General introduction of gastritis and Placenta previa (ceaserean section)

Gastritis also known as stomach irritation, stomach inflammation, erosion of the stomach
lining.

Furthermore it could be caused by factors such as prolonged use of nonsteroidal anti-

inflammatory drugs (NSAIDs), excessive alcohol consumption, Helicobacter pylori infection,
stress, and certain autoimmune disorders.

It mostly observed in adults than children, associated signs and symptoms of gastritis
include abdominal pain or discomfort, nausea, vomiting, indigestion, bloating, loss of
appetite, and a feeling of fullness. In some cases, gastritis can lead to more severe
symptoms like blood in the vomit or stool, and it may be associated with weight loss.

A 10 years old boy master Sam.P.T was admitted on the 20th of January, he was presented
with abdominal pain, fever, vomiting and was crying due to the discomfort.

He was first received at children emergency room where the diagnosis of Gastritis was
made.

On the interview the mother thought the boy just had a normal stomach upset were she
administered some herbal medicine and pain relief, however after multiple complains and
constant vomiting, she was compelled to visit the hospital.

Master Sam.P.T was eventually admitted into Pediatric Medical Ward, on admission
his vital signs read thus T-38.6°C, P-122b/m, R-28c/m.

He was seen by the Gastroenterology disease department and investigations such as

H.pylori test and a blood test (complete blood count) was carried out checking for signs of
infection and anemia. confirmed that the causative agent was of bacterial origin and
treatment with
antibiotics commenced.

He was properly managed by both the doctors in-charge and nurses and was discharged in
a satisfactory condition, five days after initial visit to the hospital.

On the other hand, Placenta previa (ceaserean section) is a congenital anomaly in older
females.

It is a condition where the placenta covers the opening in the mother's cervix, the opening of
the uterus.

The exact cause of placenta previa is not always clear, but several factors may contribute,
including: Prior Cesarean Section, maternal age, multiple pregnancies

The same is the case of mrs A.J.U a 37 year old pregnant woman who was brought to the
outpatient department in company of her husband with complains of painless vaginal
bleeding during pregnancy, pain in the abdomen, pelvic area and painful urination.

She was attended to first by the physician at the general outpatient department and
was booked for admission in the gynecology ward.
On admission her vital signs read: T-36.8°C, P-88b/m, R-24c/m.

She was reviewed by a medical team and a pelvic ultrasound was ordered.
After an ultrasound, a definitive diagnosis of placenta previa was made and she
was booked for surgery (cesarean section ).

However, before the surgery, she was placed on analgesics for the pain.
A cesarean section and delivery of her child was carried out two days after her admission
and and she stayed in the
ward for another five days for observation.
She was placed on antibiotics and discharged in a satisfactory condition and was
given a two weeks' appointment at the gynecology clinic.

CHAPTER ONE: GASTRITIS (MEDICAL CASE)

1.1 PATIENT IDENTIFICATION
Patient's initials: Master Sam.P.T
Address: No.120 MCC Street, Calabar, cross river state
Sex: Male
Religion: Christianity (Catholic)
Nationality: Nigerian
Next of kin: Mrs. Ann.P.T
Relationship of next of kin: mother
Date of Admission: 20-01-2024
Unit: Medical (Gastroenterology)
Ward: Pediatric Medical Ward
Bed No: Bay 3, Bed 4
Medical Diagnosis: Gastritis
Date of Discharge: 25-01-2024
Condition: Satisfactory
1:2
REVIEW OF RELATED LITERATURE

Introduction: The cells of the body need energy for all their metabolic activities most of this
energy is derived from the food we eat.

The digestive system consists of several organs that work together to break down and
absorb nutrients from the food we consume

The organs of the Digestive system are: mouth, esophagus, stomach, pancreas, liver,
gallbladder, small intestine, large intestine rectum and anus.
The organs of the Digestive tract are divided into upper and lower digestive tract

Upper Digestive include Mouth, Esophagus, Stomach, Small Intestine.

Lower Digestive Tract: Large Intestine (Colon), Rectum, Anus (Guyton and Hall 2020).

For the purpose of this study, focus would be placed on the stomach.

The Stomach
The stomach is a muscular organ located in the upper part of the abdomen. It plays a crucial
role in the digestive system. Key features of the stomach include:
• Anatomy: The stomach is divided into regions, including the
cardia, fundus, body, and antrum. It connects to the esophagus at the cardiac sphincter and
to the small intestine at the pyloric sphincter.

