University of Bahrain

College of Health Sciences

Nursing Department

Adult Health II
NUR 328

Nursing Care Plan

Objective: By the end of clinical posting, the student will be able to design a comprehensive nursing care
plans for the selected medical, surgical conditions.

Student Name: Kawther Mohd Ali Student No: 20165879

Signature of the student: ----------------------------

Revised, 2017

WD: Nursing Care Plan

 Adult Health II
NUR 328
Nursing Care Plan

Date: 5/11/2020 Pt' initial: H.W.F Diagnosis left septic knee WD 23 S/N Zahra
Nursing Assessment Patient's Nursing Nursing Nursing Intervention Rationale Evaluation
Subjective Objective problem Diagnosis Objective
Date Data
-Pt start c/o -The Pt have Skin Impaired The Pt 1.Assess site of impaired skin integrity 1. Prior assessment of 1.The main cause is
sever pain multiple damage skin condition and determine etiology (e.g., acute or wound etiology is pressure ulcer.
in pressure pressure sore involving integrity will chronic wound, burn, dermatological critical for proper 2. The wound reach
sore areas. with foul epidermis, R/T improved lesion, pressure ulcer, leg ulcer). identification of nursing stage IV.
smelling. in healing 2. Determine size and depth of wound interventions. 3. Position changed
dermis, pressure
-large sacral and future (e.g., full-thickness wound, stage III or 2. The wound reach every 2 hours.
subcutaneous sore stage
pressure pressure stage IV pressure ulcer). stage IV. 4. Dressing with
sore with tissue, IV. sore will be 3. Do not position client on site of betadine applied.
3. To avoid adverse
minimal muscle, and prevented impaired tissue integrity. If consistent effects of external 5. Diet rich in
slough. bone. during with overall client management goals, mechanical forces protein and vitamin
-Lt Knee: hospitaliza turn and position client at least every 2 (pressure, friction, and C provided.
wound,pain, tion ASE hours, and carefully transfer client. shear).
swelling. decreased 4. Apply dressing with betadine on 4. Early protection
pain, pressure sore areas 3 time a day. against infection, and
redness, 5. Assess client's nutritional status; help in wound healing.
and refer for a nutritional consultation 5. Inadequate
swelling and/or institute dietary supplements. nutritional intake places
and the client at risk for
improved skin breakdown and
healing compromises healing.

WD: Nursing Care Plan

WD: Nursing Care Plan