Nursing 194 CONCEPT MAP

Acute pain r/t bladder hemorrhaging amb bladder spasms 1. Medicate with antispasmodics or analgesics as prescribed. Document pain relief obtained, using pain scale. 2. If patient is losing urine around catheter, check catheter and drainage tubing for evidence of obstruction. 3. Encourage intake of fluids to 2-3L/day to help reduce spasms. A.F. Admitted 5/28/12 83yr old female Admitting Diagnosis: Bladder Cancer Allergies: Penicillin 1. Monitor for and report abdominal cramps, diarrhea, colic, irritability, nausea, or muscle weakness. 2. Monitor mental orientation and signs of disorientation. 3. Assess vital signs for decreasing BP, changes in LOC, tachycardia, tachypnea, thready pulse. Goal met Fluid Volume Deficit r/t to active fluid volume loss secondary to hemorrhaging amb bleeding and decreased hgb

Goal met

Goal- Within 1 hr of intervention, patient's subject perception of discomfort decreases, as documented by a pain scale.

Chronic pain r/t bladder cancer aeb patient stating she aches after chemo.

Goal-Patient is normovolemic and free of signs of shock and electrolyte imbalance.

RBC@10 .4 HCT@33 .1

1.

Administer opioid and non opioid analgesics in correct dose, at correct frequency, and via correct route. Assess for signs and symptoms of tolerance, and when it occurs, discuss treatment with health care provider. Use nonpharmacologic approaches, such as acupressure, biofeedback, relaxation therapy, application heat or cold, and massage.

2.

3.

Goal-Patient participates in a prescribed regimen and reports that pain and side effects associated with the prescribed therapy are reduced to a level of 3 or less within 1-2 hours of intervention.

Goal met.