PRAKASH COLLEGE OF NURSING

CASE STUDY ON

JAUNDICE

SUB -MEDICAL SURGICAL NURSING

Submitted To - Submitted By -

Ms Anjali Kamini

Nursing Lecturer Msc (N) 1st yr

PIPRAMS PIPRAMS

Submitted On -
0 1/04/2021
.

General objectives:

At the end of class students will able to understand and gain knowledge regarding
jaundice and implementing the patient in clinical area.

Specific objectives:

Students will able to

 Introduce the jaundice

 Define the definition of jaundice
 Enumerate the etiological and risk factors, classification/ types of jaundice
 Explain the pathophysiology of jaundice
 Know the diagnostic evaluation of jaundice
 List out the clinical manifestation of jaundice
 Describe the medical management of jaundice
 Discuss the nursing management of jaundice
 Conclude the jaundice
 INTRODUCTION

I am Kamini, studying 1st year M.Sc (N) in Prakash College of Nursing Dept of

Medical Surgical Nursing.

Mr. Rahul, 25 years, male from Greater noida in Prakash Hospital in Emergency

ward on 29-3-21 at 4:30pm under the consultant of Dr. Naveen with the complains of

yellowing of the skin and the whites of the eyes

 IDENTIFICATION

Student Profile Patient Profile

Name Of The Student: Kamini Name of the patient: Mr. Rahul
M.Sc(N) 1st yr
Age:25yr
Subject: Medical Surgical Nursing
Sex: male
Topic: jaundice

Submitted to: Ms Anjali Address: Greater Noida

Nursing Lecturer
Dept.of Medical Surgical Nrsing E.P NO: 11794104
Submitted on:
Bed no:1 Ward:EW
1/04/21
Education: Graduate
Venue:
Occupation: computer
hospital
operator
Time duration:
Marital status: single
No.of.persons attended
Date of admission:
date of care started
29/03/21 at 4:30pm
total days of nursing care
Name of the doctor: Dr. Naveen
 Diagnosis: jaundice

HISTORY COLLECTION

Chief complains:

My patient Mr. Rahul, 25years, male admitted in Prakash Hospital complains yellowing of the
skin and the whites of the eyes last 2 days.

Present medical history:

He admitted in EW due to yellowing of the skin and the whites of the eyes2 days on
wards with complain of jaundice as diagnosed by physician

Past medical history:

There is no past medical history

Present surgical history:

Not significant of surgical history

Family history:

Family profile:

Slink name of the family age sex relation occupation remark

members ship
1 L.Nooka raju 50y M Father Employ -
-
2 L.Lakshmi 45y F mother House
wife
3. Rahul 25y M Patient Com.O Unhealthy
prea-
tor
 Nutritional history:

Sl.no Time Diet Amount Caloric Protein Carbohydrate Fat

1. 7am milk idly 150ml 110k.cal 3.0 4.0 3.8
2. 8-30am -2 2nos 372k.cal 6.9 58.9 0.2
with chutney
3. 12:30pm rice with 200 grms 690k.cal 6.9 74.5 5.2
curry
4. 4:00pm milk 150ml 150 110k.cal 3.0 4.0 3.8
5. 8:30pm rice with grms 372k.cal 20.8 58.9 0.2
curry

Personal history:

Diet: patient diet includes vegetarian and non vegetarian. he takes food in per day 3 times
& non veg-2 times/week.

Rest & sleep: disturbed sleep pattern

Elimination: abnormal bowel & bladder (bowel – constipation & urination is frequently
& small amount of urine is passing)

Socio economic history: nil

Environmental history:- Housing:

building and own house Ventilation:

adequate ventilation Electricity:

present

Water supply: municipality tap

Physical examination:

vitals signs patient value normal value remarks

Temperature 98.60F 98.60F normal
Pulse 92b/min 72b/min abnormal
Respiration 22b/min 16-18b/min abnormal
Blood pressure 120/60mmhg 120/80mmhg abnormal
Spo2 93% 100% normal
Genarl appearance:

