B.

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUTAION

BACKGROUND

S: Independent
*Itchy skin Impaired Skin Rashes may Short-term Short-term
*Rashes Integrity related cause the skin to goal: *Use a thin *Reduce irritation goal:
throughout the to inflammation change color, After 4 hours of clothing and soft and pressure from After 4 hours of
body. of dermal and itch, become nursing loom. the suture line of nursing
epidermal as warm, bumpy, intervention, the clothes, leave the intervention, the
O: manifested by dry, cracked or patient will able incision open to patient was able
air increases the
*Redness of the skin rashes. blistered, swell to feel comfort to feel comfort
healing process
skin and may be and the patient’s and the patient’s
and reduce the
*Temperature painful. temperature will risk of infection. temperature was
38.6 be back to back to normal.
normal.
*Observe skin * To determine Long-term goal
Long-term goal turgor circulation baseline by After 5 days of
After 5 days of daily notes and which changes nursing
nursing sensory as well in status can be intervention, the
intervention, the as other changes compared. patient’s skin
patient’s skin that occur. was back to
will be back to normal and
normal and rashes are
reduce rashes. *Keep clothes * To prevent reduced.
and linen clean infection.
and bacteria free.

Dependent:

*Administer *To prevent

hydrocortisone inflammation