Cholecystitis, the inflammation of the gallbladder, is a common and often painful condition frequently encountered in healthcare settings. For nurses and nursing students, understanding the nuances of cholecystitis, particularly in formulating accurate nursing diagnoses and developing effective care plans, is crucial for optimal patient outcomes. This comprehensive guide delves into the critical nursing diagnoses associated with cholecystitis, providing a structured approach to assessment, interventions, and rationales. Designed to serve as a robust resource, this article can even be adapted into a Cholecystitis Nursing Diagnosis Ppt for educational purposes, enhancing understanding and knowledge dissemination.
Cholecystitis is most often triggered by gallstones (cholelithiasis) obstructing the cystic duct, leading to bile buildup and subsequent inflammation. These stones, or calculi, are formed from cholesterol, calcium bilirubinate, or a combination, resulting from alterations in bile composition. Gallstones can lodge in various parts of the biliary system, including the common bile duct, cystic duct, hepatic duct, small bile ducts, and even the pancreatic duct. Furthermore, crystal formation within the gallbladder submucosa can also incite widespread inflammation. While acute cholecystitis with cholelithiasis is frequently managed surgically, alternative treatments aimed at stone fragmentation and dissolution are increasingly utilized.
Cholelithiasis, the presence of stones within the gallbladder, arises from imbalances in bile components. These gallstones are composed of cholesterol, calcium bilirubinate, or mixtures of these substances. Factors contributing to gallstone formation include conditions that cause gallbladder sluggishness, such as pregnancy, hormonal contraceptives, diabetes mellitus, celiac disease, liver cirrhosis, and pancreatitis.
Nursing Care Plans
Effective nursing care for patients with cholecystitis centers around several key objectives: alleviating pain and promoting rest, maintaining fluid and electrolyte balance, preventing potential complications, and providing thorough patient education regarding the disease process, prognosis, and treatment modalities. The following nursing care plans address critical diagnoses relevant to cholecystitis.
Risk for Deficient Fluid Volume
Patients suffering from cholecystitis and cholelithiasis are significantly at risk for deficient fluid volume. This risk stems from multiple factors, including excessive fluid losses due to vomiting and diarrhea, reduced oral intake resulting from nausea and anorexia, and disruptions in clotting processes linked to liver dysfunction. These combined factors can lead to dehydration and compromised tissue perfusion, potentially exacerbating the inflammatory response characteristic of cholecystitis and increasing the likelihood of systemic complications.
Nursing Diagnosis
- Risk for Deficient Fluid Volume
Risk factors may include
- Excessive fluid losses via gastric suction, vomiting, abdominal distension, and gastric hypermotility.
- Restricted fluid intake due to medical orders or patient condition.
- Altered clotting processes impacting fluid balance.
Possibly evidenced by
(This section is typically “Related to” or “Risk Factors” in actual diagnosis, “Possibly evidenced by” is more about signs and symptoms which are not applicable for “Risk for” diagnosis)
Desired Outcomes
- The patient will maintain adequate fluid balance, evidenced by stable vital signs, appropriate urine output, and moist mucous membranes.
- The patient will demonstrate understanding of fluid replacement needs and strategies.
Nursing Assessment and Rationales
1. Maintain accurate records of fluid intake and output (I&O), noting output that is less than intake, and increased urine specific gravity. Assess skin turgor and mucous membranes for dryness, evaluate peripheral pulses, and monitor capillary refill.
Rationale: Meticulous I&O monitoring is crucial for evaluating fluid status and identifying fluid volume deficits. An output less than intake, coupled with increased urine specific gravity, indicates concentrated urine and potential dehydration. Assessing skin turgor, mucous membranes, peripheral pulses, and capillary refill provides valuable insights into hydration levels and circulating blood volume, guiding fluid replacement strategies.
2. Monitor for signs and symptoms of increased or persistent nausea and vomiting, abdominal cramps, generalized weakness, muscle twitching, seizures, irregular heart rate, paresthesia, hypoactive or absent bowel sounds, and depressed respirations.
