.
    Identify patient’s motivation for weight loss and assist with goal setting.The individual may harbor a repressed feeling of hostility, which may be expressed inward on the self. Because of a poor self-concept, the person often has difficulty with relationships. Note: When losing weight for someone else, the patient is less likely to be successful and maintain weight loss.
    Be alert to the patient and SO’s myths about weight and weight loss.Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will pursue me or rape me”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.
    Assist patient in identifying feelings that lead to compulsive eating. Encourage journaling.Awareness of emotions that lead to overeating can be the first step in behavior change (people often eat because of depression, anger, and guilt).
    Develop strategies for doing something besides eating for dealing with these feelings, such as talking with a friend.Replacing eating with other activities helps retrain old patterns and establish new ways to deal with feelings.
    Help staff be aware of and deal with their own feelings when caring for a patient.Judgmental attitudes, feelings of disgust, anger, and weariness can interfere with care and be transmitted to the patient, reinforcing negative self-concept and image.
    Refer to community support and therapy group.Support groups can provide companionship, enhance motivation, decrease loneliness and social ostracism, and give practical solutions to common problems. Group therapy can be helpful in dealing with underlying psychological concerns.

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    Nursing Care Plans for Obesity
    Nursing Care Plans for Obesity

    Nursing Care Plan 3: Diagnosis – Impaired Social Interaction

    May be related to:

    • Verbalized or observed discomfort in social situations
    • Self-concept disturbance

    Possibly evidenced by

    • Reluctance to participate in social gatherings
    • Verbalization of a sense of discomfort with others

    Desired Outcomes

    • Verbalize awareness of feelings that lead to poor social interactions.
    • Become involved in achieving positive changes in social behaviors and interpersonal relationships.
    Nursing InterventionsRationale
    Review family patterns of relating and social behaviors.Social interaction is primarily learned within the family of origin. When inadequate patterns are identified, actions for change can be instituted.
    Encourage the patient to express feelings and perceptions of problems.Helps identify and clarify reasons for difficulties in interacting with others (may feel unloved and unlovable or insecure about sexuality).
    Assess the patient’s use of coping skills and defense mechanisms.May have coping skills that will be useful in the process of weight loss. Defense mechanisms used to protect the individual may contribute to feelings of aloneness and isolation.
    Have the patient list behaviors that cause discomfort.Identifies specific concerns and suggests actions that can be taken to effect change.
    Involve in role-playing new ways to deal with identified behaviors and situations.Practicing these new behaviors enables the individual to become comfortable with them in a safe situation.
    Discuss negative self-concepts and self-talk, “No one wants to be with a fat person,” “Who would be interested in talking to me?”It may be impeding positive social interactions.
    Encourage the use of positive self-talk such as telling one-self “I am OK,” or “I can enjoy social activities and do not need to be controlled by what others think or say.”Positive strategies enhance feelings of comfort and support efforts for change.
    Refer for ongoing family or individual therapy as indicated.Patient benefits from the involvement. To provide support and encouragement.

    Related FAQs

    1. What is obesity related to in a nursing diagnosis?

    Obesity Nursing Diagnosis: Imbalanced Nutrition: More Than Body Requirements related to excess food intake secondary to obesity, as evidenced by excess body weight of about 20%, excess body fat by skin folds, excess food intake more than body requirements, and impaired eating pattern.

    2. What is the nursing management of obesity?

    Management should include dietary modification, behavior interventions, medications, and surgical intervention if needed. Dietary modification should be individualized with close monitoring of regular weight loss. Low-calorie diets are recommended. Low calorie could be carbohydrate or fat restricted.

    3. What are the 4 main parts of a nursing care plan?

    Nursing care plan formats are usually categorized or organized into four columns: (1) nursing diagnoses, (2) desired outcomes and goals, (3) nursing interventions, and (4) evaluation

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    Nursing Care Plans for Obesity
    Nursing Care Plans for Obesity

    4. How can nurses help with childhood obesity?

    Nurses can help parents and children by providing nutritional advice and, through weight management programmes, offer strategies for decreasing caloric intake and increasing physical activity.

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  • Nursing Care Plans for Colostomy – Best Nursing Care Plans (2022)

    This article discusses Nursing Care Plans for Colostomy plus its causes, symptoms, preventions, treatments, and interventions.