• The stomach has a complex anatomy that includes various regions and
layers:
• 1. Regions of the Stomach:
• Cardia: The area around the opening where the esophagus connects to the
stomach.
• Fundus: The upper portion that curves above the entrance of the esophagus.
• Body: The main central region of the stomach.
• Antrum: The lower portion that connects to the pyloric canal leading to the
small intestine.
2. Sphincters:
• Cardiac Sphincter (Lower Esophageal Sphincter): Located at the junction
between the esophagus and the stomach, it regulates the passage of food into the stomach.
• Pyloric Sphincter: At the bottom of the stomach, it controls the release of
chyme into the small intestine.
3. Wall Layers (from innermost to outermost):
• Mucosa: The innermost layer that contains gastric glands producing gastric
juices.
• Submucosa: Connective tissue layer containing blood vessels and nerves.
• Muscularis Externa: Consists of three layers of smooth muscle responsible for
churning and mixing food.
• Serosa: The outermost layer, a protective layer covering the stomach.
4. Blood Supply:
 • The stomach receives its blood supply from branches of the celiac artery.
5. Gastric Glands:
• Found in the mucosa, these glands secrete gastric juices, including
hydrochloric acid and digestive enzymes such as pepsin.
6. Innervation:
• Nerves in the stomach wall coordinate muscle contractions and regulate the
release of gastric juices.
7. Hormones:
• The stomach produces hormones like gastrin, which stimulates the production
of gastric juices.
• This intricate anatomy enables the stomach to perform its vital functions in the
digestive process, including the storage and digestion of food. The coordinated activity of its
muscles and secretion of gastric juices contribute to the breakdown of ingested substances
into a form suitable for further processing in the small intestine.


Clinical significance
Gastritis:inflammation of the stomach


Function:
• Storage: The stomach acts as a temporary storage reservoir
for food, allowing for controlled release into the small intestine. This helps regulate the rate
of digestion.
• Digestion: Gastric glands in the stomach lining produce gastric
juices, including hydrochloric acid and enzymes. Hydrochloric acid creates an acidic
environment necessary for the activation of enzymes, and enzymes like pepsin initiate the
digestion of proteins.
• Mechanical Processing: The muscular walls of the stomach
contract and relax, churning and mixing food with digestive juices. This mechanical
processing helps break down food into a semi-liquid mixture called chyme.
• Protection: The stomach lining has a layer of mucus that
protects it from the corrosive effects of gastric acid and digestive enzymes, preventing
damage to the stomach wall.
• Initiation of Nutrient Absorption: While the stomach is not a
major site for nutrient absorption, some substances, such as alcohol and certain
medications, can be absorbed in small amounts through the stomach lining.
• Release of Chyme: The pyloric sphincter controls the release
of chyme from the stomach into the small intestine. This regulated release allows for further
digestion and absorption in the small intestine.
• Hormone Production: The stomach produces hormones,
including gastrin, which stimulates the secretion of gastric juices and the contraction of
stomach muscles.

Overall, the stomach is a vital component of the digestive system, preparing food for further
digestion and absorption in the small intestine.

Definition of condition
Gastritis is a medical term referring to the inflammation of the stomach lining. This
inflammation can result from various factors, including infections, long-term use of certain
medications, excessive alcohol consumption, stress, or autoimmune disorders. Gastritis can
lead to symptoms such as abdominal pain, nausea, vomiting, indigestion, and in some
cases, it may cause erosions or ulcers in the stomach lining. Diagnosis and treatment are
typically conducted by healthcare professionals based on the underlying cause and severity
of the condition. (Leonard R. Johnson2018)

