IV.

NURSING CARE PLAN

Nursing Care Plan

Nursing Diagnosis Objective of Care Planned Intervention Rationale Implementation Evaluation
Subjective cues: Short term goal: At the end of the 5 days › To reduce risk of › Keep the affected At the end of the 5 days
“Mmbah ako katuli - To minimize the intervention the patient dermal injury when area clean and dry nursing intervention the
pahap bang sangom, impaired skin will be able to: severe itching is › Keep foot dry, patient was able to:
katol toongan neyh integrity and - Display improvement present especially between - Display improvement
ku. Ati piddi iya bang inflammation in feelings of › To prevent further the toes. in feelings of
ni katol sab - To eliminate the discomfort due to invasion of › Change socks discomfort due to
toongan.” discomfort felt by the itchiness. microorganism regularly itchiness.
(Translated to patient. - Minimize the area of › Moisture potentiates › Alternate pairs of - Minimize the area of
English: “I can’t infection skin breakdown shoes infection
sleep very well at Long term goal: › To decrease irritable › Wear light, well-
night, my foot is very - To fully eliminate the itching, which ventilated shoes
itchy. And it is impaired skin usually associated › Protect feet in public
painful when I integrity and with pain places
scratch it so hard.”) inflammation. › Treat feet- use
powder, preferably
Objective cues: antifungal, on
The following are infected foot daily.
observed on the client’s › Don’t share shoes
physical appearance:
Right and Left Foot:
- Scaly red patch
surrounding the
toes, ranging in
size from 2-3 cm
- Scaling on the
soled that extends
up to the side of
the foot
- Cracked,
 blistered, or
peeling between
the toes
- Raw skin from
scratching
Assessment
The patient shows
symptoms of severe
itchiness on right and left
foot, which is associated
with pain on the scale of
4/10.

V/S taken as follows:

T: 36.5 °Celsius
P: 84 beats/mins.
R:18 breaths/mins.
Bp: 64/110