Saint Paul University Philippines

Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
NURSING CARE PLAN
Problem 1: Pain in the Shoulder area
1st Level Assessment: Presence of Health Treat due to pain in the shoulder area
2nd Level Assessment: unable to recognize and treat the condition due to the insufficient knowledge on health care.

ASSESSMEN ANALYSIS OBJECTIVES NURSING METHOD OF RESOURCES EXPECTED

T/ OF THE INTERVENTON FAMILY REQUIRED OUTCOMES
CUES PROBLEM S AND CONTACT
RATIONALE
Subjective Due to a lack Short Term:  Build rapport  Home visits  Time and Short Term:
Data: of  After 6 hours with the family efforts of the
 Client D.P. understandin the client will  Observation students.  After 6
stated that g about the verbalize  Assessment  Knowledge hours, the
“sumasakit health issue, understandin of pain.  Interview of the client will
yung parte the family is g with Determine the student verbalize
ng balikat ko unable to regards to location,  Return nurse with the
palagi” detect the the duration, demonstration regards to appropriate
presence of management frequency and s the issues. diversional
Objective , treatment activities
the illness or severity of  Cooperation
Data: problem. and pain. and
 Physical and
Pain Level: 7 prevention of participation relaxation
Client D.P. Assessments
the sickness.  Conduct a of the family skills.
was well. He is history and the
relaxed and assessment student.
calm during Long Term: Long Term:
of pain.  Transportatio
the whole  After 12
n
interview. hours the  After 12
 Determine the
client will do hours the
 physical signs and client will
activities for symptoms learn how
pain relief related to the to do
pain. simple
 Client will stretches to
demonstrate relax the
the use of right foot.
appropriate  Client will
diversional demonstrat
activities and e the use
relaxation of
skills. appropriate
diversional
activities
and
relaxation
skills.
Problem 2: Blurry Vision
1st Level Assessment: Presence of Health Treat due to Blurry vision
2nd Level Assessment: Inability to properly treat the concern due to aging

ASSESSMEN ANALYSIS OBJECTIVES NURSING METHOD OF RESOURCES EXPECTED

T/ OF THE INTERVENTON FAMILY REQUIRED OUTCOMES
CUES PROBLEM S AND CONTACT
RATIONALE
Subjective The family Short Term:  Build rapport  Home visits  Time and Short Term:
Data: is unable to  After 6 hours with client efforts of the  After 6 hours
 Client Mrs. make the client will  Observation students. the client will
C.G. stated decisions verbalize  Assess the  Knowledge verbalize
that “ang with understandin client’s  Interview of the understandin
paningin ko respect to g with description of student g with
Malabo na taking regards to pain.  Return nurse with regards to
siguro nadin appropriate the demonstration regards to the
dahil sa health management  Assess the s the issues. management
edad ko” actions due , treatment client’s  Cooperation , treatment
to failure to and previous  Physical and and
Objective prevention of prevention of
comprehen experiences Assessments participation
Data: the sickness. the sickness.
d the with pain of the family
Pain Level: 0
magnitude relief. and the
Client need  Client will  Client will
of the student.
glasses to see verbalize verbalize
condition  Determine the  Transportatio
me properly. physical physical
client’s n
activities for emotional activities for
pain relief. reaction to pain relief.
pain
Long Term:
 After 12 Long Term:
hours the  After 12
 client will do hours the
physical client will do
activities for physical
pain relief activities for
pain relief
 Client will
identify the  Client will
factors or identify the
activities that factors or
seem to activities that
trigger the seem to
pain. trigger the
pain.
Problem 3: Sore arns
1st Level Assessment: Presence of Health Treat due to the soreness of arms
2nd Level Assessment: Inability to recognize the presence of the condition due to young age and afraid to tell the adutls

ASSESSMEN ANALYSIS OBJECTIVES NURSING METHOD OF RESOURCES EXPECTED

T/ OF THE INTERVENTON FAMILY REQUIRED OUTCOMES
CUES PROBLEM S AND CONTACT
RATIONALE
Subjective The family is Short Term:  Build rapport  Home visits  Time and Short Term:
Data: unable to  After 6 hours with patient  Observation efforts of the  After 6 hours
 Client C.D. make the client will  Interview students. the client will
stated “ decisions to verbalize  Assess for  Return  Knowledge verbalize
namamaga take understandin presence of demonstratio of the understandin
po kamay appropriate g with defining ns student g with
ko kuya” health regards to characteristic  Physical nurse with regards to
actions due the s. Behavioral Assessments regards to the
Objective to fear of management, and the issues. management
Data: consequenc treatment physiological  Cooperation , treatment
Stress level: 7 es of actions. and to stress can and and
Client looked prevention of be clues to participation prevention of
afraid and in the sickness. the level of of the family the sickness.
pain. coping and the
difficulty. Long Term:
student.
Long Term:  After 12
 Transportati
 After 12 hours the
 Observe for on
hours the client will
causes of
client will learn stress
ineffective
learn stress management
coping such
management and coping
as lack of
and coping strategies.
support
strategies.
 The family system or  The family
will have a recent will have a
treatment change in life treatment
plan and situation. plan and
individual individual
responsibilitie  Identify responsibiliti
s. specific es
stressors.

 Provide
chances to
express
concerns and
expectations.

 Evaluate
resources
and support
systems
available to
the patient.