Activity 1.

3 Case scenario: Patient P is a white man, 58 years of age, married, with three children who
live in the same subdivision, assumes to have good paternal role in the family, and worked as a sales
representative. He traveled by car over a wide area and spent a great deal of his time driving and smoking.
The patient had his first general check-up accompanied by his wife last May 2020 and claimed that he has
been feeling well and no other health problems except ordinary cough and colds. His usual diet includes
1-2 cups of rice, 1-2 servings of chicken/pork/beef, and coke/juice; 6-8 glasses of water per day; with
seafood allergies; and goes out to lunch with colleagues weekly. In terms of elimination, he uses a
laxative twice a week for bowel function and urinary problems. He jogs only when he feels the need. He
also verbalized that he misses going to church with his wife but watches religious services with her on
TV. He wears glasses to correct his astigmatism and has no hearing problems. Mr. P added that he has no
sexual activity because of work schedule. When Patient P met the physician for the first time in
September, he denied any major complaints and stated that he was there to appease his wife. His medical
history revealed no major illness or injuries, apart from an appendectomy at 14 years of age. He admitted he
had smoked two packs of cigarettes every day for the last forty years and revealed that his grandfather
died of lung cancer.

When the nurse observed a frequent, nonproductive cough, she questioned Patient P about it. The patient
claimed it was simply a tickle in his throat that came about early morning due to pollen allergy and the
cough usually awakens him three-four times per night. However, even without the presence of pollen, the
cough remained, the nurse made a note for the physician to check into the cough when he examined the
patient. Mr. P further verbalized that he feels positive even if he is experiencing symptoms and he is able
to cope with stressors by talking to his wife regularly.
The physician found nothing remarkable on Patient P's physical examination, even though he listened to
the patient's chest to assess the cough. As a precaution, however, he ordered a chest x-ray and some
routine lab work. Three days later, the results of the exams came out. The chest film showed an infiltrate
in the patient's right lower lobe. Laboratory work showed mild anemia with a hemoglobin of 10.0g/dL
and hematocrit of 31%. The patient was contacted and asked to return to the clinic to discuss the findings.

The next day at the clinic, the nurse asked the patient to describe his cough and sputum
characteristics. Mr. P claimed that he sometimes observes blood in his sputum, however he
associated it with irritation due to cough. Upon weighing Mr. P the nurse noted a decrease in his
weight from his previous check-up: from 79 kg to 68 kg. According to Mr. P his weight may be due
to his poor appetite and occasional weakness. The physician explained the results and showed Patient
P and his wife the x-rays and recommended further testing to have a definitive diagnosis. The
physician also ordered sputum for cytology, an MRI of the chest, and scheduled a bronchoscopy with
biopsy for later in the week, contingent upon approval from the insurance company.

Patient P was given instructions for collecting the sputum specimens. His insurance approved
both the MRI and bronchoscopy. Three days later, Patient P, accompanied by his wife, went to the
hospital for bronchoscopy. After the bronchoscopy was completed, the physician explained to Patient
P's wife that everything appeared normal with the procedure, but he still wanted the MRI. After the
MRI was completed, the result showed a peripheral lung tumor. Based on the lung scan, the physician
believed the mass was likely cancer, but he also wished to get a consult from a thoracic surgeon and
obtain a biopsy to determine exactly what they were dealing with.

The biopsy was scheduled and three days later, the result revealed Non-small cell Lung
Cancer Stage IV. After series of consultations with oncologists, Mr. P was advised to have a
combination of chemotherapy, radiation therapy, and immunotherapy.

Activity 1.4 Instruction: Based on the case scenario, classify objective from subjective cues. Write
your answers in the space provided.
SUBJECTIVE CUES OBJECTIVE CUES
 Has poor appetite  58 y/o male, white man
 Experienced Occasional weakness  Noticeable weight loss of 11kg from last visit:
 Observed blood in the sputum but has associated it before – 79kg, now – 68kg
with irritation due to cough  Frequent, non-productive cough
 Used of laxatives twice a week for bowel and
urinary problems  Diagnostic/Lab findings:
 Has denied any major health concerns except for
cough which usually awakens him 3 to 4 times per  Hgb: 10.0 g/dL
night, and colds that he only thought as normal and  Hct: 31%
was due only to pollen allergies
 Admitted to have lacked sexual and physical  Chest x-ray showing infiltrate in the Right Lower
activities (particularly with exercise) and with usual lobe of the Lungs
diets of high fat-high carbs, and high sugar diet and  MRI showing Peripheral lung tumor
goes out to lunch with colleagues weekly  Biopsy revealed stage IV lung cancer
 Claimed to have seafood and pollen allergies
 Admitted to have smoked 2 packs of cigarettes per
day and a grandfather who died of lung cancer
 Missed going to church with wife
 Has positive outlooks towards own health even
when experiencing symptoms
 Was able to cope with stressors through his wife
 Claimed to have no hearing problem but wears
glasses to correct astigmatism
 Concept Map of a Lung Cancer