Consciousness: conscious

Orientation: oriented time, place, and date

Nourishment: moderate nourished Health: un

healthy

Body build: moderate

Activity: dull

Look: anxious

Hygiene: moderately hygiene

Speech: clear

REVIEW OF SYSTEMS

Skin /integumentary system:

Colour: black

Texture: wrinkles skin/dry skin Skin

turgor: present Hydration: well

hydrated

Discolouration: no discolouration of skin

Subjective symptoms: dry skin is present Nails:

Nail beds: pale in colour

Nail plates: flat, absnce of clubbing Cyanosis: no

central and peripheral cyanosis Colour: black

Texture: dry
Eyes:

eye brows: symmetric Eyelashes:

equally distributed Papillary

reflex: abnormal Conjunctiva:

abnormal

Vision: abnormal vision (blurred vision)

Ears:

Pinna: normally placed

Cerumen: no defect

Otarrhea: no discharges from ear Hearing:

no defect in hearing process Nose:

Nasal septum: no deviation of nasal septum

Nasal pathway: clear nasal pathway

Smell: no defect

Mouth & pharynx:

Lips: absence of cracks and pale in colour

Tongue: coated tongue

Bleeding : no history of bleeding Tooth

decay: history of tooth decay Dental care: no

history of dental caries Neck:

ROM: not possible

Lymph nodes: not palpable

Trachea: present in midline

Thyroid gland: not enlarged

Jugular vein: not distended.

SYSTEMIC EXAMINATION
Respiratory system:

History of smoking: smoking habit is evident but at present he has stopped

Sputum: sputum with thick expectoration

Asthma: no h/o asthma

Wheezing: present

Haemoptysis: no H/o of haemoptysis

Cough: present

Shortness of breath: present

Inspection: on inspection the thoracic cavity is normal, no deviations, no lesions are found

Palpation: no palpable masses detected on palpation

Percussion: on percussion wheezing sounds and adventious breath sounds are evident

Auscultation: on auscultation rounchi, wheezing sounds are evident. Abnormal bronchial vesicular
sounds are evident.

Cardiovascular system:

H/O hypertension: hypertensive Varicose

veins: no H/o varicose veins Dyspnoea:

present

Orthopnea: not evident

 Chest pain: evident

Palpitation: present

Heart sounds: present S1 S2 sounds

Pluse:92b/min

Heart beat: abnormal rate and rhythm

Inspection: on inspection the thoracic cavity is normal and clear, no lesions detected, sutured
mark presented

Palpation: no palpable masses detected

Percussion: no percussion performed

Auscultation: on auscultation at 5 areas , pulmonic, aortic, erbs point, mitral, apical area. S1
S2 sounds are clear and gallop sounds present

INVESTIGATIONS

Slink Name of the Pt value Normal value Remarks

investigation
1. Hb% 11.1gms 12-14gms abnormal
2. TWBC 8300cells/cumm 1,500000cells/cumm abnormal
3. DC P 86% 4,5000c/cumm abnormal
L 11%
E 0.3%
4. platelet count 1.7 laks/cumm
bil.urea 47mg/dl 10-40mg/dl abnormal
5. 0.5-1.4mg/dl normal
sr. creatine 1.0
6. ECG normal abnormal
7.  Extreme
tachycardia
 lt.ant. hemi
block
 invented T
wave
 ST-T
abnormality
 excessive
overload of
lt. atrium, lt.
 ventricular
hypertrophy
8. x-ray abnormal abnormal abnormal

MEDICATIONS

Slink Medications Dose Route Time Nursing responsibility

1. Inj. Dytor20 1gm IV BD  assess the patient general
2. Inj. Taxim 1gm IV th condition of client
8
hrly  observe the client for side
3. Inj. PNZ 40mg IV OD effects
4. T. Ivas T.Mtoprolol 10mg oral BD  immediate nursing
oxygen inhalation 25mg oral OD intervention are to be done
5.
6. floret}  administration of
7. nitrofix} nebulisation alternatives agonist to prevent
duolin} the sid effects
 administer continuous oxygen
inhalation

LIVER

INTRODUCTION:

