day 1: My patient was 39, female, morbid obese. Hx or anemia, asthma, oa, anxiety/depression, hypothyroidism, hypertensi

[answerhappygod]

day 1: My patient was 39, female, morbid obese.
Hx or anemia, asthma, oa, anxiety/depression, hypothyroidism,
hypertension. She is 3 weeks s/p bariatric surgery. She lives with
her boyfriend and son in an apartment. She owns multiple pets (3
guineas, 2 cats, 1 bunny). She is unemployed (disabled). She came
to the ER complaining of abd pain, n/v, diarrhea. Physical exam:
RUQ abdominal pain and positive Murphy’s sign (Choleocystitis).
day 2: She had a robotic sleeve
laparoscopic choleocystectomy the following day. (The surgeon
went in through the same incision site from the bariatric
surgery). She tolerated the procedure well and was extubated
to the post-op floor to recover.
day 3: Nausea, vomit or diarrhea are
gone. She is ambulating on her own and is independent.
Doctor’s orders is to discharge today, discontinue tramadol and
acetaminophen (used for pain), patient can resume next stage of her
bariatric diet as planned (stage III) (day 2).
During her time with me on day 3
- Reported pain 7/10. Shooting, throbbing, stabbing at incision
site. It was alleviated with (heat) warm blankets and
re-positioning. Reported 5/10 after.
- "Craving a coffee"
- "Can't wait for a real meal after she leaves"
- "Craving a pizza or Mcdonald's"
- Touching the incision site often
- All her studies were normal except her MCH, MCHC, total
protein, albumin were slightly low which is normal for
anemia.
NURSING DX: (are these in the correct order
based on Maslow's?) what would be
the supporting evidence for each one?
1. Acute pain related to incision for cholecystectomy
surgery
2. Imbalanced nutrition less than body requirements related to
restrictions in diet in postoperative period
3. Deficient knowledge ——— (not sure what to say here
but she did state that she was craving coffee, and couldn’t wait to
leave get a real meal. Should i have it related to nutrition
post-op?) what would be the supporting
evidence?
4. Risk for infection related to surgical site incision.