Predisposing
Factors: Precipitating
Factors:
 Sedentary
Lifestyle  Family
 Smoking history of
 58 lung cancer
 Male
Carcinogens

Binds to DNA of cell

causing damage

Damaged DNA causes

Encourage patient to eat Failure of cellular
foods that are relatively regulation in the bronchial
high in iron such as epithelium
green leafy vegetables
like kangkong, Cont. re-exposure
malunggay, and kamote to co-carcinogens
taps, fresh and dried
fruits like raisins and Continues cellular
mango, and organ meats mutation leading to
like liver. abnormal cell growth
and tumor forms

Accumulation of
Compensation to a genetic changes
growing tunor
Tumor grows aggressively and
anemia becomes malignant and invasive
in nature and becomes NSCLC Diagnostic results:

Chest x-ray showing

infiltrate in the Right
Laboratory results: Lower lobe of the Lungs
 Hgb: NSCLC MRI showing
10.0 g/dL Peripheral lung tumor
 Hct: 31% Biopsy revealed stage
IV lung cancer

 Anorexia
 Weight loss
Central tumor Peripheral
Tumor
 Growth of Tumor Recommended treatment:
 Weigh the patient daily irritates the airway  Combination of:
specifically every morning o Chemotherapy
o Radiation
 Encourage patient to o immunotherapy
maintain good oral hygiene
such as brushing the teeth  Frequent, non-
every morning after waking
productive cough
up and in the evening before
sleeping or every after  Hemoptysis
meals, or with the use of  pain
mouthwash.

 Encourage patient to eat

small frequent feedings
many times a day rather
than a 3 large meal per day.
 Teach patient how to perform
 Encourage patient to totally DBE and CE, or encourage
avoid if possible or at least use of Incentive Spirometer.
limit intake of caffeinated or  Elevate head of bed, or
carbonated, and high sugar encourage sleeping in a
content drinks, and reclined chair if dyspnea is
smoking. experienced.
 Arrange intake of high-
calorie, high protein meals  Provide humidifier or
at the times that the patient vaporizer.
usually feels most like
 Encourage patient to increase
fluid intake to 1-2 L of water
or at least 8-10 glasses of
water or non-carbonated
drink unless contraindicated

 Administer pain medication

(analgesics or opioids) per
doctor’s order but try to
withhold it as long as the
patient can still tolerate the
pain.

 Give expectorants and

antimicrobial agents per DO.

Legends:

Predisposing Factors: Precipitating Factors: Disease Process

Nursing Management Medical Management S/s

 Gordon’s Functional Health Patient Data
Pattern
Demographic data Name: Patient P
Age: 58 y/o
Sex: Male
Marital status: Married
Religion: Not Specified
Nationality/ Ethnicity: White man (probably American)
Occupation: Sales Representative
Health perception-health Patient rarely visits doctor for check-up. First general check-up was on
management pattern May 2020 of which he claimed he has been feeling well and no other
health problems except cough and cold. Patient practices an unhealthy
lifestyle with diet mostly composed of high fat, high carb, and high sugar
diet, smokes 2 packs of cigarettes per day, and has little to no physical
activities at all. No particular health practices mentioned.
Nutrition-metabolic pattern Patient’s usual diets composed mostly of meats than vegetables (can
consume 1-2 servings of meats), 1-2 cups of rice per day, and likes to drink
juice/coke. Patient can drink 6-8 glasses of water per day. He also claimed
he was allergic to seafood and claimed to have poor appetite and has noted
a decrease of 11 kg of weight since last visit for check-up (weight before:
79kg, weight now: 68kg).
Elimination pattern Patient claimed to have problems in elimination and has been using
laxative twice a week for bowel and urinary problems.

Activity-exercise pattern Patient rarely has physical activities and claimed to jog only when needed.
He traveled by car over a wide area and spent greatly of his time driving.
He also claimed to be experiencing occasional weakness.