Rationale: Prolonged vomiting, gastric aspiration (e.g., via NG tube), and restricted oral intake can precipitate deficits in essential electrolytes such as sodium, potassium, and chloride. These electrolyte imbalances manifest in a range of signs and symptoms, including nausea, vomiting, muscle weakness, and neurological changes. Recognizing these signs is vital for prompt electrolyte replacement and management.
3. Assess for unusual bleeding: oozing from injection sites, epistaxis (nosebleeds), bleeding gums, ecchymosis (bruising), petechiae (small red spots), hematemesis (vomiting blood), or melena (black, tarry stools).
Rationale: Obstructed bile flow in cholecystitis can lead to reduced prothrombin production and prolonged coagulation times. This increases the patient’s susceptibility to bleeding and hemorrhage. Careful assessment for unusual bleeding provides early detection of coagulation abnormalities and guides appropriate interventions to prevent further blood loss.
Gallbladder inflammation and gallstones, key factors leading to cholecystitis and related nursing diagnoses.
Nursing Interventions and Rationales
1. Eliminate noxious sights or smells from the patient’s environment.
Rationale: Noxious stimuli can trigger the vomiting reflex, further contributing to fluid loss. Minimizing these triggers helps to reduce nausea and vomiting episodes.
2. Perform frequent oral hygiene with alcohol-free mouthwash; apply lip lubricants.
Rationale: Frequent vomiting and restricted oral intake can lead to dryness and discomfort of the oral mucous membranes. Regular oral hygiene keeps the mouth moist and clean, reducing the risk of mucosal dryness and cracking, while alcohol-free mouthwash prevents further irritation. Lip lubricants prevent chapping and cracking of the lips.
3. Utilize small-gauge needles for injections and apply firm pressure for a longer duration than usual after venipuncture.
Rationale: Patients with cholecystitis may have impaired clotting due to liver involvement. Using smaller needles minimizes tissue trauma during injections, and prolonged pressure after venipuncture helps to prevent hematoma formation and bleeding at puncture sites.
4. Maintain NPO (nothing per oral) status as prescribed.
Rationale: Keeping the patient NPO reduces gastrointestinal secretions and motility. This allows the gallbladder and digestive system to rest, minimizing further irritation and potential complications. NPO status is often necessary in acute cholecystitis to manage symptoms and prepare for potential procedures.
5. Insert a nasogastric (NG) tube, connect to suction, and maintain patency as indicated.
Rationale: An NG tube connected to suction is used to decompress the stomach, removing gastric contents and reducing nausea and vomiting. This intervention is crucial for resting the gastrointestinal tract, especially in cases of severe vomiting or abdominal distension, and prevents aspiration in vulnerable patients. Maintaining patency ensures the tube remains functional and effective in drainage.
Acute Pain
Patients with cholecystitis and cholelithiasis frequently experience acute pain. This pain arises from several factors, including obstruction of the gallbladder or bile ducts by gallstones, inflammation and irritation of the gallbladder wall, and tissue ischemia resulting from compromised blood flow to the affected area. The pain is typically localized in the right upper quadrant of the abdomen and may be accompanied by other distressing symptoms such as fever, nausea, and vomiting. This pain, known as biliary colic, can be severe and debilitating.
Nursing Diagnosis
- Acute Pain
May be related to
- Gallbladder distension and inflammation
- Biliary spasm
- Obstruction of bile flow
Possibly evidenced by
- Reports of pain, biliary colic (waves of intense pain)
- Facial expressions of pain; guarding behavior
- Autonomic responses (changes in blood pressure, pulse rate)
- Self-focusing; narrowed focus on pain
Desired Outcomes
- The patient will report a reduction in pain intensity and improved pain control.
- The patient will demonstrate the use of relaxation techniques and diversional activities to manage pain.
- The patient will be able to rest and engage in activities of daily living with minimal pain interference.
Nursing Assessment and Rationales
1. Observe and meticulously document the location, severity (using a 0–10 pain scale), and character of pain (e.g., steady, intermittent, colicky).