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    Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

    Introduction

    A colostomy is a surgical surgery that involves the removal of one end of the large intestine through the abdominal wall. One end of the colon is diverted via an incision in the abdominal wall to establish a stoma. A stoma is a skin opening to which a feces-collecting pouch is attached. Whether temporary or permanent, people who have colostomies have pouches on their sides where feces gather and may be conveniently disposed of.

    Colostomies aren’t often permanent, especially in children who have been born with congenital abnormalities.

    A colostomy can result from one of several procedures to correct problems with the lower digestive tract. Ileostomy and urostomy are two other types of “ostomies.” An ileostomy is a diversion of the small intestine’s bottom. A urostomy is a diversion of the tubes that carry urine out of the bladder.

    Colostomy

    This procedure is usually performed for lesions in the large intestine caused by cancer, diverticulitis, or obstruction of the large intestine in an area close to the rectum.

    Reasons for Colostomy

    The colostomy is done in the following situations:

    A blockage of the intestines may be due to a tumor or congenital disorder.

    Injury of the intestine that does not heal (intestinal ulcer) after blood supply is restored.

    A severe infection leads to gangrene or the death of some part of the intestine.

    Sigmoid colon cancer requires the removal of a large portion of the colon and rectum.

    Surgery to control anus bleeding resulting from fistula in inflammatory bowel disease.

    Surgical procedures are done around the anus, resulting in injury or damage to the colon.

    Conditions that require removal of rectum and anus such as ulcerative colitis, proctitis, and colon cancer

    Risks of Colostomy

    Organ damage is among the other risks of colostomy. Injury can affect the small intestines, colon, anus, and rectum, which result in incontinence or constant leakage of stool out from a new opening around the anus. The stool may have a foul odor that causes embarrassment to the patient.

    Breaking open of wounds around the anus, requiring re-surgery to close the opening.

    A hernia may occur at the opening of the colon, causing the anus to touch the ground nearly.

    Constipation.

    Gas in the colon or rectum causes diarrhea.

    Risk of impaired skin integrity, e.g., pressure ulcer.

    Infections around the wound either from fecal matter or blood.

    Internal bleeding from the damaged intestine during surgery.

    Pain around the anus or abdomen after the operation may be treated by administering pain-relieving drugs.

    Tear at the stoma site due to local inflammation, impingement on the wound by stool, incomplete skin closure, and external pressure from a bag/stool.

    Infections because of contamination of the stoma tract with stool, increased secretion in the wound at the stoma site, and opening from the intestine to the skin surface.

    Types of colostomy

    Temporary colostomy: A temporary colostomy is performed to divert the fecal stream from the distal colon, which may be obstructed by tumor inflammation, or requires being “put-to-test” because of anastomosis or a pouch procedure. A temporary colostomy may be created in the transverse colon or sigmoid colon.

    Permanent colostomy: A permanent colostomy is performed to treat malignancies of the colon. Other indications may include irrevocable rectal strictures, incontinence of bowel, or inflammatory bowel disease. A permanent colostomy can be fashioned similar to a temporary colostomy but is often an end.

    Position

    Supine, with arms extended on arm boards.

    Incision Site

    Dependent on the segment of the colon to be used.

    Packs/ Drapes

    Laparotomy pack colostomy

    Four folded towels

    Transverse Lap sheet

    Minor pack

    Instrumentation

    Major Lap tray

    Intestinal tray

    Closing tray

    Internal surgical staples

    Supplies/ Equipments

    Basin set

    Blades

    Needle counter

    Penrose drain

    Internal stapling instruments

    Glass rod and tubing with a colostomy pouch

    Solutions – saline, water

    Sutures

    Medications

    Dressings

    Procedure

    The abdomen is opened in the usual manner, and the segment of the colon is mobilized.

    The colon can be brought out through the main incision or through an adjacent site from which a disk of skin and subcutaneous tissue has been excised.

    The underlying rectus fascia muscle and peritoneal layers are incised to accommodate the colon. The appropriate segment is excised between two atraumatic (intestinal) clamps or the internal stapling instrument used to prepare and create the stoma.

    A rod or bridge may be placed under the colon to avoid retraction in a loop colostomy.

    The abdomen is rinsed with warm saline and routinely closed layers.

    A colostomy pouch is applied over the stoma.

    Methods of performing Colostomy

    Loop Colostomy

    When the colostomy is only temporary, this method is frequently used. This is due to the procedure’s ease of reversibility.

