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    NCP Burn Risk Infection

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    Braingie Racho
    The nursing care plan addresses the risk of infection from open burn wounds by outlining short and long term objectives to protect the wounds from contamination and monitor for signs of infection, with nursing interventions such as proper isolation techniques, hand washing, and daily wound examinations to minimize risk and promote healing over 3 days. The plan also evaluates the patient's vital signs and condition to identify any localized or systemic infection and ensure the fast healing of the open burn wounds.

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    NCP Burn Risk Infection

    Uploaded by

    Braingie Racho
    8K views1 page
    The nursing care plan addresses the risk of infection from open burn wounds by outlining short and long term objectives to protect the wounds from contamination and monitor for signs of infection, with nursing interventions such as proper isolation techniques, hand washing, and daily wound examinations to minimize risk and promote healing over 3 days. The plan also evaluates the patient's vital signs and condition to identify any localized or systemic infection and ensure the fast healing of the open burn wounds.

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    Ncp Burn Risk Infection

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    The nursing care plan addresses the risk of infection from open burn wounds by outlining short and long term objectives to protect the wounds from contamination and monitor for signs of infection, with nursing interventions such as proper isolation techniques, hand washing, and daily wound examinations to minimize risk and promote healing over 3 days. The plan also evaluates the patient's vital signs and condition to identify any localized or systemic infection and ensure the fast healing of the open burn wounds.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    8K views1 page

    NCP Burn Risk Infection

    Uploaded by

    Braingie Racho
    The nursing care plan addresses the risk of infection from open burn wounds by outlining short and long term objectives to protect the wounds from contamination and monitor for signs of infection, with nursing interventions such as proper isolation techniques, hand washing, and daily wound examinations to minimize risk and promote healing over 3 days. The plan also evaluates the patient's vital signs and condition to identify any localized or systemic infection and ensure the fast healing of the open burn wounds.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    Download as doc, pdf, or txt
    of 1

    Jundale G.

    Batbatan BSN-III Section: B


    NURSING CARE PLAN
    Problem: Open burn wounds
    Nursing Diagnosis: Risk for infection related to loss of skin barrier and impaired immune response.
    Taxonomy: Health perception/Health management pattern.
    Cause Analysis: Tissue destruction results from the coagulation, protein denaturation, or ionization of cellular contents.
    CUES OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATION

    Subjective: Short term objective: Independent:


    After 8 hours of duty the Open Implement appropriate isolation techniques as -Minimize risk of cross-contamination and spread
    The patient verbalize:
    burn wound will protected indicated. of bacterial contamination.
    Unsa maning sunuga oy Emphasize/model good handwashing technique -Prevents cross-contamination; reduces risk of
    dugay kaayo mauga sigig ga from contamination of for all individuals coming in contact with patient. acquired infection.
    duga lami kaayo tilaan he he infectious microorganism that Use gowns, gloves, masks, and strict aseptic -Prevents exposure to infectious organisms.
    he… Sige na nalang ta ug may affect the wound healing technique during direct wound care and provide This measures reduce potential bacterial
    sterile or freshly laundered bed linens/gowns. colonization of burn wound.
    trapo ani kapoy kaayo unya process. And the burn will be Provide special care for eyes, e.g., use eye covers -Eyes may be swollen shut and/or become
    pagkataud-taud gabasa napod monitor from any unusual and tear formulas as appropriate. infected by drainage from surrounding burns
    trapo napod hay development and it will be Examine wounds daily, note/document changes -Identifies presence of healing (granulation
    free of purulent exudates and in appearance, odor, or quantity of drainage. tissue) and provides for early detection of burn-
    kakapoy.Wala pa ra ba tung wound infection.
    tigtrapo ug tigtabang nako. debris. Examine unburned areas (such as groin, neck -Opportunistic infections (e.g., yeast) frequently
    Manimaho na gyud ko ani ug creases, mucous membranes) routinely. occur because of depression of the immune
    system and/or proliferation of normal body flora
    samot.
    during systemic antibiotic therapy.
    Monitor vital signs for fever, increased -Indicators of sepsis (often occurs with full-
    Long term objective: respiratory rate/depth in association with changes thickness burn) requiring prompt evaluation and
    After 3 days of duty the in sensorium, presence of diarrhea, decreased intervention.
    platelet count, and hyperglycemia with
    Objective: patient condition will be
    glycosuria.
    protected from localized or
    (Not applicable; presence of systemic infection and the Dependent:
    signs and symptoms patient will appreciate the fast Administration of medication depends on
    establishes an actual healing process of the open physicians order
    diagnosis.) burn wound.

    References: Nursing Care Plans: Guidelines for individualizing patient care 6th edition. Doenges, M &Moorhouse, MF

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