Rationale: Detailed pain assessment is fundamental for differentiating the underlying causes of abdominal pain. Characterizing the pain helps distinguish biliary colic from other types of abdominal discomfort. Pain severity assessment using a standardized scale provides a baseline and monitors the effectiveness of pain management interventions. Documentation tracks disease progression, complication development, and response to treatment.
2. Carefully note the patient’s response to pain medication and promptly report to the physician if pain is not adequately relieved by prescribed measures.
Rationale: Persistent, severe pain that is unresponsive to routine pain management may signal developing complications, such as gallbladder rupture or progression of inflammation, or indicate the need for alternative or more aggressive interventions. Prompt communication with the physician ensures timely reassessment and adjustment of the treatment plan.
Nursing Interventions and Rationales
1. Promote bed rest and assist the patient to assume a position of comfort.
Rationale: Bed rest in a low-Fowler’s position can help reduce intra-abdominal pressure and may alleviate pain. However, allowing the patient to assume a position of comfort is paramount, as individuals will instinctively seek the least painful position, which may vary.
2. Use soft or cotton linens, apply calamine lotion or oil baths, and utilize cool or moist compresses as indicated.
Rationale: While not directly related to the source of abdominal pain, these comfort measures address potential secondary discomforts. Soft linens minimize skin irritation. Calamine lotion or oil baths can soothe itching if jaundice is present. Cool or moist compresses may provide localized relief from abdominal discomfort, although their primary benefit is often psychological comfort.
3. Control the environmental temperature to maintain a cool room.
Rationale: A cool environment can contribute to overall patient comfort and may indirectly help minimize dermal discomfort, especially if fever is present.
4. Encourage the use of relaxation techniques such as deep breathing exercises and guided imagery. Provide diversional activities like reading or listening to music.
Rationale: Relaxation techniques and diversional activities are non-pharmacological pain management strategies. They promote rest, reduce muscle tension, and redirect the patient’s attention away from the pain, enhancing coping mechanisms and potentially reducing the perception of pain.
5. Make time to actively listen to the patient and maintain frequent, reassuring contact.
Rationale: Anxiety can amplify pain perception. Providing emotional support, actively listening to the patient’s concerns, and maintaining frequent contact can help alleviate anxiety, promote a sense of security, and refocus attention, indirectly contributing to pain relief.
6. Maintain NPO status and insert and/or maintain NG suction as indicated.
Rationale: Maintaining NPO status and utilizing NG suction are crucial in managing acute cholecystitis. These measures remove gastric secretions that stimulate the release of cholecystokinin, a hormone that triggers gallbladder contractions. Reducing gallbladder stimulation helps minimize pain associated with gallbladder spasms and inflammation.
7. Administer medications as prescribed and indicated:
-
7.1. Analgesics: (e.g., opioids like morphine or hydromorphone, or non-opioids like ketorolac)
Rationale: Analgesics are the mainstay of pain management in acute cholecystitis. Opioid analgesics are often required for severe biliary colic, while non-opioids may be used for milder pain or in conjunction with opioids. Pain medication aims to reduce pain intensity and improve patient comfort. -
7.2. Antispasmodics: (e.g., hyoscyamine, dicyclomine)
Rationale: Antispasmodics can help reduce smooth muscle spasms in the biliary tract, potentially alleviating pain associated with biliary colic. -
7.3. Sedatives: (e.g., phenobarbital – Note: Sedatives are less commonly used for primary pain management in acute cholecystitis; analgesics and antispasmodics are preferred.)
Rationale: Sedatives may be used adjunctively to promote rest and relaxation, especially if anxiety is exacerbating pain. However, they are not primary pain relievers in this context. -
7.4. Monoctanoin (Moctanin) (This medication is used for dissolving retained gallstones after cholecystectomy, not typically for acute cholecystitis pain.)
Rationale: Monoctanoin is a solvent used to dissolve cholesterol gallstones. It is administered via a nasal-biliary tube post-cholecystectomy to address retained stones in the bile duct. It is not a pain medication and not indicated for acute pain management in cholecystitis. -
7.5. Smooth muscle relaxants: (e.g., papaverine, nitroglycerin, amyl nitrite – Note: Nitroglycerin and amyl nitrite are more commonly used for cardiac conditions; papaverine may be used, but less frequently than antispasmodics.)