Sleep-rest pattern Patient claimed he was usually awakens 3 to 4 times per night due to his
frequent, non-productive cough. No mentioned use of any medications that
promotes sleep.

Cognitive-perceptual pattern Patient claimed to have no problems in hearing and no other sensory
deficits except sight, claimed to have astigmatism and wears glass to
correct it.
Self-perception-self-concept pattern Patient claimed he has been feeling well and has denied any major health
concerns except the cough and cold which he thought was just normal and
was only due to a pollen allergy. Patient manages to practice unhealthy
lifestyle (smoking, eating high-fat and high carb diet, and little to no
exercise at all), but still feels no doubt about his health and shows
positivity towards it even when experiencing symptoms already. He also
added that he only went to the check-up to appease his wife, but still agreed
to undergo series of examination ordered to him by his physician.
Role-relationship pattern Patient is married with three children who lives in the same village as he
and his wife, and assumed to have good paternal relationship with his
family.

Sexuality-reproductive pattern Patient is a married guy with three children from his wife. No STI or any
disease affecting his genitals mentioned, but claimed to have no sexual
activities due to work schedule.

Coping-stress tolerance pattern Patient claimed that he copes with stress by talking to his wife.

Value-belief pattern Patient has expressed that he misses going to church with his wife but has
claimed that he watches religious services on TV with her. No mentioned
restrictions in their religion with regards to food or medical procedures.
Nursing Diagnosis 1 (PE Ineffective Airway Clearance related to obstruction caused by tumor
Format): secondary to Lung cancer, as evidenced by frequent, non-productive
cough and presence of mass in the lungs as seen on MRI.
Causal Analysis (Cite your Ineffective or absence of cough (frequent, non-productive cough).
source/s):
Carpenito, Lynda Juall, RN, MSN, CRNP.., (2013, 14th ed) Nursing
Diagnosis: Application to Clinical Practice.., Airway Clearance,
Ineffective.., pp.551
Level of Priority and justification: Highest priority because this can be life threatening if not being
managed immediately.

Nursing Diagnosis 2 Risk for infection related to compromised host defenses secondary to
(PE Format): Lung cancer
Causal Analysis (Cite your Patient is at risk for being invaded by pathogenic organisms because
source/s): immune system may be exhausted due to the existing terminal illness.

Carpenito, Lynda Juall, RN, MSN, CRNP.., (2013, 14th ed) Nursing
Diagnosis: Application to Clinical Practice.., Infection, Risk for.., pp.
353
Level of Priority and justification: Medium priority as the problem has not taken placed yet but may occur
if not prevented.

Nursing Diagnosis 3 Imbalanced nutrition: less than body requirements related to decreased
(PE Format): appetite secondary to lung cancer as evidenced by extreme weight loss
and deficient interest in food (poor appetite).
Or..

Imbalanced nutrition: less than body requirements r/t increased caloric

requirement and difficulty in ingesting sufficient calories secondary to
lung cancer as evidenced by weight loss and deficient interest in food
(poor appetite).
Causal Analysis (Cite your Intake of nutrients insufficient to meet metabolic needs.
source/s):
Carpenito, Lynda Juall, RN, MSN, CRNP.., (2013, 14th ed) Nursing
Diagnosis: Application to Clinical Practice.., Nutrition, Imbalance: Less
than Body Requirements,pp.447
Level of Priority and justification: 2nd highest priority because nutrition is one of the priorities of a person
according to Maslow’s hierarchy of needs.
Nursing Dx: Ineffective Airway Clearance related to obstruction caused by tumor secondary to Lung cancer, as evidenced by frequent, non-productive cough
and presence of mass in the lungs as seen on MRI.
Level of priority: High
Causal analysis: Ineffective or absence of cough (frequent, non-productive cough).

Cues Objectives Interventions Rationale Evaluation

Subjective: Long term: Independent: Long term:

