CUES

SUBJECTI
VE:
nahihira
pan siya
maglunok
as
verbalize
d by the
mother of
the
patient.
OBJECTIV
E:
Patient
coughs
after fluid
intake.
Patient is
crying
frequently
.

NURSIN BACKGROU GOALS/

NURSING
G
ND
OUTCOM INTERVENTI RATIONALE
DIAGNO KNOWLED
ES
ONS
SIS
GE
Impaired
swallowing or
Impaired
Dysphagia. It is
swallowing usually a sign
related to
of a problem
behavioral
with your
feeding
throat or
problems
esophagus the
as evidence muscular tube
by
that moves
coughing
food and
after fluid
liquids from
intake.
the back of
your mouth to
your stomach.

After 24hrs
of giving
nursing
interventio
n the
patient
must be
able to
demonstrat
e effective
swallowing
after fluid
intake.
After 2hrs
of teaching
the mother
on how to
breastfeed
properly
the mother
must be

1. Observe for
signs associated
with swallowing
problems
2. Check if the
mother is
breastfeeding
properly.
3. Assess for
coughing after a
swallow.
4. Alert all staff
the patient has
impaired
swallowing.
5. Auscultate
lung sounds
after feeding
and note any
new lung sounds
such as crackles
or wheezes

1. Observe for
signs
associated with
swallowing
problems
2. Check if the
mother is
breastfeeding
properly.
3. Assess for
coughing after
a swallow.
4. Alert all staff
the patient has
impaired
swallowing.
5. Auscultate
lung sounds
after feeding
and note any
new lung
sounds such as

EVALUA
TION
Goal has
been met
the patient
has been
able to
swallow
after fluid
intake.

Goal has
been met
the mother
has been
able to
demonstrat
e proper
breastfeedi

able to
demonstrat
e proper
way of
breastfeedi
ng

The
mother
does not
know how
to
breastfee
d
properly.

Mayor, Erliz Faye B.

BSN II-B

6. Newborn
screening.

crackles or
wheezes
6. Newborn
screening.

ng.