    A hole in the abdominal wall above the pelvic bone is created on one or both sides. The intestine is fed through this incision, and a bag is attached to collect feces, which is usually flushed down the toilet.

    Thorough colostomy (also called end stoma)

    This entails creating a hole near the belly button in the skin covering your abdomen. A surgeon will then construct a stoma or aperture by bringing a loop of intestine out through the hole. An ostomy is a name for the opening. Your healthcare professional might refer to this as a stoma ileostomy if no section of your colon was removed.

    Surgical staples are used to suture a loop colostomy in place. Surgical tape or an ostomy pouch, a tiny adhesive bandage, keeps the colostomy in place.

    Colostomies are divided into two categories: side and end. Both cause the same problems for the patient, but they can be treated at home using unique dressing materials.

    The treatment of a colostomy is a delicate procedure that necessitates a great deal of patience on the part of the patient.

    Dressing sheets, adhesive strips, and elastic bandages are frequently required to keep excrement away from the skin. At the same time, the opening heals and does not become infected with hazardous bacteria that can generate an odor.

    A stoma is an opening in the abdomen through which feces enter into a bag attached to the abdominal wall, and ostomates are people who have one.

    After surgery, the protruding part of your intestine or colon that exits out from your body is called a stoma. The stoma may turn pink or scarlet over time, and a rigid ring of flesh called granulation tissue will form around it. An ostomy is a small opening under your skin used to remove stool from your body.

    After surgery, your bowel movements are frequently loose and watery. Mucus, usually brown or clear in color, will be passed.

    A colostomy bag is a device that collects feces from a stoma. It’s a waterproof bag worn outside your body that contains a little filter to catch any solid debris so you don’t feel it and can go about your business as usual.

    A colostomy bag is usually put on the patient’s body so that an ostomate can move around freely without worrying about the pouch’s positioning or leakage.

    Colostomy surgery is a lengthy and complicated procedure. It involves a team of surgeons and can take anywhere from 6 to 8 hours to complete, depending on how much intestine needs to be removed. For a patient, the long duration is inconvenient.

    Procedure for Colostomy

    Several procedures may be done depending on the type of colostomy.

    Procedure for a temporary colostomy

    This procedure is done to divert stool away from damaged bowel due to surgery. The surgeon will create a stoma at the colon level, remove a section of the healthy bowel and seal the remaining open ends. The length of a temporary colostomy depends on the size of the remaining bowel. The stoma will be closed from about 4-12 inches below the exit site. The goal is to avoid stool impaction at the opening from the intestine to the skin surface and promote the wound’s healing.

    Deciding how long you need a temporary stoma should be based on your lifestyle, strength, and available support from family or friends. If you have strong supportive people around you who can help with the care of your bowel incontinence after surgery, you may not need a long-term colostomy.

    Potential complications for temporary colostomy are infection at the open wound site, skin breakdown, and accumulation of stool at the opening from the intestine to the skin surface.

    Procedure for a permanent colostomy

    This procedure is done when the damaged bowel cannot be restored after surgery, as in the case of colon cancer. In this procedure, the surgeon will create a stoma at the level of the damaged section of the colon and rectum and then staple or suture the remaining ends together. The stoma will be sealed from about 4-12 inches below the exit site. The goal is to divert stool away from the damaged area and prevent the accumulation of stool at the opening from the intestine to the skin surface.

    Potential complications for permanent colostomy are infection at the site of an open wound, skin breakdown, stomal stenosis (stoma narrows and cannot pass stool), and fecal accumulation at the opening from the intestine to the skin surface.

    Bowel Technique

    This is a specific technique of undertaking a colostomy. The aim is to prevent fecal matter from leaking out of the stoma. This technique helps reduce pain, swelling, and other complications after surgery.

    Bowel technique procedure has a low risk of complications.

    Steps for bowel technique

    The patient should lie on his left side with knees bent, and hips flexed towards the chest, right arm overhead in a semi-flexed position.

    The nurse will hold the stoma and ask the patient to relax while wrapping a thick gauze bandage around the waist.

    The patient should remain in this position for 20 minutes.

    The next step will be to perform a bowel evacuation, irrigation of stoma with saline solution or hydrogen peroxide solution (3%).

    The next thing to do will be to clean the entire skin area with soap and water. This procedure must be repeated every 6 hours for the first two days following surgery.