 The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the
oral cavity, where food enters the mouth, continuing through the pharynx,
oesophagus, stomach and intestines to the rectum and anus, where food is expelled.
 There are various accessory organs that assist the tract by secreting enzymes to help
break down food into its component nutrients. Thus the salivary glands, liver,
pancreas and gall bladder have important functions in the digestive system.
 Food is propelled along the length of the GIT by peristaltic movements of the
muscular walls. ANATOMY AND PHYSIOLOGY:
 The primary purpose of the gastrointestinal tract is to break food down into nutrients,
which can be absorbed into the body to provide energy. First food must be ingested
into the mouth to be mechanically processed and moistened.
 Secondly, digestion occurs mainly in the stomach and small intestine where proteins,
fats and carbohydrates are chemically broken down into their basic building blocks.
 Smaller molecules are then absorbed across the epithelium of the small intestine and
subsequently enter the circulation. The large intestine plays a key role in reabsorbing
excess water. Finally, undigested material and secreted waste products are excreted
from the body via defecation (passing of faeces).
 In the case of gastrointestinal disease or disorders, these functions of the
gastrointestinal tract are not achieved successfully. Patients may develop symptoms of
nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction.
  Gastrointestinal problems are very common and most people will have experienced
some of the above symptoms several times throughout their lives.

ANATOMY OF GASTROINTESTINAL:

UPPER GASTROINTESTINAL TRACT

The upper gastrointestinal tract consists of the esophagus, stomach, and

duodenum.The exact demarcation between "upper" and "lower" can vary. Upon dissection,
the duodenum may appear to be a unified organ, but it is often divided into two parts based
upon function, arterial supply, or embryology.

LOWER GASTROINTESTINAL TRACT

The lower gastrointestinal tract includes most of the small intestine and all of the large
intestine. According to some sources, it also includes the anus.

 Bowel or intestine
 Small Intestine: Has three parts:
 Duodenum: Here the digestive juices from the pancreas(digestive enzymes) and
hormones and the gall bladder (bile) mix. The digestive enzymes break down
proteins and bile andemulsify fats into micelles. The duodenum contains
Brunner's glands which produce bicarbonate. In combination with bicarbonate
from pancreatic juice, this neutralizes HCl of the stomach.
 Jejunum: This is the midsection of the intestine, connecting the duodenum to the
ileum. It contains the plicae circulares, and villi to increase the surface area of
that part of the GI Tract. Products of
 digestion (sugars, amino acids, fatty acids) are absorbed into the bloodstream.
 Ileum: Has villi and absorbs mainly vitamin B12 and bile acids, as well as any
other remaining nutrients.
 Large Intestine: Has three parts:
 Caecum: The Vermiform appendix is attached to the caecum.
 Colon: Includes the ascending colon, transverse colon, descending colon and
sigmoid Flexure: The main function of the Colon is to absorb water, but it also
contains bacteria that produce beneficial vitamins like vitamin K.
 Rectum

 Anus: Passes fecal matter from the body.

The Ligament of Treitz is sometimes used to divide the upper and lower GI tracts

FUNCTIONS OF LIVER:

The liver regulates most chemical levels in the blood and excretes a product called
bile, which helps carry away waste products from the liver. All the blood leaving the stomach
and intestines passes through the liver. The liver processes this blood and breaks down the
nutrients and drugs into forms that are easier to use for the rest of the body. More than 500
vital functions have been identified with the liver. Some of the more well-known functions
include the following:
  Production of bile, which helps carry away waste and break down fats in the small
intestine during digestion
 Production of certain proteins for blood plasma
 Production of cholesterol and special proteins to help carry fats through the body
 Conversion of excess glucose into glycogen for storage (glycogen can later be
converted back to glucose for energy)
 Regulation of blood levels of amino acids, which form the building blocks of
proteins
 Processing of hemoglobin for use of its iron content (the liver stores iron)
 Conversion of poisonous ammonia to urea (urea is an end product of protein
metabolism and is excreted in the urine)
 Clearing the blood of drugs and other poisonous substances
 Regulating blood clotting
 Resisting infections by producing immune factors and removing
bacteria from the bloodstream
When the liver has broken down harmful substances, its by-products are excreted into
the bile or blood. Bile by-products enter the intestine and ultimately leave the body in the
form of feces. Blood by-products are filtered out by the kidneys, and leave the body in the
form of urine.

