Sakamoto, Karen S.July 28, 2009BSN – 4BRot 3 PCMC
NURSING CARE PLAN
I.Mr. AA, 3yoDx: Acute symptomatic seizure 2 to metabolic
encep. 2 to AGE
Assessment N.Diagnosis Inference Planning Intervention Rationale Evaluation
O:>The patientconsume his bottle whilelying downRisk for aspirationrelated to body positioningwhile bottlefed.Ingestion of milk formula passing tothe normalingestion pathwaythat has a possibilityto obstructor block the pathway because of poor body positioningthat resultto risk of aspiration.
After 5hours of nursinginterventions, the patientwill be abletodemonstratetechniques to preventaspiration.>assess thecondition of the patient.>identify at-risk clientaccording tocondition.>educate the patient andrelative toelevate clientto highest or best possible position(e.g., sittingupright inchair)>educate the patient andrelative toavoidwashingsolids downwith liquids>advice the patient andrelative notto jump>to obtain baselinedata>to managedifferentintervention>normalgravityhelps thefood godown toyour digestivetractsmoothlythus preventingaspiration>it may justadd up toaspiration if present>to let thefood beabsorbedAfter 5 hoursof nursinginterventions, the goalwas met asevidenced by patient ableto consumehis milk formula properly andthe absenceof the risk for the patient toexperienceaspiration.