    The nurse will then have to apply a layer of gauze on the stoma and cover it with adhesive tape or skin prep solution. Band-Aids are not recommended as they stick to wound tissue and may cause pain, bleeding, infections, and skin breakdown at the site of bandage attachment.

    Two days after surgery, the nurse will remove adhesive tape and gauze bandage and attach a wafer dressing or stoma guard. This is to prevent pressure sores from forming around the stoma.

    On day three following surgery, the nurse will remove the wafer dressing or stoma guard, apply a layer of gauze on the stoma, and cover it with an adhesive bandage.

    Every day after surgery, the nurse will clean the entire skin area with a mild soap solution. A permanent wafer dressing or stoma guard will be applied to the stoma about ten days following surgery.

    The frequency of bowel eliminations after surgery is to follow the doctor’s orders, usually every 2-3 days until healing occurs. This will be reduced to 2 times weekly for some time.

    Stomal expansion may also occur. This means that a small thin skin layer around the stoma gradually turns into a thick fold of skin. This will cause the stoma to enlarge and may cause difficulty when passing stool through that stoma opening.

    Stomal enlargement is common in people who have had a colostomy for more than three months. In this case, applying an elastic ring at the base of the stoma helps keep it snugly in place. The flexible ring is applied to the stoma by a nurse and must be worn for at least two weeks continuously, followed by another two weeks with breaks of one day.

    Perioperative Nursing Considerations

    The colostomy pouch may or may not be applied in surgery.

    A Vaseline gauze may encircle the stoma with a “fluff” type dressing applied.

    If the institution has an “Ostomy Nurse,” the application of the colostomy pouch may be delayed until the clinical specialist can work with the patient and family.

    Nursing Diagnosis for Colostomy

    Specific nursing diagnoses for colostomy exist depending on the type of operation, the stage of recovery, and other factors that may affect the patient’s health.

    Nursing diagnoses include the following:

    Potential Nutritional Alteration: This diagnosis relates to a reduction in nutritional intake or absorption due to lifestyle changes, physical constraints, or pain following surgery.

    Educating Patients: This nursing diagnosis describes a lack of knowledge or ability to care for a wound and avoid consequences.

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    Nursing Care Plans for Colostomy
    Nursing Care Plans for Colostomy

    Reduced fluid intake, stool changes that cause dehydration, or fecal impaction near the stoma are all symptoms of potential fluid volume change.

    Abdominal distension due to gas accumulation around the stoma

    Anxiety stemming from the surgery, a pre-existing condition, and life changes, as well as a shift in role.

    Infection at the surgical site might harm the patient’s overall health.

    Skin Integrity: There’s a chance it’ll be harmed. Due to the presence of feces surrounding the stoma or at the opening from the gut, this diagnosis relates to the possibility of skin breakdown and other skin-related issues after surgery.

    Injury Potential: The danger of harm from fecal impaction around the stoma or at the entry from the intestine to the skin surface is described in this nursing diagnostic.

    Dyspnea as a result of surgery-related pain and fatigue-related weakness.

    Chronic pain may impact the patient’s overall health as a result of the operation’s harm to the colon, rectum, and anus.

    Constipation: This diagnosis refers to decreased bowel movements caused by inadequate fiber intake, inadequate water intake, and stool impaction around the stoma

    Infection Risk: This diagnosis relates to a wound infection caused by feces entering the wound or moisture accumulating at the passage from the intestine to the skin surface.

    Nursing Care Plans for Colostomy Based on Diagnosis

    Nursing Diagnosis: Fluid Volume and Risk for deficient.

    Risk factors may include:

    Excessive losses through regular routes, e.g., preoperative emesis and diarrhea; high-volume ileostomy output.

    Losses through abnormal routes, e.g., NG/intestinal tube, perineal wound drainage tubes.

    Medically restricted intake.

    Altered absorption of fluid, e.g., loss of colon function.

    Hypermetabolic states, e.g., inflammation, healing process.

    Desired Outcomes

    Maintain adequate hydration as evidenced by moist mucous membranes, good skin turgor, and capillary refill, stable vital signs, and individually appropriate urinary output.

    Nursing Interventions

    Monitor intake and output (I&O) carefully, measure liquid stool. Weigh regularly.

    Rationale: Provides direct indicators of fluid balance. Most significant fluid losses occur with ileostomy, but they generally do not exceed 500–800 mL/day.

