NCP Aleeyah 2n

Assessment Nursing Specific planning Nursing rationale evaluation
diagnosis explanation intervention

Subjective data: Acute pain Ectopic Short term: Independent: 1. To Short
“ansakit ng tiyan related to pregnancy is After 2 hours 1. monitors determine term:
ko” verbalized by distension of gestation of nursing maternal presence of After 2
the patient fallopian located intervention vital sings hypotension hours of
tube outside the s, the and nursing
Objective data: uterine patient will 2. Monitor of tachycardia interventio
Pain scale: 8/10 cavity. The be able to presence caused by ns the
fertilized experience amount of rupture or goals were
Pallor ovum gradual vaginal hemorrhage met as
Distress implants reduction/re bleeding evidence
outside of lief of pain 2. Increased by the
V/S taken as the uterus, 3. Monitor pain and patient
follows : usually in Long term: for abdominal stated that
T 36.5 C the fallopain Within 3 increased distensions he was
BP, 110/70 tube. days of and pain of indicates controlled
HR 88 bpm Predisposing nursing abdominal rupture and
RR 14 bpm factors intervention distention possible Long term:
include s, the and rigdity intra After 3
adhesions of patient will abdominal days of
the tube be able to: 4. Monitor hemorrhage nursing
slapingitis, 1. Verbalize complete interventio
congenital reduction/re CBC blood 3. To ns the
and lief of pain. count determine goals were
developmen the amount met as
tal 2. Move his 5. Provide of blood evidence
anomalies of left upper comfort loss by, the
the fallopian extremity measures. patient
tube, without 4. Promotes stated that
previous facial 6. Provide relaxation he can
ectopic grimace diversional and may able to
pregnancy activities enhance verbalize
use of an patients reduction/
intrauterine Dependent: coping relief of
device for 1. Administer abilities by pain and
more than 2 analgesics refocusing move his
years, as attention left upper
multiple indicated extremity
induced 5. Diversional without
abortions, activities facial
menstrual aids in grimace
reflux, and refocusing
decreased attention
tubal and
motility. enhancing
coping with
limitations
6. To maintain
acceptable
level of pain
Assessment Nursing Specific planning Nursing rationale evaluation
diagnosis explanation intervention
Subjective data: Risk for fluid the first Short term: Independent: Short
“nakaramdam volume warning After 30 1. Oral fluid term:
ako ng deficit r/t signs of an minutes of 1.. Urge the patient replacement is After 30
pagdurugo” as blood loss as ectopic nursing to drink prescribed indicated for mild minutes of
verbalized by the evidence by pregnancy intervention amount of fluid. fluid deficit and is a nursing
patient light vaginal are light s cost-effective method interventio
2.. Provide for replacement
bleeding and vaginal The patients ns the
comfortable treatment. Older
Objective data: pallor bleeding and complete patients have a goals were
environment by
Pallor pelvic pain. blood count covering patient decreased sense of met as
Light Vaginal If blood will be back with light sheets. thirst and may need evidence
Bleeding leaks from to normal ongoing reminders to by, patient
the fallopian drink. Being creative stated the
V/S taken as tube, you Long term: in slecting fluid CBC went
follows: may feel After 3 days sources (e.g., back to
Dependent:
T 36.5 C shoulder of nursing flavored gelatin, normal
Maintain bed rest frozen juice bars,
BP, 110/70 pain or an intervention Monitoring V/S sports drink) can
HR 88 bpm urge to have s the patient Monitor intake and Long term:
facilitate fluid
RR 14 bpm a bowel risk for fluid After 3
out take of fluid replacement. Oral
movement. deficit has volume hydrating solutions days of
Your specific been (e.g., Rehydralyte) nursing
symptoms prevented Monitor can be considered as interventio
depend on hemoglobin, needed. ns
where the hematocrit and The goals
blood 2. Drop situations were met
RBC
collects and where patient can as
experience
which Administer evidence
overheating to
nerves are medication as prevent further fluid by patient
irritated prescribed loss. stated that
the risk
for fluid
deficit has
been
prevented

NCP Aleeyah 2n

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NCP Aleeyah 2n

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Assessment Nursing Specific planning Nursing rationale evaluation

diagnosis explanation intervention

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