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Needs / Problem

Nursing Diagnosis Scientific Basis Objectives of Care Nursing Interventions Rationale


Cues

Physiologic Impaired tissue Pyeloplasty is an After 8 hours of


Deficit: integrity: Surgical operation to correct student nurse –
Surgical incision incision secondary a blockage that has patient interaction, Measures to minimize
secondary to to surgical occurred between the patient will be impairment and promote
pyeloplasty procedure the kidney and the able to: healing:
ureter. The ureter is
the tube which 1. display 1. Reinforce initial dressing, - protects wound from
drains the kidney progressive change as ordered. mechanical injury and
into the bladder. improvement Strictly aseptic contamination
Removing the in wound technique.
blockage allows healing. 2. Gently remove tape and - reduces risk of skin
urine to drain freely dressing when changing. trauma and disruption of
from the kidney to wounds
the bladder. 3. Inspect incision. Note - to note any signs of
characteristics and infection or complication
integrity.
(Source: Operating Room 4. Promote good nutrition - to promote faster wound
Technique By Nancymarie
Phillips) with adequate protein healing
and calorie intake and
vitamin or mineral
supplements
5. Encourage adequate - to promote wound
periods of rest and sleep. healing and meet
comfort needs of the
patient
6. Practice aseptic - reduces risk of cross
technique in cleansing or contamination
dressing or medicating
lesions.
7. Apply ice if appropriate - reduces edema formation
and as ordered. that may cause and
undue pressure on the
incision during initial post
operative procedure

(soure: NANDA 10th edition)


(source: NANDA 10 edition)
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