Types of Gastritis
• Acute Gastritis:
• Typically caused by irritants like NSAIDs, excessive alcohol, certain
medications, or infections.
• It involves a sudden onset of inflammation and can resolve with appropriate
treatment.
• Chronic Gastritis:
• Develops gradually and may persist over a longer period.
• Helicobacter pylori infection, autoimmune disorders, or long-term use of
certain medications can contribute.
• Erosive Gastritis:
• Involves damage to the stomach lining, leading to erosions or ulcers.
• Often associated with chronic NSAID use, excessive alcohol consumption, or
severe stress.
• H. pylori-Associated Gastritis:
• Caused by the Helicobacter pylori bacterium, a common bacterial infection in
the stomach.
• It can lead to both acute and chronic inflammation.
• Autoimmune Gastritis:
• Results from the immune system mistakenly attacking the cells of the
stomach lining.
• Can lead to a deficiency in intrinsic factor, affecting vitamin B12 absorption.
• Chemical Gastritis:
• Caused by exposure to irritating substances, such as corrosive chemicals or
certain medications.
• Reactive Gastritis:
• A non-specific term that may refer to inflammation in response to various
triggers. (Leonard R. Johnson2018)

The specific type of gastritis and its treatment depend on the underlying cause, and a
healthcare professional can determine the appropriate diagnosis and management based on
individual circumstances. (Guyton and Hall 2020).

Causes of gastritis

Gastritis is often caused by irritation of the stomach lining due to factors such as infection (H.
pylori), prolonged use of NSAIDs, excessive alcohol consumption, stress, or autoimmune
disorders. If you suspect gastritis, it's essential to consult a healthcare professional for an
accurate diagnosis and appropriate treatment.
Epidemiology

The epidemiology of gastritis involves various factors. Infection with Helicobacter pylori (H.
pylori) is a common cause and is prevalent worldwide. Other factors contributing to gastritis
include age, as it tends to be more common in older adults, and lifestyle choices like
excessive alcohol intake or prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Additionally, the prevalence can vary based on geographic regions and socioeconomic
factors. Regular medical check-ups and a healthy lifestyle can help prevent and manage
gastritis.

Pathophysiology
The pathophysiology of gastritis involves inflammation of the stomach lining. Infection with
H. pylori, a bacterium that colonizes the stomach, triggers an immune response leading to
inflammation. Other causes, like NSAID use or excessive alcohol consumption, can directly
irritate the stomach lining. Chronic inflammation may result in damage to the protective
mucous layer, allowing stomach acid to harm the underlying tissues. This damage can
manifest as erosions or ulcers. Understanding these mechanisms helps guide treatment
approaches for gastritis.

Signs and symptoms

• Abdominal pain or discomfort
• Nausea
• Vomiting
• Bloating
• Feeling of fullness
• Loss of appetite
In more severe cases, symptoms may include:
• Black, tarry stools (indicating bleeding)
• Vomiting blood
If you're experiencing persistent or severe symptoms, consult a healthcare professional for
evaluation and guidance. (Jennifer Shih, M.D 2017)

Diagnostic investigation
• Endoscopy: Direct visualization of the stomach lining to identify
inflammation, erosions, or ulcers. Biopsies may be taken during endoscopy for further
analysis.
• Blood tests: Checking for the presence of H. pylori antibodies
or assessing blood cell counts to detect anemia or infection.
• Stool tests: Detecting H. pylori infection or signs of bleeding in
the gastrointestinal tract.
• Breath tests: Measuring the presence of H. pylori by analyzing
breath samples.
• Imaging studies: In some cases, imaging tests like X-rays or
CT scans may be used to assess the stomach and surrounding structures.

Medical Management
The goal of medical management is aimed at the cause; if the causative organism is viral,the
goal will be to relieve symptoms, until patient gains full recovery. If the causative organism is
bacterial, the patient is placed on antibiotic therapy until full recovery.

Medical management of gastritis often depends on the underlying cause. Common

approaches include:
• Antibiotics: If H. pylori infection is identified, a combination of
antibiotics is typically prescribed to eradicate the bacteria.(Hinkel and Cheever 2018)
• Proton Pump Inhibitors (PPIs): These medications reduce
stomach acid production, helping to heal the stomach lining. Examples include omeprazole,
lansoprazole, or esomeprazole. (Hinkel and Cheever 2018)
• Histamine H2 blockers: Medications like ranitidine or
famotidine can also reduce stomach acid and promote healing. (Hinkel and Cheever 2018)
• Antacids: These provide quick relief by neutralizing stomach
acid. They are often used in combination with other medications. (Guyton and Hall 2020)
• Avoidance of irritants: Lifestyle changes such as avoiding
NSAIDs, limiting alcohol intake, and managing stress can help prevent irritation of the
stomach lining (Guyton and Hall 2020)
Individual treatment plans vary, and it's essential to follow your healthcare provider's
recommendations for the best outcome.