 Patient Has poor appetite At the end of 1 week of  Elevate the head of  This is to help ease Goals were partially met. Patient
the breathing.
(anorexia) nursing intervention, the patient’s bed was able to show dramatic
 Experienced Occasional the patient will be able by putting pillows increase in weight, reports better
weakness (fatigue)
 Observed blood in the
to: in the back of his appetite, and showed no signs of
sputum but has head and shoulder malnutrition, but is having
associated it with a. Demonstrate patent area if mechanical difficulties with eliminating
irritation due to cough airway with fluid bed is not habits of smoking.
(hemoptysis) secretions easily available.
expectorated, clear
 Admitted to have
smoked 2 packs of breath sounds, and  Teach patient to do  This exercise Short-term:
noiseless DBE by inhaling promotes lung
cigarettes per day and a
expansion and Goals were met. Patient and SO
grandfather who died of respirations as deeply through the reduces work of
lung cancer evidenced by nose and exhaling were able to understanding to the
breathing. importance of proper nutrition by
normal breathing through the mouth
(others may include eating those recommended diet and
Dyspnea, chest pain,
pattern. by doing purse lip,
avoiding those that are not
malaise or by using an beneficial to the patient, have
b. Manageable or incentive identified and enumerate foods that
diminished spirometer as often are high in calorie and protein
coughing and being as he can tolerate.
free from infections
Objective: as evidenced by  Demonstrate to  Coughing exercise
normal vital signs. client on how to helps loosening
 Noticeable weight loss perform coughing secretions and
of 11kg from last visit: c. Weight increases or exercise/ technique facilitates excretion
before – 79kg, now – of mucous and
68kg
may at least return (inhale deeply and letting the patient
 Frequent, non-productive to normal, and cough 2 to 3 times perform afterwards
cough appetite returns to upon exhaling) and to ensure that he
normal. let him perform it understood the
 Diagnostic/Lab in return. teachings.
findings:

 Hgb: 10.0 g/dL  To provide

 Hct: 31%  Provide humidifier moisture to loosen
or vaporizer. secretions.
 Chest x-ray showing
infiltrate in the Right
Lower lobe of the Lungs Short-term:
 MRI showing Peripheral At the end of a 2 hours  Encourage patient  Fluid intake
lung tumor intervention, the patient to increase fluid moistens secretions
 Biopsy revealed stage IV and SO will be able to: intake to 1-2 L of and facilitates easy
lung cancer water or at least 8- excretion.
a. Demonstrate 10 glasses of water
(note: other objective DBE/CE efficiently. or non-carbonated
cues that may or may not b. Identify and drink unless
be seen) demonstrate other contraindicated.
alternative pain
 Wheezing upon control methods and  To reduce the
 Teach relaxation
auscultation relaxation anxiety that the
techniques and
 Excessive sputum techniques patient might be
production c. Maintain comfort as allow patient to feeling. Reclining
 Fever much as possible. sleep in reclining in chair helps ease
 Possible pleural chair if he is breathing
friction rub upon experiencing discomforts by
severe dyspnea. allowing free
examination
passage of air
 Encourage patient
to limit activities  To conserve energy
and prevent further
or instruct SO to fatigue.
put patient’s things
within patient’s
reach.

 Encourage patient  To promote healing

and prevent edema.
to eat foods that
are high in calorie
and protein such as
milk, eggs, oral
nutrition
supplements, and
chicken, and fish,
and advice to eat
small frequent
meals rather than
three large meals
daily.

 Teach clients about  To increase the

alternative pain patient’s sense of
control method control while
preventing patient
such as relaxation to be dependent on
techniques, pain medications.
biofeedback, or by
diverting patient’s
attention to other
things when
 experiencing pain
as much as
possible.

Dependent:

 Administer pain  To ensure that the

medication right amount and
(analgesics or timing is observed,
opioids) per since pain
doctor’s order but medications are
quite addictive.
try to withhold it as
long as the patient
can still tolerate
the pain.

 Administer O2  To supplement
inhalation per DO oxygen and ensures
through nasal that the patient
cannula if the receives adequate
patient became oxygenation. Also
severely dyspniec. to prevent
hypoxia/hypoxemia
.

 Give Enteral or  To provide

parenteral nutrition nutrition and
(via IV) if needed nourishment in case
the patient became
and per Doctor’s
 discretion. unable or unwilling
to eat.

 Give expectorants  To relieve dyspnea

and antimicrobial and combat
agents per DO. possible infection.

 Give
chemotherapeutic
agents per DO.

Collaborative:
 This may be the
 Assist in radiation or treatment of choice
chemotherapy. for the patient.

 Prepare to assist in  To always be ready

the resection of just in case
tumor, lobe, or lung patient’s condition
worsens or if the
patient and the
doctor decides to
undergo this if
other treatment has
failed

Student’s Name & Signature: Durban, A.Y., BUKSU-SN

Nursing Dx: Imbalanced nutrition: less than body requirements related to decreased appetite secondary to lung cancer as evidenced by weight loss and
deficient interest in food (poor appetite).., or

Imbalanced nutrition: less than body requirements r/t increased caloric requirement and difficulty in ingesting sufficient calories secondary to lung cancer as
evidenced by weight loss and deficient interest in food (poor appetite).