DEFINITION:

The liver is an important organ of the body that is responsible for detoxification,
metabolism, synthesis and storage of various substances.
It's the largest internal organ in the body (the skin is considered the largest organ in the entire
body) and it weighs about 3 pounds (1500g). It's located just under the ribs in the right
upper part of the abdomen. Most of the liver is
protected by the rib cage, but it is possible for doctors to feel the edge of it by pressing deep
into the abdomen when the patient inhales a big breath of air.

Risk Factors
Factors that may increase your chances of getting jaundice are similar to risk factors for liver
and gallbladder disorders. They may include:
 Drinking too much alcohol
 Using illicit drugs
 Taking medicines that may harm the liver
 Being exposed to hepatitis A, hepatitis B, or hepatitis C
 Being exposed to certain industrial chemicals

Causes of Acute Liver Failure In

Infants
 Infections: Herpes simplex, echovirus, adenovirus, hepatitis B,
parvovirus, others
 Drugs / toxins: Acetaminophen
 Cardiovascular: Extracorporeal membrane oxygenation, hypoplastic left heart
syndrome, shock, asphyxia, myocarditis
 Metabolic: Galactosemia, tyrosinemia, iron storage, mitochondrial
condition, HFI, fatty acid oxidation, others

In Toddlers and Older Children

 Infections: Hepatitis A, B and D, NANB hepatitis, Epstein-Barr virus,
cytomegalovirus, herpes, leptospirosis, others
 Drugs / toxins: Valproic acid, isoniazid, halothane, acetaminophen, mushroom,
phosphorous, aspirin, others
 Cardiovascular: Myocarditis, heart surgery, cardiomyopathy, Budd-
Chiari syndrome
  Metabolic: Fatty acid oxidation, Reye's syndrome, leukemia, others

PATHOPHYSIOLOGY:
 BOOK PICTURE PATIENT PICTURE
CLINICAL MANIFESTATION: CLINICAL MANIFESTATION:
The manifestations of heart failure
depends on the specific ventricular involved  breathlessness
the precipitating cause of failure, the degree  cough
of impaired, the rate of progression the
 fever
duration of the failure and the clients
underlying conditions.  oedema in lower extremities
The signs and symptoms of heart failure  tachycardia
can be related to which ventricles are  increased pulse and respiration rate
affected. Left sided heart failure causes  oliguria
different manifestations then right sided heart
 insomnia
failure. In chronic heart failure. Patient may
have right and left ventricular failure.
left side heart failure:
 Pulmonary congestion includes:-
dysnea, cough, pulmonary crackles low
oxygen saturation levels
heart sounds s3 or ventricular gallop
detected on auscultation, orthopnea,
paraxymal nocturnal dysnea, adventitious
breath sounds heard in various areas of
lungs, oliguria, insomnia, tachycardia,
palpitations
right side heart failure:
 Congestion in peripheral tissues
and the viscra predominates
 Increased jugular venous distension
 Systemic clinical manifestation:
 oedema of lower extremities
 hepatomegaly
 as cites
 anorexia and nausea, weakness and Assessing for heart failure:
weight gain due to retention of fluid general:
Assessing for heart failure:  fatigue
general:  decreased activity tolerance
 fatigue  dependent edema
 decreased activity tolerance
 dependent edema
  weight gain
cardiovascular: cardiovascular:
 third heart sound s3  apical impulses enlarged with left
 apical impulses enlarged with lateral displacement
leftlateral displacement  jugular venous distension(JVD)
 pallor and cyanosis
 jugular venous distension(JVD)
respiratory: respiratory:
 dysnea on exertion  dysnea on exertion
 pulmonary crackles that don’t clear  pulmonary crackles that don’t clear
with cough with cough
 paroxysmal nocturnal dysnea
 orthopnea
(PND)
 paroxysmal nocturnal dysnea
(PND)
cerbro vascular:
cerbro vascular:
 un explained confusion or
 un explained confusion or
altered mental status
altered mental status
 light headedness
 light headedness
renal:
renal:
 oliguia and decreased frequency
 oliguia and decreased frequency
during the day
during the day
 nocturia
gastro intestinal:
gastro intestinal:
no significance
 anorexia and nausea
 enlarged liver
 ascites
 hepato jugular reflux
DIAGNOSTIC EVALUATIONS
DIAGNOSTIC EVALUATIONS
 history collection and physical
 history collection and physical examination
examination  Hemoglobin
 assessment of ventricular function  Total White Blood Count
 serum chemistries, cardiac enzymes, BNP  Direct count –P;L;E
levels, liver function tests, serum  Platelet count
electrolytes, BUN,CBC.  Bilirubin urea
 Chest x-ray  Serum creatinine
 12 lead ECG  ECG
 Echocardiography  Chest x- ray
 Exercise stress testing  Routine urinalysis
 Nuclear imagaing studies
 Hemodynamic monitoring
 Cardiac catherization
 Routine uninalysis
MEDICAL MANAGEMENT MEDICAL MANAGEMENT

