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    Concept Map 3 MM (Abdominal Pain)

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    Matt McKinley
    Matt McKinley presented with abdominal pain, nausea, vomiting, poor skin turgor, weakness, fatigue, thirst, and vital signs indicative of dehydration. He is at risk for fluid volume deficit related to fluid losses through his gastrointestinal system as evidenced by his symptoms. He has an imbalanced nutrition status due to his inability to ingest food adequately due to his abdominal pain. He experiences acute pain related to his abdominal pain as shown by his grimacing appearance. Nursing interventions include aiming for 1500mL of oral fluids daily unless contraindicated, monitoring intake and output every 8 hours, providing freely available water, offering fluids regularly, and monitoring central venous pressure to prevent further fluid volume loss.

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    Concept Map 3 MM (Abdominal Pain)

    Uploaded by

    Matt McKinley
    214 views2 pages
    Matt McKinley presented with abdominal pain, nausea, vomiting, poor skin turgor, weakness, fatigue, thirst, and vital signs indicative of dehydration. He is at risk for fluid volume deficit related to fluid losses through his gastrointestinal system as evidenced by his symptoms. He has an imbalanced nutrition status due to his inability to ingest food adequately due to his abdominal pain. He experiences acute pain related to his abdominal pain as shown by his grimacing appearance. Nursing interventions include aiming for 1500mL of oral fluids daily unless contraindicated, monitoring intake and output every 8 hours, providing freely available water, offering fluids regularly, and monitoring central venous pressure to prevent further fluid volume loss.

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    Abdominal pain concept map

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    Matt McKinley presented with abdominal pain, nausea, vomiting, poor skin turgor, weakness, fatigue, thirst, and vital signs indicative of dehydration. He is at risk for fluid volume deficit related to fluid losses through his gastrointestinal system as evidenced by his symptoms. He has an imbalanced nutrition status due to his inability to ingest food adequately due to his abdominal pain. He experiences acute pain related to his abdominal pain as shown by his grimacing appearance. Nursing interventions include aiming for 1500mL of oral fluids daily unless contraindicated, monitoring intake and output every 8 hours, providing freely available water, offering fluids regularly, and monitoring central venous pressure to prevent further fluid volume loss.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    214 views2 pages

    Concept Map 3 MM (Abdominal Pain)

    Uploaded by

    Matt McKinley
    Matt McKinley presented with abdominal pain, nausea, vomiting, poor skin turgor, weakness, fatigue, thirst, and vital signs indicative of dehydration. He is at risk for fluid volume deficit related to fluid losses through his gastrointestinal system as evidenced by his symptoms. He has an imbalanced nutrition status due to his inability to ingest food adequately due to his abdominal pain. He experiences acute pain related to his abdominal pain as shown by his grimacing appearance. Nursing interventions include aiming for 1500mL of oral fluids daily unless contraindicated, monitoring intake and output every 8 hours, providing freely available water, offering fluids regularly, and monitoring central venous pressure to prevent further fluid volume loss.

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    Concept Map Template

    Matt McKinley

    Signs and Symptoms


    Pain score 7/10
    N/V
    Meds: Poor skin turgor
    Zosyn 3.375 mg IV piggyback
    25ml/hr for 4 hours Weakness
    Fatigue
    Norco 5mg PO PRN
    Diagnostics: Thirst
    Chest X-ray
    CT scan Vitals @ 1630: BP: 105/75, HR: 132,
    Abdominal O2%: 94%, Temp: 97 F, RR: 14
    EKG
    pain
    Lab work:
    WBC:19.8, RBC: 3.76,
    Hgb: 10.3, Hct 31.2 *Risk for fluid volume deficit related to abdominal pain as
    evident by to loss of fluids through abdominal route*

    Patho: •The negative fluid balance that causes dehydration Imbalanced nutrition related to abdominal pain as evident by
    results from decreased intake, increased output (renal, inability to ingest food
    gastrointestinal [GI], or insensible losses), or fluid shift (ascites,
    effusions, and capillary leak states such as burns and sepsis). The Acute pain related to abdominal pain as evident by grimacing
    decrease in total body water causes reductions in both the appearance
    intracellular and extracellular fluid volumes. Clinical
    manifestations of dehydration are most closely related to
    intravascular volume depletion and the physiologic compensation
    attempts that takes place. As dehydration progresses,
    hypovolemic shock ultimately ensues, resulting in end organ
    failure and death. (Huang, 2019).

    Patient Goal: Patient explains measures that can be taken to treat or prevent fluid volume loss by the end of the
    shift

    Nursing Interventions

    Aim for 1500 mL of oral liquids per day unless contraindicated by a medical condition such as
    congestive heart failure. (Betty J. Ackley, 2002)

    Monitor total fluid intake and output every 8 hours. (Betty J. Ackley, 2002)

    Provide water that is freely available on the bedside or bedside chair (Betty J. Ackley, 2002)

    Offer fluids regularly throughout the day. (Betty J. Ackley, 2002)

    Monitor central venous pressure, right atrial pressure, and pulmonary wedge pressure for decrease
    (Betty J. Ackley, 2002)
    Concept Map Template

    Matt McKinley

    References
    Ackley, B. J. R. N. (2002). Nursing diagnosis handbook. Elsevier Mosby.

    Huang, L., MD. (2019, February 03). Dehydration. Retrieved March 9, 2019, from

    https://emedicine.medscape.com/article/906999-overview#a5

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