Rationale: Smooth muscle relaxants aim to relieve ductal spasms and reduce biliary colic pain. Papaverine is a smooth muscle relaxant; nitroglycerin and amyl nitrite are vasodilators that can also relax smooth muscles, but their use in biliary colic is less common. -
7.6. Chenodeoxycholic acid (Chenix), ursodeoxycholic acid (Urso, Actigall) (These are oral bile acids used for dissolving small cholesterol gallstones over time, not for acute pain relief.)
Rationale: These bile acids are used for oral dissolution therapy for small, cholesterol-based gallstones in patients who are not surgical candidates. This is a long-term treatment (months to years) and is not for acute pain management. Effectiveness depends on stone size, number, and gallbladder function.
Risk for Imbalanced Nutrition: Less Than Body Requirements
Patients with cholecystitis and cholelithiasis are at significant risk for imbalanced nutrition: less than body requirements. This risk is multifactorial, resulting from dietary restrictions imposed to prevent symptom exacerbation, nutrient losses due to impaired digestion and absorption, specifically fat malabsorption, and pain and dyspepsia leading to reduced oral intake. These factors can collectively contribute to malnutrition and nutrient deficiencies, potentially weakening the immune system, hindering healing processes, and worsening the inflammatory response.
Nursing Diagnosis
- Risk for Imbalanced Nutrition: Less Than Body Requirements
Risk factors may include
- Self-imposed or prescribed dietary restrictions (e.g., low-fat diets).
- Nausea and vomiting, dyspepsia (indigestion), abdominal pain.
- Loss of nutrients due to malabsorption, particularly fat malabsorption from bile flow obstruction.
Possibly evidenced by
(Similar to “Risk for Deficient Fluid Volume”, “Possibly evidenced by” is not directly applicable to “Risk for” diagnosis.)
Desired Outcomes
- The patient will report a reduction in nausea and vomiting.
- The patient will demonstrate a progression toward desired weight maintenance or gain, as appropriate for their individual needs.
- The patient will tolerate a diet that meets nutritional needs without exacerbating symptoms.
Nursing Assessment and Rationales
1. Calculate and document daily caloric intake. Minimize negative comments about the patient’s appetite or food intake.
Rationale: Accurate calorie counts help identify nutritional deficits and guide dietary interventions. Negative comments or pressure regarding eating can create a negative atmosphere around mealtimes, further diminishing appetite and intake. A neutral and supportive approach is more conducive to encouraging nutritional intake.
2. Weigh the patient regularly, as indicated by the care plan and patient status.
Rationale: Regular weight monitoring provides an objective measure of nutritional status and the effectiveness of dietary interventions. Weight loss or failure to gain weight (when indicated) may signal inadequate nutritional intake.
3. Assess for signs and symptoms of abdominal distension, frequent belching (eructation), guarding behavior, and reluctance to move.
Rationale: These nonverbal cues can indicate discomfort associated with impaired digestion, gas pain, and abdominal fullness. They may suggest intolerance to food or specific food types and guide dietary modifications.
4. Monitor relevant laboratory studies, such as BUN, prealbumin, albumin, total protein, and transferrin levels.
Rationale: These laboratory values provide objective data on the patient’s nutritional status. BUN (blood urea nitrogen) can be affected by hydration and protein intake. Prealbumin, albumin, total protein, and transferrin are markers of protein status and can indicate protein-calorie malnutrition. Serial monitoring helps assess nutritional deficits and the effectiveness of nutritional support interventions.
Nursing Interventions and Rationales
1. Consult with the patient to identify food preferences, dislikes, foods that trigger distress, and preferred meal schedules.
Rationale: Involving the patient in meal planning promotes a sense of control and autonomy, which can improve appetite and encourage dietary intake. Understanding individual preferences and intolerances allows for tailoring dietary plans to maximize nutrient intake while minimizing discomfort.
