8/15/2019 Nursing Care Plan Form

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NURSING CARE PLAN

Name: Magayam, Danilo Age: 60 years old Sex: Male Occupation: Librarian

Problem: Abdominal Left Lower Quadrant pain.

CUES NURSING

DIAGNOSIS

NURSING

OBEC!I"ES

NURSING IN!ER"EN!ION RA!IONALE E"ALUA!ION

S:“Masait yung tyan

o!

":

• #a$ial grima$e

• %olding t&e

affe$ted area.

• Slig&tly

irritable.

A$ute 'ainrelated to

 present illness

After ( &our of )ursing

*nter+ention patient

will be able to

+erbalie relief or

de$rease in pain.

(. Assess for referred pain,as appropriate.

-. "bser+e non+erbal

$ues/pain be&a+iors

. 'ro+ide $omfortmeasures, 1uiet

en+ironment, and $alm

a$ti+ities

2. *nstru$t/en$ourage use of

rela3ation te$&ni1ues su$&

as fo$used breat&ing,

imaging, 4D5s.. 7n$ourage ade1uate rest

 periods.6. Administer analgesi$s, as

indi$ated, to ma3imum

dosage, as needed.

(. 8o &elp determine possibility of

underlying $ondition

organ dysfun$tion

re1uiring treatment.-. "bser+ations may/may

not be $ongruent wit&

+erbal reports or may

 be only indi$ator

 present w&en $lient is

unable to +erbalie.

. 8o promote non

 p&arma$ologi$al pain

management.

2. 8o distra$t attention

and redu$e tension.

. 8o pre+ent fatigue.

6. 8o maintain

“a$$eptable! le+el of

 pain.

After ( &our of nursinginter+ention t&e patient

was able to tolerate t&e

 pain and was able to

sleep.

Name of Student: Jaris S. De Los Santos Grade:

 _______________________________________ 

 Year and Section: BSN-IV Clinical Instructor: ______________________________