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    Assessment Nursing Diagnosis Rationale Planning Intervention Rationale Evaluation

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    Tweenie Dalumpines
    The patient presented with complaints of abdominal pain and activity intolerance related to preterm labor. The nurse assessed the patient and identified risk factors including multiple gestation. Nursing interventions focused on monitoring vital signs, encouraging bed rest, applying external monitoring, and instructing the patient on signs of complications. After 8 hours of nursing care, the goal of enhancing activity intolerance was met as the patient was able to use identified techniques. The evaluation showed nursing interventions were effective.

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    Assessment Nursing Diagnosis Rationale Planning Intervention Rationale Evaluation

    Uploaded by

    Tweenie Dalumpines
    120 views3 pages
    The patient presented with complaints of abdominal pain and activity intolerance related to preterm labor. The nurse assessed the patient and identified risk factors including multiple gestation. Nursing interventions focused on monitoring vital signs, encouraging bed rest, applying external monitoring, and instructing the patient on signs of complications. After 8 hours of nursing care, the goal of enhancing activity intolerance was met as the patient was able to use identified techniques. The evaluation showed nursing interventions were effective.

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    ncp

    Original Title

    Ardamoy Ncp Dr Final

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    The patient presented with complaints of abdominal pain and activity intolerance related to preterm labor. The nurse assessed the patient and identified risk factors including multiple gestation. Nursing interventions focused on monitoring vital signs, encouraging bed rest, applying external monitoring, and instructing the patient on signs of complications. After 8 hours of nursing care, the goal of enhancing activity intolerance was met as the patient was able to use identified techniques. The evaluation showed nursing interventions were effective.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    120 views3 pages

    Assessment Nursing Diagnosis Rationale Planning Intervention Rationale Evaluation

    Uploaded by

    Tweenie Dalumpines
    The patient presented with complaints of abdominal pain and activity intolerance related to preterm labor. The nurse assessed the patient and identified risk factors including multiple gestation. Nursing interventions focused on monitoring vital signs, encouraging bed rest, applying external monitoring, and instructing the patient on signs of complications. After 8 hours of nursing care, the goal of enhancing activity intolerance was met as the patient was able to use identified techniques. The evaluation showed nursing interventions were effective.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Assessment Nursing Rationale Planning Intervention Rationale Evaluation

    Diagnosis
    Subjective:
    Activity Preterm labor is After 8hoursof Independent: After rendering
    “Gulpi nalang intolerance related defined as nursing proper nursing
    nag sakit busog, to muscle or uterine interventions, the  Assess status  Assessment interventions, the
    nabatyagan ko cellular contractions patient will use of the client provides a goal was MET.
    run nga daw hypersensitivity. occurring after identified and fetus. baseline date The patient was
    mamata run ko” 20weeks of techniques to for future able to use
    gestation and enhance activity comparisons. identified
    Objective: before 37 intolerance. techniques to
    •Continued completed weeks  Encourage  Bed rest enhance activity
    uterine of gestation. Risk bed rest with relieves intolerance.
    contraction. factors include patient in side pressure of the
    multiple lying position. fetus on the
    • Facial gestation, history cervix.
    mask of pain. of previous
    preterm labor of
    •Irritability. delivery,  Apply  Uterine and
    abdominal external fetal
    • V/S taken surgery during uterine and monitoring
    as follows: current fetal provides
    pregnancy, monitoring. evidence of
    T:37.3 uterine anomaly, maternal and
    P:84 history of cone fetal well-
    R:19 biopsy, maternal being.
    BP: 100/80 age younger than
    20 or older than
    age 35.
     Monitor  Maternal pulse
    patients vital over 120 beats
    signs closely, per minute or
    every persistent
    15minutes. tachycardia or
    tachypnea,
    chest pain,
    dyspnea and
    adventitious
    breath sounds
    may indicate
    impending
    pulmonary
    edema.

     Instruct  Early
    patient to recognition of
    report any possible
    feelings of adverse effects
    difficulty of allows for
    breathing or prompt
    chest pain, intervention.
    dizziness,
    nervousness
    and irregular
    heartbeats.
     Monitor  Monitor of
    uterine uterine
    contractions, contractions
    including provides
    frequency and evidence of
    domain. effective
    therapy.

    Collaborative:

     Obtain  Urine, vaginal


    diagnostic and cervical
    studies cultures help to
    including rule out
    complete infection as a
    blood count, causative
    hemoglobin factor for
    and preterm labor.
    hematocrit,
    urine, vaginal
    and cervical
    cultures as
    ordered.

    Submitted by: Janella A. Ardamoy BSN-IV January 22, 2018

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