2. Create a pleasant and relaxing atmosphere at meal times; remove any noxious stimuli from the eating environment.
Rationale: A pleasant and calm eating environment promotes relaxation and can enhance appetite. Removing unpleasant sights, sounds, or odors reduces nausea triggers and makes mealtimes more appealing.
3. Provide thorough oral hygiene before meals.
Rationale: A clean and fresh mouth can improve taste perception and enhance appetite. Good oral hygiene removes unpleasant tastes and odors, making food more palatable.
4. Offer effervescent drinks with meals, if tolerated by the patient.
Rationale: Effervescent drinks may help settle the stomach, reduce nausea, and relieve gas. However, it’s crucial to monitor tolerance, as carbonated beverages can sometimes exacerbate gas and gastric discomfort in some individuals.
5. Encourage ambulation and increased activity levels as tolerated.
Rationale: Physical activity, even gentle ambulation, can aid in the expulsion of flatus, reduce abdominal distension, and stimulate appetite. Increased mobility also contributes to overall well-being, prevents complications of immobility, and supports recovery.
6. Consult with a registered dietitian or nutritional support team as indicated.
Rationale: Dietitians are experts in nutritional assessment and therapy. Consultation is essential for patients with significant nutritional risks or deficits. Dietitians can conduct comprehensive nutritional assessments, calculate individualized nutritional needs, and recommend the most appropriate dietary modifications or nutritional support strategies (e.g., enteral or parenteral nutrition).
7. Initiate a low-fat liquid diet once the NG tube is removed and bowel sounds return.
Rationale: Following NG tube removal and the return of bowel function, a gradual dietary progression begins. A low-fat liquid diet is typically the initial step, as it is easily digestible and minimizes gallbladder stimulation. Limiting fat intake reduces the gallbladder’s workload and pain associated with fat digestion.
8. Advance the diet gradually as tolerated, typically progressing to a low-fat, high-fiber diet. Restrict gas-producing foods (e.g., onions, cabbage, popcorn) and foods or fluids high in fats (e.g., butter, fried foods, nuts).
Rationale: A low-fat, high-fiber diet is generally recommended for long-term management of cholecystitis. This dietary approach meets nutritional requirements while minimizing gallbladder stimulation and reducing the risk of symptom recurrence. High-fiber foods promote bowel regularity, while avoiding gas-producing foods and high-fat items helps prevent digestive discomfort and gallbladder attacks.
9. Administer bile salts (e.g., Bilron, Zanchol, dehydrocholic acid (Decholin)) as prescribed.
Rationale: Bile salts can aid in the digestion and absorption of fats, fat-soluble vitamins, and cholesterol, particularly in cases of chronic cholecystitis where bile flow may be impaired. These medications supplement the body’s natural bile production and improve nutrient absorption.
10. Provide parenteral and/or enteral feedings as needed, based on nutritional status and clinical condition.
Rationale: Parenteral nutrition (IV feeding) or enteral nutrition (tube feeding) may be necessary for patients who cannot meet their nutritional needs orally, particularly if they have prolonged nausea, vomiting, or are NPO for an extended period. The route and type of nutritional support depend on the severity of nutritional deficits, gallbladder involvement, and the need for gastric rest.
Deficient Knowledge
Patients with cholecystitis and cholelithiasis may experience deficient knowledge regarding their condition. This knowledge deficit can arise from a lack of prior information, misinformation about the disease, misinterpretation of available information, and unfamiliarity with medical terminology and concepts related to cholecystitis. Deficient knowledge can lead to increased anxiety, confusion, poor adherence to treatment plans, and the development of preventable complications. Patient education is paramount to empower individuals to manage their health effectively.
Nursing Diagnosis
- Deficient Knowledge
May be related to
- Lack of exposure to information resources.
- Cognitive limitations or barriers to learning.
- Misinterpretation of information.
- Unfamiliarity with the disease process and treatment regimen.
Possibly evidenced by
- Patient questions and requests for information.
- Statements of misconceptions about cholecystitis or its management.
- Inaccurate follow-through of prescribed instructions.
- Development of preventable complications due to lack of understanding.