 The goal of management of heart failure

to relieve patient symptoms, to improve  Inj. Dytor 20- 1gm, IV,BD
functional status and quality of life and  Inj. Taxim 1grm, IV 8th hrly
to extend survival.  Inj. PNZ 40mg, IV, OD
 medical management based on type  T. IVAS10mg oral, BD
, severity and cause of heart failure  T. Metoprolo 25mg, oral, OD
 specific objectives of medical  Continuous O2 inhalation
management includes the following  Floret
 eliminates or reduce any etiologic  Nitrofix nebulisation
contributory factors such as controlled  duolin
hyprtension or aterial fibrillation with a
rapid ventricular response
 optimize pharmacologic and other
therapeutic regimens
 reduce the work load on the heart by
reducing preload and after load
 promote a life style conducive to
cardiac health
 prevent episodes of acute
decompensate heart failure
 managing the patient with heart
failure includes providing
comprehensive education and
counselling to the patient and family
 it is important that patient and family
understand the nature of heart failure
and the importance of their participation
in the treatment regimen
 life style recommendations include
restriction of dietary sodium,
avoidance of excessive fluid intake,
alcohol and smoking weight reduction
when indicates and regular exercises
pharmacologic therapy
  angiotensin I- converting enzyme
inhibitors
 angiotensin II receptor blockers
 hydralazine and isosorbid dinitrate
 betablockers and calcium channel
blockers
 diuretics
 digitalis
 intravenous infusion
- nesiritide
- milrinome
- dobutamine
 medications for diastolic
dysfunction
other medications for heart failure:
 anticoagulants
 non steroidal inflammatory drugs Nutritional therapy:
 Provided a low sodium (2-3g/day) diet
Nutritional therapy: and avoidance of drinking excessive
amount of fluid are usually recommended
 a low sodium (2-3g/day) diet and
 dietary restriction of sodium reduces fluid
avoidance of drinking excessive amount
retention and the symptoms of peripheral
of fluid are usually recommended
and pulmonary congestion
 dietary restriction of sodium reduces fluid
 diet needs to be made with consideration
retention and the symptoms of peripheral
of good nutirion as well s the patients
and pulmonary congestion
likes and dislikes and cultural food
 diet needs to be made with consideration
patterns
of good nutirion as well s the patients
likes and dislikes and cultural food Additional therapy:
patterns  supplemented oxygen
Additional therapy:
 supplemented oxygen
 other interventions
 coronary artery revascularization with
PTCA; CABG surgery may be
considered
 ventricular function may improve in
some patients when coronary flow is
increased.
 Cardiac resynchronization therapy
 Cardiac transplantation
 Mechanical circulation assistance
 with an implanted ventricular
assist device
 ultra filtration

COLLABORATIVE THERAPY: COLLABORATIVE THERAPY:

 treatment for underlying cause  treatment for underlying cause
 o2 therapy at 2-6l/min by nasal cannula  o2 therapy at 2-6l/min by nasal cannula
 rest activity period  rest activity period
 drug therapy  drug therapy
 daily weights  daily weights
sodium restricted diet
 sodium restricted diet
 circulatory assisted devices
 cardiac resynchronization therapy with
internal cardio ventricular defibrillator
 cardiac transplantation

