In the case under consideration, the most prominent symptom that the patient has is painfully itching lesions that may bring about hyperthermia. According to Urden, Stacy, and Lough (2017), this illness may be caused by different reasons. In the discussed situation, it is a possible consequence of the skin rash if it is not given sufficient treatment. The patient claims that she first felt and saw the lesions after hiking in a place of nature, that is why it is possible that she caught a virus.
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Gordon (2014) states that hyperthermia is an “increase in body temperature above normal range for age” (p. 144). It means that the organism, having encountered a threat, mobilizes its immunity sources in an attempt to combat the intervention. Thus, the thermoregulation of the body fails to work correctly. For an average adult of 35 years old, the normal temperature is around 36 degrees Celsius. Getting higher, it is likely to bring about negative consequences to the organism. Firstly, it affects the state of blood vessels. Secondly, hyperthermia provokes intensive sweating. Thirdly, a temperature above the normal level usually causes general discomfort. Fourthly, the illness damages metabolism. Finally, hyperthermia never stays in the same state.
Thus, it is vital for a healthcare professional to adjust the environment to Mary’s condition so that her temperature can be regulated. Access to clothing and covers should be limited to ensure that she is not able to prevent cooling. The patient should receive required medication that can lower her body temperature. Fortunately, oxygen therapy is not likely to be needed in this case. Mary should be ordered to drink more to prevent dehydration. The possibility to use additional cooling mechanisms should be considered, but associated measures should be modified depending on her condition. A high caloric diet should be ensured to overcome complications and streamline recovery.
In addition to this care plan, a nurse should pay much attention to the education of the patient and her family. In particular, it is significant to teach her how to control exposure to the cold and hot environment. The information about the major signs of hypothermia should be provided, as well as details regarding diet and food intake. The necessity to avoid alcohol should be discussed.
Impaired Skin Integrity
The patient may suffer from impaired skin integrity, which can be proved by her complaints during the assessment. This condition is likely to be associated with chemical irritation that can be observed as a rash. The diagnosis can be supported not only by the presence of damaged skin but also by associated pain and tenderness.
Taking into consideration this particular case, the nursing care plan should start with the monitoring of tissue integrity. In addition to that, much attention should be paid to the patient’s skin care practices because they can affect the condition of affected skin adversely. Tissue care should be provided to minimalize rash, tenderness, and pain. It can include the use of medication (such as antibiotics) and hygiene and dressing changes (Wayne, 2016). The exposure of skin should be minimalized to prevent associated complications.
Mary should be educated regarding the necessity to control her diet to promote healing. In addition to that, she should know how to maintain tissue integrity and ensure that it is well hydrated. The patient should learn how to assess her skin and maintain hygiene procedures (Selasa, 2013). Education should also focus on medication intake and the use of high-quality dressing and pillows, etc.
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Gordon, M. (2014). Manual of nursing diagnosis (13th ed.). Burlington, MA: Jones & Bartlett Learning.
Selasa. (2013). Impaired tissue integrity. Web.
Urden. L. D., Stacy, K. M., & Lough, M. E. (2017). Critical care nursing: Diagnosis and management (8th ed.). Maryland Heights, MO: Elsevier.
Wayne, G. (2016). Impaired tissue integrity. Web.