    Monitor vital signs, noting postural hypotension, tachycardia. Evaluate skin turgor, capillary refill, and mucous membranes.

    Rationale: Reflects hydration status and the possible need for increased fluid replacement.

    Limit intake of ice chips during the period of gastric intubation.

    Rationale: Ice chips can stimulate gastric secretions and wash out electrolytes.

    Monitor laboratory results, e.g., Hct and electrolytes

    Rationale: Detects homeostasis or imbalance and aids in determining replacement needs

    Administer IV fluid and electrolytes as indicated.

    Rationale: It may be necessary to maintain adequate tissue perfusion/organ function.

    Nursing Diagnosis: Skin/Tissue Integrity, impaired

    May be related to:

    Invasion of body structure (e.g., perineal resection).

    Stasis of secretions/drainage.

    Altered circulation, edema, malnutrition.

    Possibly evidenced by:

    Disruption of skin/tissue: the presence of incision and sutures, drains.

    Desired Outcomes

    Achieve timely wound healing free of signs of infection.

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    Nursing Care Plans for Colostomy
    Nursing Care Plans for Colostomy

    Nursing Interventions

    Observe wounds, note characteristics of drainage.

    Rationale: Postoperative bleeding is most likely to occur during the first 48 hr, whereas infection may develop at any time. Depending on the type of wound closure (e.g., first or second intention), complete healing may take 6-8 mo.

    Change dressings as needed using the aseptic technique

    Rationale: Large amounts of serous drainage require that dressings be changed frequently to reduce skin irritation and potential for infection.

    Encourage a side-lying position with the head elevated. Avoid prolonged sitting.

    Rationale: Promotes drainage from perineal wounds/drains, reducing pooling risk. Prolonged sitting increases perineal pressure, reduces circulation to the wound, and may delay healing.

    Irrigate wound as indicated, using normal saline (NS), diluted hydrogen peroxide, or antibiotic solution.

    Rationale: May be required to treat preoperative inflammation and infection or intraoperative contamination.

    Provide sitz baths.

    Rationale: Promotes cleanliness and facilitates healing, especially after removing packing (usually day 3–5).

    Nursing Diagnosis: Acute Pain

    May be related to:

    Physical factors: e.g., disruption of skin/tissues (incisions/drains).

    Biological: activity of disease process (cancer, trauma).

    Psychological factors: e.g., fear, anxiety.

    Possibly evidenced by:

    Reports of pain, self-focusing.

    Guarding/distraction behaviors, restlessness.

    Autonomic responses, e.g., changes in vital signs.

    Desired Outcomes

    Verbalize that pain is relieved/controlled.

    Display relief of pain, able to sleep/rest appropriately

    Demonstrate relaxation skills and general comfort measures as indicated for the individual situation.

    Nursing Interventions

    Assess pain, noting location, characteristics, intensity (0–10 scale).

    Rationale: Helps evaluate the degree of discomfort and effectiveness of analgesia or may reveal developing complications. Because abdominal pain usually subsides gradually by the third or fourth postoperative day, continued or increasing pain may reflect delayed healing or peristomal skin irritation. Note: Pain in the anal area associated with abdominal-perineal resection may persist for months.

    Encourage the patient to verbalize concerns. Active-listen these concerns and provide support by acceptance, remaining with the patient, and giving the appropriate information.

    Rationale: Reduction of anxiety/fear can promote relaxation or comfort.

    Provide comfort measures, e.g., mouth care, back rub, repositioning (use proper support measures as needed). Assure patient that position change will not injure stoma.

    Rationale: Prevents drying of oral mucosa and associated discomfort. Reduces muscle tension, promotes relaxation, and may enhance coping abilities.

    Encourage the use of relaxation techniques, e.g., guided imagery, visualization. Provide diversional activities.

    Rationale: Helps patient rest more effectively and refocuses attention, thereby reducing pain and discomfort.

    Assist with ROM exercises and encourage early ambulation. Avoid prolonged sitting position.

    Rationale: Reduces muscle/joint stiffness. Ambulation returns organs to normal position and promotes the return of the usual level of functioning. Note: The presence of edema, packing, and drains (if perineal resection has been done) increases discomfort and creates a sense of needing to defecate. Ambulation and frequent position changes reduce perineal pressure.

    Investigate and report abdominal muscle rigidity, involuntary guarding, and rebound tenderness.

    Rationale: Suggestive of peritoneal inflammation, which requires prompt medical intervention.

