NU140 Unit 10 Final Care Plan Example

Fluids First, Then Pain, Then Food: A Final Care Plan Ranking Three Nursing Diagnoses for a Composite 58-Year-Old Woman Admitted With Gallstone Pancreatitis, Worked Through to Evaluation and Revision

[Student Name]

Purdue University Global

NU140: Nursing Fundamentals

Unit 10 Final Care Plan

[Instructor Name]

[Date]

The patient is composite; values and volumes are bracketed where illustrative, and medical orders are the provider's.

The Patient

[Mrs. C.], a composite 58-year-old school bus driver, arrived by ambulance doubled over with upper abdominal pain boring through to her back, which began after a large dinner. She has vomited five times. Her heart rate is [118], blood pressure [102/64], temperature [37.9] C, and respirations [22]. Her mucous membranes are dry, and she has passed little urine since morning. Her lipase is [1,480] U/L, far above the laboratory's range, and an ultrasound shows gallstones. She rates her pain [9] out of 10 and lies curled on her side. Her provider has ordered nothing by mouth, IV fluids, IV pain medicine and close monitoring.

Assessment Summary

The key cues are signs of fluid loss and shift (fast pulse, lower blood pressure, dry mouth, low urine output, vomiting), severe pain, and an inability to eat. In acute pancreatitis, inflammation makes blood vessels leak, and large volumes of fluid can move out of the circulation into the tissues around the pancreas, so a patient can be dangerously low on circulating volume even before much fluid is visibly lost. Early, adequate IV fluid is a central part of treatment in the first day (Tenner et al., 2013).

Ranking the Diagnoses

1. Deficient fluid volume related to vomiting and fluid shift from inflamed tissues, as evidenced by tachycardia, low blood pressure for her, dry mucous membranes and low urine output. It ranks first because falling circulating volume threatens perfusion to the kidneys, brain and heart and can progress to shock.

2. Acute pain related to pancreatic inflammation, as evidenced by a rating of 9, guarding and a curled position. It ranks second: it is severe and must be treated promptly, and pain also raises heart rate and breathing, but it is not immediately life-threatening in the way volume loss is.

3. Inadequate nutritional intake, linked to the nothing-by-mouth order and repeated vomiting. It ranks third because nutrition can safely wait a short time while fluid and pain are addressed, and early feeding is started as soon as she can tolerate it.

Pain is the problem she would rank first; fluid is the problem that can harm her fastest, and the plan explains that difference to her.

Diagnosis One: Deficient Fluid Volume

Outcome: within 12 hours, heart rate below [100], systolic blood pressure above [110], urine of [35] mL or more each hour, and moist mucous membranes. Interventions and rationales: give IV fluids at the prescribed rate and monitor response, because early adequate fluid replacement supports perfusion in pancreatitis; measure vital signs hourly at first, because rising heart rate or falling pressure signals worsening deficit; record intake and output hourly with a urine meter if ordered, because urine output reflects kidney perfusion; listen to lung sounds and watch for breathlessness, because aggressive fluids can cause overload; check laboratory results such as hematocrit and BUN as ordered, because rising values suggest continuing deficit.

Diagnosis Two: Acute Pain

Outcome: pain rating of [4] or less within one hour of each dose, and ability to rest and change position. Interventions and rationales: give IV analgesics as prescribed and reassess within an hour, because pancreatitis pain is severe and undertreated pain increases stress responses; help her into a position of comfort, often sitting up and leaning forward or lying on her side with knees bent, because these positions can ease tension on the inflamed area; keep the environment quiet and explain each procedure, because anxiety heightens pain.

Diagnosis Three: Imbalanced Nutrition

Outcome: tolerates a low-fat diet within [48] to [72] hours without increased pain or vomiting. Interventions and rationales: maintain nothing by mouth as ordered while vomiting continues, with frequent mouth care, because oral comfort matters when she cannot drink; give antiemetics as prescribed; when her pain eases and vomiting stops, start oral intake as ordered with small low-fat meals, because early feeding is now preferred in mild pancreatitis when tolerated (Tenner et al., 2013); weigh daily.

Evaluation and Revision

At 12 hours, the fluid outcome was partly met: her heart rate fell to [96] and urine output reached [0.6] mL per kilogram per hour, but she developed crackles at both lung bases and her breathing rate rose to [26]. The provider was notified, the fluid rate was reduced, and oxygen was started; the plan was revised to add four-hourly lung assessment and daily weights to detect overload. Pain outcomes were met after the second dose, with ratings of [3] to [4]. By day three she tolerated clear liquids and then a low-fat diet. A new teaching need was added: preparing her for a planned gallbladder removal during this admission, since gallstones caused the attack and may cause another (Potter et al., 2023).

Summary

The plan shows why the patient's most pressing complaint is not always the first priority, how each problem's outcome guides evaluation, and why a care plan is revised as the patient changes. Using standard diagnoses keeps the ranking clear to the whole team (Herdman et al., 2024).

References

Herdman, T. H., Kamitsuru, S., & Takáo Lopes, C. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.

Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology guideline: Management of acute pancreatitis. The American Journal of Gastroenterology, 108(9), 1400-1415. https://doi.org/10.1038/ajg.2013.218