Nursing Management
Nursing care plan of patient with Gastritis is usually focused on symptomatic management.
For patients who demonstrate signs of abdominal discomfort, have a history of rheumatic
fever, blood in stool, or signs of bloating of the stomach, loss of appetite, nursing care
focuses on prompt initiation and administration of antibiotics therapy or proton pump
inhibitors(PPIs) histamine H2 blockers.

The nurse instructs patient about signs and symptoms that require reporting to the
hospital.

The nurse encourages patient to stay in bed during febrile stage of illness and hygiene
The nurse, should educate patient about techniques to prevent transmission such as
disposing used tissues properly.

A blood examination maybe done ones or twice daily as the acute stage of Gastritis.

The nurse educatest patient about the importance of taking the full course of therapy,
possible complications and symptoms to watch out for that may indicate complications
(Hinkle & Cheever, 2018)

Complications of gastritis can include:

• Peptic Ulcers
• Bleeding
• Stricture
• Increased Risk of Stomach Cancer
• Black stools due to bleeding
• Anaemia
 • Belching
• Peritonitis
• Weight loss
• Vitamin B12 deficiency (Donna D. Ignatavicius, 2023)

Course and prognosis

Mortality from gastritis is rare, the course and prognosis of gastritis depend on various
factors, including the underlying cause, how well it responds to treatment, and any lifestyle
changes made In general.

Most uncomplicated cases resolve within 10-15 days. Treatment failure may occur due to
antibiotics resistance and poor
compliance.

This disorder is the leading cause to death in many people.

Mortality is rare but may occur if anyway is compromised. (Donna D. Ignatavicius, 2023)

1:3 ASSESSMENT OF PATIENT UNDER STUDY

1.3.1 General description of patient
Master Sam.P.T a 10-year old boy, healthy looking and properly dressed was brought in by
his mother Mrs. Ann.P.T who held him by the hand. He was moody, in pain and crying.
They were received by the nurses on duty and admitted into the ward.

1.3.2 Patient Complaints/ Reasonfor Admission

Patient was brought by his mother to children emergency room (CHER) with history of
Abdominal pain and stomach bloating . He was seen by physicians at children emergency
and after careful examination a diagnosis of Gastritis was made, thus, transferred to
pediatric Medical Ward for expert
management

1.3.3 Nursing assessment using Gordons 11 functional health pattern

Health Perception/Health Management: Patient's mother gives him medications from patent
medicine store, she treats patient for malaria and typhoid at home. Patient has no previous
history of hospitalization or surgery.He believes his condition can be cured by modern
medicine.

• Nutritional Metabolic Pattern: Patient eats three times daily. Mother agrees
the food given to the patient contains adequate nutrients. patient drinks a lot ofwater; his
mother claims he takes snacks such as biscuit almost every day.Elimination Pattern: Patient
eliminates bowel content 2-3 times daily andurinatesas the need arises. Patient has never
complained about urinary or bowelelimination problem.

• Activity/Exercise Pattern: Patient goes to school each day and plays football
in the street with his friends and enjoys watching television with his siblings.

• Sleep/Rest Pattern: Patient sleeps for about an hour after returning from
school and sleeps at about 10pm till about 6am the next day to prepare forschool.

• Cognitive perception Pattern: Patient has no problem with sensory

perception,he can speak and understand pidgin, English and Igbo.

• Self-Perception/Self Concept: Patient believes he will be okay after medical

treatment.

• Role Perception Pattern: Patient is the third child in a household of five, with
two older siblings. Patient helps around the house with chores such as washingplates.

• Sexuality-Reproductive Pattern: Patient has well normal penis, no known

history of sexual abuse.

• Coping-Stress Tolerance Pattern: Patient copes with stress by eating,

playingand sleeping.

• Value-Belief Pattern: Patient believes in God, the father who is the creator.
He is aware he attends St Bernard Catholic church and he is a Christian.

