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Cues Problem Physiologic Behavioral: Date Identified: July 19, 2016 Subjective Cues

The client presented with a pain scale of 7/10 at the operative site from a recent external hemorrhoid surgery. Vital signs and laboratory results were noted. The physiological problems identified were actual pain at the operative site and potential risks for constipation and self-care deficit related to toileting. Behavioral problems included actual anxiety and knowledge deficit regarding the disease condition, as well as potential risks for ineffective health maintenance and decisional conflict due to lack of relevant information.

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78 views

Cues Problem Physiologic Behavioral: Date Identified: July 19, 2016 Subjective Cues

The client presented with a pain scale of 7/10 at the operative site from a recent external hemorrhoid surgery. Vital signs and laboratory results were noted. The physiological problems identified were actual pain at the operative site and potential risks for constipation and self-care deficit related to toileting. Behavioral problems included actual anxiety and knowledge deficit regarding the disease condition, as well as potential risks for ineffective health maintenance and decisional conflict due to lack of relevant information.

Uploaded by

itsmeaya
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CUES

Date Identified: July 19, 2016


Subjective Cues:
Gasakit pa ang akon buli.
as verbalized by the client
Objective Cues:
Pain scale of 7/10 noted
Anxiety noted
Vital signs are as follows:
Temperature: 36.8C
Pulse Rate: 65 bpm
Respiratory rate: 18 cpm
Blood Pressure: 140/100
Others
Laboratory Results
WBC
12.1 (5.00-10.00 x 10^ 9/L)
Monocytes
7 (2.00-6%)

PROBLEM

Pain at operative site

PHYSIOLOGIC

BEHAVIORAL

Actual
Alteration in comfort: Pain related to
post operation wound secondary to
External Hemorrhoids

Actual
Fear related to perceived pain during
elimination secondary to External
Hemorrhoids

Potential
Risk for constipation related to
reluctance to defecate secondary to
External Hemorrhoids

Potential
Risk for self-care deficit: toileting r/t
pain during elimination secondary to
External Hemorrhoids

Eosinophils
15 (1.00-4%)

Lack of information about disease


condition

Actual
Knowledge Deficit related to
unfamiliarity of disease condition

Actual
Moderate anxiety related to inadequate
knowledge on disease condition

Potential
Potential
Risk for ineffective health maintenance Risk for decisional conflict related to
related to lack of knowledge regarding lack of relevant information
basic health practices

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