Level of priority: 2nd highest priority

Causal analysis: Intake of nutrients insufficient to meet metabolic needs.

Cues Objectives Interventions Rationale Evaluation
Subjective: Long term: Independent: Long term:
 It will give a Goals were partially met. Patient
 Patient has poor At the end of 12 weeks  Explain to patient better was able to show dramatic
appetite (anorexia) understanding on
intervention, the patient and SO about the the need of
increase in weight, reports better
will be able to: importance of appetite, and showed no signs of
 Mr. P’s usual diets are meeting the daily
composed of high fat-
maintaining proper nutritional malnutrition, but is having
high carbs, and high d. Show increase in nutrition. requirements of difficulties with eliminating
sugar content with weight as the body habits of smoking.
insufficient fluid intake evidenced by
daily weight returning to  Weigh the patient  Weighing the
patient every
its previous state or daily specifically
 Goes out to eat lunch morning with the
with colleagues every more (within every morning same clothing
week. normal rate) ensures accurate
e. Show no signs of weight
 With decrease physical malnutrition measurement. This
activities (jog only is also to evaluate if
f. Reports better
when needed), ride with interventions are
appetite. working.
car and spend great deal
of his time driving
g. Show willingness for Short-term:
lifestyle
 Smokes 2 packs of modification.  Encourage patient  It enhances good Goals were met. Patient and SO
cigarettes per day to maintain good appetite and better were able to understanding to the
taste of food.
 oral hygiene such importance of proper nutrition by
as brushing the eating those recommended diet and
Short-term: teeth every avoiding those that are not
At the end of 1-2 hours morning after beneficial to the patient, have
intervention, the patient waking up and in identified and enumerate foods that
Objective:
and SO will be able to: are high in calorie and protein.
the evening before
 Weight loss: >10% of sleeping or every
the previous weight: h. Show better after meals, or with
from 79kg to 68kg. understanding on the
the use of
 Chest x-ray showing importance of eating
a well balance diet mouthwash.
infiltrate in the Right
Lower lobe of the with high in calories
Lungs and protein and  Encourage patient  It will enhance the
appetite and will
 MRI showing limiting foods that to eat small
facilitate better
Peripheral lung tumor are high in sugar frequent feedings digestion of food
 Biopsy revealed stage content and high fats many times a day
IV lung cancer and demonstrate it in rather than a 3
return. large meal per day.
i. Identify and  Encourage patient
enumerate foods that  These lifestyle
to totally avoid if increases loss of
are high in calorie
possible or at least appetite.
and protein.
limit intake of
caffeinated or
carbonated, and
high sugar content
drinks, and
smoking.

 Encourage patient
to increase fluid  Restricting fluids
 intake to 1-2 L of with meals and
water or at least 8- before prevents
gastric distention
10 glasses of water thus decreasing loss
or non-carbonated of appetite.
drink unless
contraindicated,
but restrict intake
with meals and
avoid fluid intake
an hour before and
after meals.

 Encourage patient  To promote healing

to eat foods that and prevent edema.
are high in calorie
and protein such as
milk, eggs, oral
nutrition
supplements, and
chicken, and fish.

 Arrange intake of  This increases the

high-calorie, high likelihood that the
protein meals at patient consumes
the times that the adequate calories
and protein.
patient usually
feels most like
eating. (example if
patient likes to eat
 most during
morning or lunch)

Dependent:

 Give Enteral or
parenteral nutrition  To provide
nutrition and
(via IV or NGT) if nourishment in case
needed and per the patient became
Doctor’s unable or unwilling
discretion. to eat.

 Give dietary
 To ensure that
supplements as per patients receives
DO adequate nutrition.
Also, there are
dietary supplements
that may interact
with the
medications for
cancer treatment

Collaborative:

 Refer patient to a
dietician if needed.

Student’s Name & Signature: Durban, A.Y., BUKSU-SN

Nursing Dx: Risk for infection related to compromised host defenses secondary to Lung cancer
Level of priority: Medium priority
Causal analysis: Patient is at risk for being invaded by pathogenic organisms because immune system may be exhausted due to the existing terminal illness.