    Administer medication as indicated, e.g., narcotics, analgesics, patient-controlled analgesia (PCA).

    Rationale: Relieves pain, enhances comfort, and promotes rest. PCA may be more beneficial, especially following anal-perineal repair.

    Provide sitz baths.

    Rationale: Relieves local discomfort, reduces edema, and promotes healing of the perineal wound.

    Apply/monitor effects of transcutaneous electrical nerve stimulator (TENS) unit.

    Rationale: Cutaneous stimulation may be used to block transmission of the pain stimulus.

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    Nursing Care Plans for Colostomy
    Nursing Care Plans for Colostomy

    Nursing Diagnosis: Body Image, disturbed

    May be related to

    Biophysical: the presence of stoma; loss of control of bowel elimination.

    Psychosocial: altered body structure.

    The disease process and associated treatment regimen, e.g., cancer, colitis.

    Possibly evidenced by:

    Verbalization of change in body image, fear of rejection/reaction of others, and negative feelings about body.

    The actual change in structure and function (ostomy)

    Not touching/looking at stoma, refusal to participate in care

    Desired Outcomes

    Verbalize acceptance of self in a situation, incorporating change into self-concept without negating self-esteem.

    Demonstrate beginning acceptance by viewing/touching stoma and participating in self-care.

    Verbalize feelings about stoma/illness; begin to deal constructively with the situation.

    Nursing Interventions

    Ascertain whether support and counseling were initiated when the possibility and necessity of ostomy were first discussed.

    Rationale: Provides information about patient’s/SO’s level of knowledge and anxiety about an individual situation.

    Encourage patient/SO to verbalize feelings regarding the ostomy. Acknowledge the normality of feelings of anger, depression, and grief over loss. Discuss daily “ups and downs” that can occur.

    Rationale: Helps patient realize that feelings are not unusual and that feeling guilty about them is not necessary or helpful. The patient needs to recognize feelings before they can be dealt with effectively.

    Review reason for surgery and future expectations.

    Rationale: Patients may find it easier to accept or deal with an ostomy done to correct chronic or long-term disease than for traumatic injury, even if ostomy is only temporary. Also, patients who will be undergoing a second procedure (to convert ostomy to a continent or anal reservoir) may encounter less severe self-image problems because body function eventually will be “more normal.”

    Note withdrawal behaviors increased dependency, manipulation, or non-involvement in care.

    Rationale: Suggestive of problems in adjustment that may require further evaluation and more extensive therapy.

    Provide opportunities for patient/SO to view and touch stoma, using the moment to point out positive signs of healing, normal appearance, and so forth. Remind the patient that it will take time to adjust, both physically and emotionally.

    Rationale: Although integration of stoma into body image can take months or even years, looking at the stoma and hearing comments (made in a standard, matter-of-fact manner) can help the patient with this acceptance. Touching stoma reassures patient/SO that it is not fragile and that slight movements of stoma actually reflect normal peristalsis.

    Provide an opportunity for the patient to deal with ostomy through participation in self-care.

    Rationale: Independence in self-care helps improve self-confidence and acceptance of the situation.

    Plan/schedule care activities with the patient.

    Rationale: Promotes a sense of control and conveys that the patient can handle the situation, enhancing self-concept.

    Maintain a positive approach during care activities, avoiding expressions of disdain or dislike. Do not take angry expressions of the patient and SO personally.

    Rationale: Assists patient and SO to accept body changes and feel all right about self. Anger is most often directed at the situation, and the individual lacks control over what has happened (powerlessness), not with the individual caregiver.

    Ascertain patient’s desire to visit with a person with an ostomy. Make arrangements for a visit, if desired.

    Rationale: A person who is living with an ostomy can be a good support system/role model. It helps reinforce teaching (shared experiences) and facilitates acceptance of change as the patient realizes “life does go on” and can be relatively ordinary.

    Nursing Diagnosis: Skin Integrity, the risk for impaired

    Risk factors may include:

    Absence of sphincter at stoma

    Character/flow of effluent and flatus from the stoma

    Reaction to product/chemicals; improper fitting/care of appliance/skin.

    Desired Outcomes

    Maintain skin integrity around the stoma.

    Identify individual risk factors.

    Demonstrate behaviors/techniques to promote healing/prevent skin breakdown.