Complication: Complication:
based on assessment data, potential
not significant
complication that may develop including the
following :
 hypotension, poor perfusion and
cardiogenic shock
 dysrhythmias
 thrombo embolism
 pericardial effusion and cardiac
tamponade. NURSING MANAGEMENT:

NURSING MANAGEMENT: Assessment:

Subjective data:
Assessment:  importance health information Past
Subjective data: health history: CAD,HTN, rapid or irregular
 importance health information Past heart rate.
health history: CAD,HTN,
cardiomyopathy, congenital heart disease
or valvular, DM, thyroid or lung disease
rapid or irregular heart rate. medications: use of an compliance with any
medications: use of an compliance cardiac medications, use of diuretics,
with any cardiac medications, use of corticosteroids, non steroidal
diuretics, estrogens, corticosteroids,
non steroidal inflammatory drugs, over the inflammatory drugs, over the counter drug
counter drug, herbal supplements.  Functional health pattern:
 Functional health pattern:  Health perception –health
 Health perception –health management:- fatigue, anxiety,
management:- fatigue, anxiety, depression.
depression.  Nutritional metabolic- usual sodium
 Nutritional metabolic- usual sodium intake, ankle swelling
intake, nausea, vomiting, anorexia,  Elimination: decreased day time
stomach bloating, weight gain, ankle urinary output, constipation
swelling  Activity exercises: dysnea, cough,
 Elimination: nocturia, decreased day palpitations, dizziness, fainting
time urinary output, constipation  Sleep and rest: dysnea, insomnia.
 Activity exercises: dysnea, orthopne,  Cognitive perceptual: chest pain or
cough, palpitations, dizziness, fainting heaviness, abdominal
 Sleep and rest: number of pillows used discomfort; behavioural changes; visual
for sleeping, paroxysmal nocturnal, changes.
dysnea, insomnia.
 Cognitive perceptual: chest pain or
heaviness, abdominal discomfort;
behavioural changes; visual changes.
objective data:
 Integumentary: cool, diaphoretic skin, objective data:
cyanosis or pallor, peripheral oedema.  Integumentary: cool, peripheral oedema.
 Respiration: tachypnea, crackles,  Respiration: tachypnea, wheezes, tinged
rhonchi, wheezes, frothy, blood tinged sputum.
sputum.  Cardiovascular: tachycardia, s3 &s4
 Cardiovascular: tachycardia, s3 &s4 murmurs, pulses alterations, increased
murmurs, pulses alterations, PMI jugular vein pressure
displaced inferiorly and posterior jugular  Gastro intestinal: abdominal
vein distension distension
 Gastro intestinal: abdominal  Neurologic: restlessness,
distension, hepatosplenomegaly, ascites. confusion, decreased alteration or
 Neurologic: restlessness, memory.
confusion, decreased alteration or
memory.
NURSING DIAGNOSIS:
1. Deficient Fluid Volume related to inadequate fluid intake, photo-therapy, and diarrhea.

Goal:
Adequate body fluids
Intervention:
 Record the number and quality of stools,
 Monitor skin turgor,
 Monitor intake output,

2. Hyperthermia related to the effects of phototherapy Goal:

The stability of the client's body temperature can be maintained
Intervention:
 Give a neutral ambient temperature,
 Keep the temperature between 35.5 ° - 37 ° C,
 Check vital signs every 2 hours.

3. Impaired skin integrity related to hyperbilirubinemia and diarrhea Goal:

The integrity of the client's skin can be maintained
Intervention:
 Assess skin color every 8 hours,
 Monitor direct and indirect bilirubin,
 Change position every two hours,
 Massage the area that stands out,
 Keep skin clean and moisture.
4. Anxiety related to medical therapy given to the client. Goal:
Parents know about treatment, symptoms can be identified to deliver the health care team.
Intervention:
 Review knowledge of the client's family,
 Give the cause of yellow health education, therapy and treatment process.
 Give health education on care to home.

