Nanda Nursing Diagnosis

Nursing Care Plan for Cesarean Section Nursing Diagnosis : Risk for Injury related to biochemical function or regulation, the effects of anesthesia, tissue trauma. Goal: Demonstrate behaviors to reduce risk factors and / or self-protection. Free from complications. Itervention: 1. Review the prenatal and intra prenatal record, the factors of clients in complications. Rationale: The presence of risk factors such as fatigue miometrial, excessive uterine distension, slow oxytocin stimulation, or thrombophlebitis a prenatal, allowing clients more susceptible to post-operative complications. 2. Monitor blood pressure, pulse and temperature. Note the skin is cold, wet, weak pulse and subtle, changes in behavior, delayed capillary refill, or cyanosis. Rationale: High blood pressure can indicate the occurrence or continuation of hypertension. Hypotension and tachycardia may indicate dehydration and hypovolemia but may not occur until the circulating blood volume has been decreased to 35% - 50...

Nursing Diagnosis for Cesarean Section : Acute pain related to surgical trauma, anesthesia, hormonal effects, distended bladder / abdomen. Goal: Identify and use interventions to treat pain / discomfort appropriately. Reveal a reduction in pain. Relaxed able to sleep / rest. Intervention: 1. Determine the characteristics and location of discomfort. Pay attention to verbal and non-verbal cues such as grimacing, stiffness, and limited movement or protect. Rationale: The client may not be verbally reported pain and discomfort directly. Distinguish specific characteristics of pain and postoperative pain helps distinguish from complications. 2. Evaluation of blood pressure and pulse, note the change in behavior change. Rationale: Pain can cause restlessness and increased blood pressure and pulse. 3. Change the position of the client, reduce harmful stimuli, and give a back rub. Encourage the use of breathing techniques, relaxation and distraction. Rationale: muscle relaxes and distracts fr...