Cues Objectives Interventions Rationale Evaluation

Subjective: Long term: Independent: Long term:
At the end of 1 week  Eating a well-
 balanced meal
Patient claimed to have intervention, the patient  Teach client decreases chances
Goals were met. Patient was able
observed blood in the will be able to: measures that to be free of infection, has
sputum but has of getting infection
prevents and boosts immune maintained adequate nutrition,
associated it with
irritation due to cough a. Remain free of infection such system, and iron in and increased in weight is
(hemoptysis) infection, as as: green leafy noticeable.
evidenced by vitals vegetables may
combat anemia.
 Claimed to have loss of signs of normal a. Eating a well
appetite range balance meal
that is high in
 Reports of frequent, non-
productive cough b. Maintain adequate vitamins and
nutrition and minerals such as
 Diet of high sugar increase in weight. kangkong,
content malunggay,
kamote taps,
 Reports occasional apple, Short-term:
weakness
orange/ponkans, Goals were met. Patient was able to
Short-term: kalabasa, show understanding on the
papaya, eggs and importance of maintaining nutrition
At the end of 1-2 hours other dairy and adequate rest to prevent
intervention, the patient products, etc.,. infection and followed
Objective: will be able to: recommendations, had enumerated
And to eat foods
and demonstrated measures to
 Weight loss: >10% of a. Show understanding
that are high in prevent infection such as hand
the previous weight: protein such as washing, proper hygiene, and
on the importance of
 from 79kg to 68kg. nutrition and beans, chicken adhering to recommended diet, and
adequate rest to liver, chicken, lastly, had watched out for early
 Diagnostic/Lab preventing infection pork, eggs, and signs of infection.
findings: (indicates
slight anemia)
many more.
b. Enumerate and
demonstrate
 Hgb: 10.0 g/dL b. Adequate rest  Providing adequate
measures to prevent
 Hct: 31% rest prevents
contracting infection fatigue which
such as proper oral predisposes patient
and hand hygiene. to infection.

Identify and
verbalize early c. Washing of  To prevent cross
recognition or hands frequently contamination and
warning signs of removes dirt and
infection such as other pathogenic
microorganism that
consistent
may be present in
productive cough the hand
with yellowish-
greenish sputum,
fever, fatigue, etc.

d. Maintaining  Provides comfort to

proper hygiene patient and washes
such as taking a out any pathogenic
bath regularly organisms present
in the body.
and oral hygiene

 Encourage  To promote diluted

increased fluid urine and frequent
intake unless urination thus
 contraindicated reducing stasis in
urine and decrease
likelihood of
getting
urinary/bladder
infection

 This reduces stasis

 Encourage DBE of secretion thus
and CE or decreasing
consider use of likelihood for
incentive respiratory
spirometer infections caused
by pathogens in
secretion pool.

 Teach client to  To treat infection

recognize early promptly.
warning signs of
infection such as
fever, persistent
productive
cough with
yellowish-
greenish sputum,
extreme fatigue
and weakness,
and flu-like
symptoms and to
 report it
immediately to
his primary
health care
giver.

Dependent:

 Teach client on  Teaching client this

how to prevents abuse of
medications
administer
antibiotic per
DO when
necessary

Collaborative:

 Refer patient to  To check for

laboratory and presence of
diagnostic section infection
for laboratory
monitoring if
necessary

Student’s Name & Signature: Durban, A.Y., BUKSU-SN

Format Nurse’s Notes
F Ineffective airway clearance

D  Received patient sitting on bed, conscious and coherent

 With Presence of frequent, non-productive cough

 Patient reports occasional weakness

A 9:00 am
 Vital signs monitored and recorded
 IVF of D5LR started and regulated well
 Elevated head of bed
 Due meds given and recorded
 Encouraged patient to increased fluid intake 1-2 L or at least 8-10 glasses of water or
non-caffeinated, non-carbonated drinks if tolerated.
 Encouraged patient to limit movement and SO instructed to put things within patient’s
reach to conserve energy and prevent further fatigue
 Health teachings done with emphasis on:
a. Eating foods that are high in calories and protein such as beans, milk, eggs, chicken
and fish, and to eat small frequent meals rather than a 3 large meals.
b. How to perform DBE and CE and to perform them several times a day or as tolerated.
c. Using alternative pain control method such as relaxation technique, biofeedback, and
diverting patient’s attention to other things when experiencing pain.
d. Proper positioning to relieved dyspnea such as to sleep in reclining chair.
  Kept comfortable and monitored for any abnormalities

R  Patient resting and comfortable in bed

 Reports feeling well and well-rested already
 Responded well to the health teachings done by performing DBE and CE several times a
day, eaten his fair share of meal, and positions himself to comfortable position when
feeling any discomforts