Theory application Roy’s adaptation model

Introduction:

 Sister callista Roy began her nursing career in 1963. After receiving B.Sc(N) noting from
moult saint marry college.
 1960receives Ms in nursing
 1977 her doctorate in sociology
 Roy’s model is characterised as a system theory with a strong analogies of intervention.

General system:
 Due to set of organized components released to form a whole employee feedback
cycle of input, through put, output.

 INPUT: Input includes tensions adaption level (the range of stimuli to which persons
adaptation early)
 THROUGH PUT: through put makes use of a person processes and effect ions. Process
refers to control mechanism that a person uses as a adaptive system. Effectors refers to
the physiologic function, self concept and role function involved in adaptation.
 OUTPUT: output is the outcome of the system when system is a person. Output refers to
person’s behaviour.

Metaparadigm and RAM:

 Human being:Person is a bio psychological being in constant interaction with changing

environment and recipient the nursing care as living system
 Environment: Environment and surrounding and effect the development and behaviour
of the persons group. The internal and external are the part of the person’s environment.
For ex: elderly person admitted to hospital all the conditions of influence on him/her.
 Health: heath is a process whereby individual are striving to achieve their maximum
potential. It can be seen in healthy people, exercises regularly, not smoking pay attention
dietary pattern. It is a process to relieve acute and chronic illness and terminal stages of
diseases & to control the sign and symptoms, to promote health of the persons by
promoting adaptive responses.
 Nurses: the nurses to reduce the ineffective responses as output behaviour of the person.
The nurse promotes the health in all life processes. The nurses suggested by the model
include approaches aimed at maintaining adaptive
 responses that support the person’s effort to creativity use his or her coping mechanism.
INPUT THROUGH PUT OUT PUT

Early detection and screening programs

-The client
Demoraghpical variables of the-monitor
patient thewill
vital signs
name have knowledge
-Administer continuous oxygen & medication
age, regarding
health education about disease condition
sex, disease process
education,
occupation Adequate
income knowledge in
disease process

Rehabilitation &
follow up

Feed back
 NURSES NOTES

Name of the patient: Rahul Ward: Emergency

Age: 25years Diagnosis: jaundice
Sex: Male Dr. Name: Dr. Naveen
E.p no: 11794104 Bed. no: 4

Time Diet Medication Nurses Care Plan

30 Idly with 29/4/21 observation:
7
chutney Inj. Dytor 20 1gm IV BD Inj. Patient is very thin & less activity and
30 water 50ml Taxim 1gm IV 8th hrly Inj. weakness; cough; fever; breathlessness.
8
00 coconut PNZ 40mg IV OD  Monitored vital signs
8
water 100ml T.Ivas 10mg oral BD  Temp:98.60 F
rice porage 1 T. Metoprolo 25mg Oral OD  Pluse:92b/min
30 cup floret}  Resp:22b/min
10
nitrofix} nebulisation  Blood pressure:120/60mmhg
duolin}  SpO2: 93%
o2 inhalation  Provide position changing
frequently
 Provide complete bed rest
 Provide calm environment
 Administer medication as per
physician prescribed
 Administered O2
 Provide nebulisation
 History collection and performed
physical examination
  Provide psychological support
 Provided health education about
 Diet
 Exercises
 Personal hygiene
 Relaxation therapy.
lakshmi/St.N

HEALTH EDUCATION

 Watch patient for signs of jaundice returning or getting worse.

 Client’s skin or the whites of the eyes turn yellow.

 If jaundice gets worse, the yellow color will move from the eyes to your baby's
face; then it will move down client’s body toward the feet.

Bibliography
 Brunner &Suddarth’s “text book of Medical Surgical Nursing”, 12th edition; volume:1; page

no:825-838 & 685-690

 Lewis “text book of Medical Surgical Nursing”, Elsevier publication; page no:820-837

 Joyce. M. Black “text book of Medical Surgical Nursing”, 7th edition; volume:2; page

no:1649-1669 & 1548-559

 Ross & Willison “anatomy & physiology” 2nd edition,2001; pageno:678-682.

 Mosby doug consult for nurses, 2006, mosby publication