Cues/Needs Subjective: ³Kagagaling lang nga anak ko sa sakit, tapos ngayon ngakasakit nanaman.

´ As verbalized by the patient¶s mother Objective: _Weakness _Pale looking _Clammy Skin _Sunken eyebags _Presence of illness V/S  P: 132  R:48  T: 37

Nursing Diagnosis Risk for infection

Goals and Objectives After 6 hours of nursing intervention, the patient¶s support familywill identify interventions to prevent/ reduce risk of infection as evidenced by positive feedbacks.

Interventions

Rationale

Evaluation After 6 hour of nursing intervention, the patient µs support familily identified intervetnions to prevent/reduce risk of infection as evidenced by poritive feedbacks. The mother stated that she would ensure to provide nutirous foods for the patient.

_Assess signs and symptoms of infection especially temperature _Stress proper hand hygiene by all caregivers between therapies/clients _Recommend routine body shower/scrubs when indicated _Emphasize necessity of taking antivirals/antibiotics as directed

_Fever may indicate infection _A first line defense against health careassociated infections _To reduce bacterial colonization _Premature dicontinuation of treatment when client begins to fell well may result in return of infection and potentiate drug-resistant strains

_Discuss importance of not taking antibiotics/using ³leftover´ drugs unless specifically instructed by healthcare provider _Encourage patient and patient¶s support family to consume nutirous foods and refrain from sedentary lifestyle

_Unappropriate use can Goal Met lead to development of drugresistant strains/secondary infections _To boost immune system

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