    Nursing Interventions

    Inspect stoma and peristomal skin area with each pouch change. Note irritation, bruises (dark, bluish color), rashes.

    Rationale: Monitors healing process and effectiveness of appliances and identifies areas of concern, need for further evaluation, and intervention. Early identification of stomal necrosis, ischemia, or fungal infection (from changes in normal bowel flora) provides timely interventions to prevent serious complications. The stoma should be red and moist. Ulcerated areas on the stoma may be from a pouch opening that is too small or a faceplate that cuts into the stoma. In patients with an ileostomy, the effluent is rich in enzymes, increasing the likelihood of skin irritation. Inpatient with a colostomy, skincare is not as great a concern because the enzymes are no longer present in the effluent.

    Clean with warm water and pat dry. Use soap only if the area is covered with a sticky stool. If the paste has collected on the skin, let it dry, then peel it off.

    Rationale: Maintaining a clean and dry area helps prevent skin breakdown.

    Measure stoma periodically: at least weekly for the first 6 weeks, then once a month for 6 mo. Measure both the width and length of the stoma.

    Rationale: As postoperative edema resolves (during the first 6 weeks), the stoma shrinks and the size of the appliance must be altered to ensure proper fit so that effluent is collected as it flows from the ostomy and contact with the skin is prevented.

    Verify that opening on adhesive backing of the pouch is at least 1⁄16 to 1⁄8 in (2–3 mm) larger than the base of the stoma, with adequate adhesiveness left to apply pouch.

    Rationale: Prevents trauma to the stoma tissue and protects the peristomal skin. Adequate adhesive area prevents the skin barrier wafer from being too tight. Note: Too tight a fit may cause stomal edema or stenosis.

    Use a transparent, odor-proof drainable pouch.

    Rationale: A transparent appliance during the first 4–6 weeks allows easy observation of stoma without the necessity of removing pouch/irritating skin.

    Apply appropriate skin barrier: hydrocolloid wafer, karaya gun, extended-wear skin barrier, or similar products.

    Rationale: Protects skin from pouch adhesive, enhances adhesiveness of pouch, and facilitates removal of the pouch when necessary. Note: Sigmoid colostomy may not require the use of a skin barrier once stool becomes formed and elimination is regulated through irrigation.

    Empty, rinse, and cleanse ostomy pouch regularly, using appropriate equipment.

    Rationale: Frequent pouch changes are irritating to the skin and should be avoided. Emptying and rinsing the pouch with the proper solution removes bacteria and odor-causing stool and flatus and deodorizes the pouch.

    Support surrounding skin when gently removing the appliance. Apply adhesive removers as indicated, then wash thoroughly.

    Rationale: Prevents tissue irritation or destruction associated with “pulling” pouch off.

    Investigate reports of burning, itching, or blistering around the stoma.

    Rationale: Indicative of effluent leakage with peristomal irritation, or possibly Candida infection, requiring intervention.

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    Nursing Care Plans for Colostomy
    Nursing Care Plans for Colostomy

    Evaluate adhesive product and appliance fit on an ongoing basis.

    Rationale: Provides an opportunity for problem-solving. Determines need for further intervention.

    Consult with certified wound, ostomy, continence nurse.

    Rationale: Helpful in choosing products appropriate for patient’s particular rehabilitation needs, including type of ostomy, physical/mental status, abilities to handle self-care, and financial resources.

    Apply corticosteroid aerosol spray and prescribed antifungal powder as indicated.

    Rationale: Assists in healing if peristomal irritation persists and fungal infection develops. Note: These products can have potent side effects and should be used sparingly.

    Related FAQs

    1. Why would you need a colostomy?

    A colostomy may be needed if you cannot pass stools through your anus. This could be the result of an illness, injury or problem with your digestive system. You may have a colostomy to treat: bowel cancer.

    2. Can you poop after a colostomy?

    Pooping will be different with a colostomy bag. Immediately after your surgery, your anus may continue to expel poop and other fluids that were left inside. But new poop will now exit through your stoma. Most people will be able to feel their bowels move and know when poop is about to come out.

    3. What is the difference between a colostomy and ostomy?

    A colostomy is an operation that connects the colon to the abdominal wall, while an ileostomy connects the last part of the small intestine (ileum) to the abdominal wall.

    4. What part of the bowel would a colostomy be placed?

    Colostomy is a surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall. Stools moving through the intestine drain through the stoma into a bag attached to the abdomen.

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