identify a SMART outcome for the patient pertaining to your

1900: A 48-year-old ED reporting severe right upper abdominal pain that radiates to the epigastric area and right shoulder. The pain started as a dull uncomfortable pain that progress ed to severe pain about 2 to 3 hours after eating fried chicken. The client is bent over with the arms folded across the stomach and recalls a past incident of similar discomfort but never went to the physician. The client has s past medical history of hypertension and hyperlipidemia. The client’s history includes an abdominal hysterectomy seven years ago and two hernia repairs, an epigastric hemis repair done three years ago, and an umbilical hernia repair done one year ago. Denies use of illicit substances. Physical exam reveals an overweight dient in severe pain with tenderness to palpation in the epigastric and right upper abdominal quadrants without rebound tenderness. Diagnostic tests reveal a thickened gallbladder and multiple stones blocking the biliary duct. A laparoscopic cholecystectomy is planned for the next day and the client is admitted to the same-day surgical holding unit. 1100: The client has a laparoscopic cholecystectomy and returns to the surgical same- day unit. The client’s VS are T 09.0’F (37 2.C). HR 1 10 BPM, RR 24 bpm, BP 150/92 mmHg. SpO, 93% RA, abdominal pain 9/10 on a 0 to 10 pain intensity scale that radiates to the right shoulder. No nauses or vomiting. Dressings dry and intact. The nurse reviews the client assessment data to prepare the plan of care. Complete the diagram by selecting from the chaices below to specify which condition the client is most likely experiencing, 2 actions the nurse would take to address that condition, and 2 parameters the nurse would monitor to assess the client’s progress. Nursing Actions Potentul Conditice meters to M Select Select – Select Select Select A B C Notify the surgeon. Bleeding Pain characteristics Change abdominal Bile leak Hemoglobin, dressings. Adhesions hematocrit, Administer Trapped carbon platelets, red blood antinausea dioxide gas cells, bilirubin medication. Characteristics of Encourage deep vomitus breathing along with Respiratory status ambulation. and Spo2 Position on the left Drainage amount side with the right and type of knee flexed. dressings A. Potential Condition: Bile leak ++ Nursing Action #1: Notify the surgeon ++ Nursing Action #2: Change abdominal dressings. ++ Parameter to Monitor #1: Drainage amount and type of dressings. ++ Parameter to Monitor #2: Pain characteristics B. Potential Condition: Bleeding ++ Nursing Action #1: Notify the surgeon ++ Nursing Action #2: Change abdominal dressings ++ Parameter to Monitor #1: O Hemoglobin, hematocrit, platelets, red blood cells, bilirubin # Parameter to Monitor #2: Drainage amount and type of dressings. C. Potential Condition: Trapped carbon dioxide gas ++ Nursing Action #1: Position on the left side with the right knee flexed ++ Nursing Action #2: Encourage deep O breathing along with ambulation ++ Parameter to Monitor #1: Respiratory Status and Sp02 ++ Parameter to Monitor #2: Pain characteristics D. Potential Condition: Adhesions ++ Nursing Action #1: Notify the surgeon ++ O Nursing Action #2: Administer antinausea medication ++ Parameter to Monitor #1: Pain characteristics ++ Parameter to Monitor #2: Characteristics of vomitus

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