1. Bertha Banner Diagnosis: Post-cesarean surgical site infection, obesity Age: 42 Weight: 183lbs/83kg Height: 62cm

2. Cont’d Marital status: married to Bruce Banner Cultural information: Jehovah’s Witness Economic status: middle class Dwelling: apartment above bakery Job: Baker/entrepreneur Main support/care giver: husband Other pertinent information: poor nutrition, hypertension, limited activity, arthritis, high cholesterol, 4 children, chronic lumbar pain

3. Admitting Diagnosis Infection along post-cesarean surgical site Pain due to infection in abdomen area Obesity

4. Orders Diet Low sodium diet Activity Up with bedside commode Out of bed 3x’s a day Encourage bathing on her own, be sure to keep wound dressings dry Medication Antibiotics Watch for nausea due to antibiotics

5. Priority Nursing Diagnosis Pain management Infection control Impaired physical mobility due to pain caused by post-caesarian infection

6. Patient Outcome/Goal Patient will report a decrease in pain (0-1/10) and shows no grimacing or signs of discomfort at end of hospitalization. Eliminate any infection from the caesarian wound to help improve patient’s mobility. Patient will state the signs and symptoms to be aware of at the end of hospitalization. Patient will demonstrate how to walk without assistance from a person or equipment (walker/cane).

7. Nursing Interventions Assess patient for pain every 2 hours Obtain any assistive device to help when patient is up out and of bed. (Commode) Monitor and record the patient's ability to tolerate mobility

8. Nursing Interventions Rationale “Relieving pain and suffering is more than giving pain medications, repositioning the patient, or cleaning a wound. The relief of pain and suffering encompasses caring nursing actions that give a patient comfort, dignity, respect, and peace. Ensuring that the patient care environment is clean and pleasant and includes personal items makes the physical environment a place that soothes and heals the mind, body, and spirit” (Gallagher-Lepak and Kubsch, 2009,pp. 85). Have clients use a commode or urinal for toileting and avoid use of a bedpan. Getting out of bed to use a commode or urinal does not stress the heart any more than staying in bed to toilet. In addition, getting the client out of bed minimizes complications of immobility and is often preferred by the client ( Winslow, 1992, pp.182) (Ackley and Ladwig, 2011, pp. 85 ).

9. Evaluation of Patient Outcome/Goal Patient reported decreased pain level (2-10) and verbalized understanding to resume her pain medication at home. Patient verbalized understanding the signs and symptoms of infection if she was to contract another infection and to contact her health care provider. Patient was able to demonstrate correct way to walk without assistance of a person or equipment. Patient also understood the benefits and importance of exercising to help with mobility.

10. Day # 2 Today you are assigned to Bertha again. Overnight she refused to move or walk in the hallway. This morning she is complaining of shortness of breath. During your assessment you note that she is breathing rapidly, warm to the touch and complaining of light headedness. What is you priority nursing diagnosis for Bertha today? Write a care plan based on your diagnosis.

11. Works Cited Ackley and Ladwig, 2011, pp. 85 Gallagher-Lepak and Kubsch, 2009, pp. 85 Winslow, 1992, pp. 182 Bedside Commode [Online Image]. Retreived September 8, 2015 from http://www.galaxymedical.net/bedside-commodes Stetoschope [Online Image]. Retrieved September 8, 2015 from http://phoenixrising.me/wp-content/uploads/Diagnosis1.jpg Bakery House [Online Image]. Retrieved September 8, 2015 from http://www.thebakeryhouse.net/images/img_7266.jpg Melissa Mccarthy [ Online Image]. Retrieved September 8, 2015 from http://thevintagepress.co/photos/melissa-mccarthy/melissa- mccarthy-thin-5401cdc7ead2b12480c9c8e0d04136f4-big-356954.jpg Melissa Mccarthy [ Online Image]. Retrieved September 8, 2015 from http://thevintagepress.co/photos/melissa-mccarthy/melissa- mccarthy-thin-5401cdc7ead2b12480c9c8e0d04136f4-big-356954.jpg Low Sodium [Online Image]. Retrieved September 8, 2015 from http://www.dietsinreview.com/images/cache/450x300_low- sodium.jpg