1.3.4 Physical Assessment by Nurses

Observation: Vital signs read by 12pm

Temperature - 38°c

Pulse - 122b/m

Respiration - 44cm

Weight - 30kg

Head to toe assessment

Head: thick black hair

Eye: well shape eye brow and lashes, normal eye pupil

Nose: well packed nose

Neck: No palpable lymph node

Upper extremity: No deformity, normal capillary refill

Chest: No abnormal sound detected on auscultation

Abdomen: No distended abdomen, no abnormal sound on auscultation

Spine: Absence of scoliosis, no kyphosis

Genitalia: Normal shaped penis and scrotum

Lower extremity: No deformity, straight legs, clean toe nails

Back: Normal shape, normal skin turgor

Skin: Dark in complexion, no scars or tribal marks
DATE ORDERED TYPE OF INVESTIGATION VALUE OF FINDINGS NORMAL
VALUESIGNIFICANCE OF FINDINGS
20/01/2024 Full blood count
Neutrophils 48% 40-75% Normal
Eosinophils 1% 1 - 6% Normal
Lymphocytes 51% 20 - 50% Elevated lymphocytes indicate infections

Urinalysis Amber/clear Amber Normal

Appearance Negative Acidic Normal
PH Negative Negative Normal
Bilirubin Negative Negative Normal
Protein Negative Negative Normal
20/01/2024 Glucose Negative Negative Normal
Ketones Negative Negative Normal
Ascorbic Acid Negative Negative Normal
Nitrate Negative Negative Normal
blood Negative Negative Normal


1.3.5 MedicalDiagnosis
•Gastritis
1.4
NURSING DIAGNOSES

1.4.1 Clustering of Symptoms

1. Headache
2. Fever
3. Bloating stomach
4. Inflamed stomach
5. Dizziness
6. Vomiting

1.4.2 Identified Nursing Diagnoses

Data 1
1. Acute pain related to inflamed stomach evidenced by patient behavior.

Data 2
2. Hyperthermia related to microbial activity evidenced by thermometer reading of 38.6°.
Data 3
3. Constant vomiting .

Data 4
4. Risk for imbalanced nutrition less than body requirement evidenced byinability to eat.

1.5
PLANNING FOR CARE
1.5.1 Medical Plan (on Admission)
⁃ Warm saline
⁃ IV ciprofloxacin 500mg twice daily
⁃ IV Gentamycin 200mg 8hourly

1.5.2 Nursing Plan

⁃ To relieve pain
⁃ To relieve Anxiety
⁃ To promote nutrition
⁃ To maintain optimal body weight
⁃ To prevent complication
⁃ To prevent reoccurrence

Objective of Care
1. Patient's temperature will be reduced by 1-2°c within one hour of nursing
intervention
2. Patient will be relieved of pain within one hour of nursing intervention
3. Patient will maintain effective airway clearance within 24hours of nursing
intervention
4. Patient will maintain optimal weight for his age throughout the period of
hospitalization.

1.6
IMPLEMENTATION OF CARE

First day of admission (20/01/2024)

A 10year old boy arrived in pediatric medical ward at about 12noon company of his
mother and was admitted into a well-made bed

Observation On Admission
Temp- 38.6°C, Weight -38kg
Plus-124b/m, Respiration-28c/m

Position: Master Sam.P.T laid supine position on the bed, but sat down most of the day.

Nutrition: patient tolerated a little amount of semi solid food (pap) in the afternoon
and custard before he went to bed, patient took in water Liberally.
Elimination: Patient urinated 4 times during the day.
Rest and Recreation: Patient slept for 7 hours at night and played games with his
mother's phone.

Chemotherapy: Patient was earlier reviewed by the Gastroenterology and Infectious disease
team and the following drugs where prescribed:
⁃ IV Amoxicillin 500mg twice daily
⁃ IV Gentamycin 200mg 8 hourly
⁃ IV metronidazole 0.6mu hourly

Second day of admission (21/01/2024)

Observation
Time Temp P R WEIGTH
6am 36.8° 100b/m 26c/m 38kg
2pm 36.6° 92b/m 26c/m 38kg
10pm 38.4° 96b/m 26c/m 38kg

Specific Care: Paracetamol was given for elevated temperature and within 2 hours the
temperature dropped to about 36.6°c

Hygiene: patient had his bath, toothbrush was changed and oral toileting was done by his
mother.

Position: Master Sam.P.T ate rice in the morning, rice in the afternoon and beans in the
evening. Patient took Coca-Cola, patient was estimated to take up to 1000mls of
water.

Rest and sleep:patient took a one-hour nap during the day, slept for 8 hours at night.
Drugs: patient was given IV Ciprofloxacin and multivite tablets.

