Cirrhosis

Cirrhosis Imbalance Nutrition: Less than Body Requirements related to anorexia, metabolic imbalance Activity Intolerance related to fatigue Assess patient's level of mobility. This aids in defining what patient is capable of, which is necessary before setting realistic goals. Encourage adequate rest periods, especially before meals, other ADLs, exercise sessions, and ambulation. Rest between activities provides time for energy conservation and recovery. Heart rate recovery following activity is greatest at the beginning of a rest period. Risk for Impaired Skin Integrity related to edema, immobility, pruritis, hypoproteinem Ineffective Breathing Patterns related to ascites Risk for Injury related to impaired coagulation Disturbed Thought Processes related to elevated blood ammonia

Copd Ineffective airway clearance Assess respirations: note quality, rate, pattern, depth, and breathing effort. Both rapid, shallow breathing patterns and hypoventilation affect gas exchange. Shallow, "sighless" breathing patterns postsurgery (as a result of effect of anesthesia, pain, and immobility) reduce lung volume and decrease ventilation. Avoid high concentration of oxygen in patients with COPD. Hypoxia stimulates the drive to breathe in the chronic CO2 retainer patient. When applying oxygen, close monitoring is imperative to prevent unsafe increases in the patient’s PaO2, which could result in apnea. NOTE: If the patient is allowed to eat, oxygen still must be given to the patient but in a different manner (e.g., changing from mask to a nasal cannula). Eating is an activity and more oxygen will be consumed than when the patient is at rest. Immediately after the meal, the original oxygen delivery system should be returned.

Stroke Impaired Physical Mobility Evaluate the safety of the immediate environment. Obstacles such as throw rugs, children’s toys, and pets can further impede one’s ability to ambulate safely.

Provide positive reinforcement during activity. Patients may be reluctant to move or initiate new activity due to a fear of falling. Allow patient to perform tasks at his or her own rate. Do not rush patient. Encourage independent activity as able and safe. Hospital workers and family caregivers are often in a hurry and do more for patients than needed, thereby slowing the patient’s recovery and reducing his or her self-esteem.