Desired Outcomes
- The patient will verbalize an understanding of the cholecystitis disease process, prognosis, and potential complications.
- The patient will verbalize an understanding of their therapeutic needs, including medications, dietary modifications, and lifestyle changes.
- The patient will actively participate in their treatment regimen and initiate necessary lifestyle modifications to manage their condition.
Nursing Assessment and Rationales
1. Thoroughly review the cholecystitis disease process and prognosis with the patient. Discuss hospitalization procedures and anticipated treatments as indicated. Encourage questions and open expression of concerns.
Rationale: Providing a foundational knowledge base empowers patients to make informed decisions about their care. Effective communication, coupled with emotional support, can reduce anxiety associated with the unknown and promote a sense of control, facilitating the healing process.
2. Review the patient’s medication regimen in detail, including the purpose of each medication, dosage, administration instructions, and potential side effects.
Rationale: Gallstone recurrence is common, and long-term medication therapy may be necessary. Patients need to understand their medication regimen to ensure adherence and manage potential side effects. For example, patients taking chenodiol should be aware that diarrhea or cramps may occur and are often dose-related and manageable. It’s also crucial to counsel women of childbearing age about the risks of pregnancy while on certain medications and the need for effective contraception.
3. Thoroughly review signs and symptoms that warrant prompt medical intervention. These include:
- Recurrent fever
- Persistent nausea and vomiting
- Worsening or unrelieved pain
- Jaundice (yellowing of skin or eyes)
- Pruritus (itching)
- Dark urine
- Clay-colored stools
- Blood in urine, stools, or vomitus
- Bleeding from mucous membranes
Rationale: Patient education on warning signs is crucial for early detection of disease progression or complications. Prompt recognition of these symptoms and seeking timely medical attention can prevent serious outcomes and facilitate timely interventions.
Nursing Interventions and Rationales
1. Clearly explain the reasons for diagnostic tests and procedures, and provide thorough preparation instructions as needed.
Rationale: Providing clear explanations about tests and procedures can reduce patient anxiety associated with the unknown. Reduced anxiety minimizes sympathetic nervous system stimulation, which can have physiological benefits.
2. Discuss weight reduction programs and resources if indicated for the patient.
Rationale: Obesity is a significant risk factor for cholecystitis and gallstone formation. Weight loss, if appropriate for the patient, is a beneficial component of long-term medical management for chronic cholecystitis and can reduce the risk of future gallbladder attacks.
3. Provide detailed instructions on dietary modifications, specifically advising the patient to avoid foods and fluids high in fats (e.g., pork, gravies, nuts, fried foods, butter, whole milk, ice cream), gas-producing foods (e.g., cabbage, beans, onions, carbonated beverages), and gastric irritants (e.g., spicy foods, caffeine, citrus).
Rationale: Dietary modifications are a cornerstone of cholecystitis management. Avoiding these food categories helps limit gallbladder stimulation, prevent symptom exacerbations, and reduce the likelihood of recurrent gallbladder attacks.
4. Recommend resting in a semi-Fowler’s position after meals.
Rationale: The semi-Fowler’s position (sitting semi-upright) after meals promotes bile flow and gastric emptying. It also encourages general relaxation during the initial digestive process, potentially reducing discomfort.
5. Counsel the patient to limit or avoid gum chewing, sucking on straws or hard candy, and smoking.
Rationale: These habits can promote excessive air swallowing, leading to increased gas formation in the gastrointestinal tract. Increased gastric distension can exacerbate discomfort and bloating.
6. Advise the patient to avoid aspirin-containing products, forceful nose blowing, straining during bowel movements, and contact sports.
Rationale: Patients with cholecystitis, particularly if there is liver involvement, may have altered coagulation. Avoiding these activities minimizes the risk of bleeding complications related to impaired coagulation, mucosal irritation, and potential trauma.
7. Recommend the use of a soft-bristled toothbrush and an electric razor.
Rationale: Using a soft toothbrush and electric razor reduces the risk of bleeding from gums and skin cuts, respectively, in patients who may have impaired coagulation due to cholecystitis-related liver dysfunction.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning CareWe love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