Third day of admission (22/10/2020)

Patient was reviewed by the medical team, paracetamol tablet was prescribed when
necessary due to the increase in temperature at 10pm the previous day and 6am today.

Observation

Time Temp P R WEIGHT

6Am 38.3°C 94b/m 26c/m 37kg
12Pm 37.4°C 93b/m 26c/m 37kg
6Pm 37.2°C 96b/m 26c/m 38kg
12Pm 36.6°C 94b/m 26c/m 38kg

General care: Patient showed tremendous improvement in condition. He was bathed,

Dressed and bed linens were changed.

Nutrition: Patient took custard in the morning, took rice in the afternoon and ate rice
in the evening.
Elimination: Patient emptied bowel twice, passed urine and had no complain about
elimination problems.

Sleep and Rest: Patient played games with his mother's phone and slept for 8 hours at
night.

Drugs: Paracetamol was administered by the nurse at 6am routine drugs were given as
prescribed.

Fourth day of admission (24/01/ 2024)

Patient verbalized that he had no pain anymore, he was also visited by his father and
siblings, he was reviewed by the medical team and they spoke about the improvement and
plans for discharge.
Observations

Time Temp P R WEIGHT

6Am 36.3°C 94b/m 26c/m 38kg
12Pm 36.4°C 93b/m 26c/m 38kg
6Pm 36.2°C 96b/m 26c/m 38kg
12Pm 36.2°C 94b/m 26c/m 38kg

General care: Patient was bathed and was also observed to be walking around.

Elimination: Patient opened bowel twice and urinated as he had the urge.
Sleep, rest and recreation: Patient was observed to be able to move around and do
things for himself, he played with his siblings during visiting hours, played game with his
mother's phone, he slept for about 10hours eventually.

Fifth day of admission (25/01/2024)

Patient was reviewed by the medical team and was discharged.

Observation

Time Temp P R WEIGHT

6Am 36.3°C 94b/m 26c/m 38kg
12Pm 36.4°C 93b/m 26c/m 38kg

Advice on discharge
Patient's mother was encouraged to complete drugs regimen at home..
An appointment was booked for two weeks in the Children Out patient department
(CHOP).

Patient and patient's mother were encouraged to keep to appointment.

Drugs prescribed on discharge include;

Tabs vitamin C 1 three times
Tabs vitamin B complex 2 three times daily

Patient's mother was also advised to:

• Protect child from contaminated food.
• Frequent hand washing
• Protect the child from eating spicy foods to avoid irritation in the stomach.
• Avoid exposure to irritants and cold.
• Report medications side effects such as itching
• Stop self-medications
Master Sam.P.T visited the clinic i.e. the Children Outpatient in company of his mother on the
30th of 2024 after five days of hospitalization.

Follow up care
Master Sam.P.T on clinical visit was seen by the nurses and his vital were taken and read
thus;
T-36.2°C
p- 946/m
R-24c/m

He had no complaints after discharge from wards two weeks earlier.

He reported that he completed his medications that was prescribed after discharge and
follow all drugs given.
He was given no further appointment and was fit to continue with his daily activities and was
advised to seek medical attention.

1.7
EVALUATION AND SUMMARY OF CARE
Master Sam.P.T a 10 years old boy was admitted on the 20th of January 2024, he was
presented with abdominal pain, fever, vomiting and was crying due to the discomfort.

After thorough examination, a diagnosis of Gastritis was made.

He stayed five days and was treated with a course of antibiotics and analgesic medications.

The medications included; Gentamycin, Crystalline penicillin, Ciprofloxacin, Vitamin B

Complex , Vitamin C, Metronidazole and Tetracycline.

During his stay a urinalysis and full blood count was carried out for baseline data for
care.
Daily nursing care was given including observation of vital signs and administration
of prescribed medications.

Master Sam.P.T's care was progressive as evidenced by improved activity tolerance in the
ward, a change from fluid to semi solids and solid meals during his stay in the
ward.
On the 25" of January 2024 he was fit for discharge after review by the medical team;
his mother settled all necessary bills and booked an appointment at Children Out
Patient for follow up care.
S/N NURSING DIAGNOSIS OBJECTIVE NURSING INTERVENTION
SCIENTIFIC RATIONALE EVALUATION
1.) Assessing level of pain serves as a baseline for care.
2.)Proper positioning will reduce