V.

Nursing Care Plan

Assessment Nursing Diagnosis Pathophysiology Desired Outcome Nursing Intervention Rationale Evaluation

Subjective Cues: Risk for Infection rel Predisposing Precipitating Short Term Goals: After 4 hours of nursing
The client’s moth ated to increased en - 4 year care, the client and SO(s)
- Location
er verbalized, “Ki vironmental exposur After 4 hours of nursing car Independent Intervention were able to
old - Type of
s-a gina ubo man e- air pollution due t e, the client and SO(s) exp s:
eh, kay may ga hi o charcoal productio - Female Housing ected to:
mo oling lapit sa a n.
mon, teh tanan n
ga aso ma haklo gi 1.) Verbalize understa ● Note risk factor for ● To assess causative 1) Identify the
d sang mga tawo, nding of individual occurrence of infec /contributing factor causative risk factor
kag sa mga bata e Definition causative/risk fact tion s. and recognize the
h” At increased risk for Exposure to or effects of smoke
being invaded by pat Environmental coming from 
Objective Cues: hogenic organisms. Factors/Events ● Discuss the effects ● Smoke coming fro charcoal production
Vital Signs: of the smoke comi m charcoal or wood on the health of the
T- 36.8C ng from charcoal p produces hydrocar family. The client’s
such as
P- 105 bpm roduction on the h bons that if inhaled mother verbalized,
R- 25 breaths/min Source: NANDA ealth of the family. deep in the lungs w “Ka delikado gid gali
BP- 80/70 mmHg Charcoal ill contribute to a v sang a-so da sa
Production ariety of respirator ulingan no, amo na
y illnesses. nga ga kabalaka
contributing to man ko para sa
Strengths: amon diri labi na gid
Family Support Air Pollution para sa mga bata”.
Faith in God Goal Met.
leading to

Increase Chances of
Inhalation of Harmful
Substances/Chemicals
resulting to

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Weakness:
Financial Instabilit
y Risk for Infection
2.) Identify interventio
ns to prevent/redu
ce the risk of infec
tion.
Long Term Goals:
Independent Intervention
After 1 month of nursing c s:
are, the client and SO(s)
are expected to:
1.) Adopt techniques,
and lifestyle chang
es to promote a sa
fe environment.
● Assist client and ● To help client/SO(s)
SO(s) to Identify re to create a safe, gr
sources available, s owth-promoting en 2) Identify
uch as adding curta vironment. interventions to
ins to the window prevent/reduce the
risk of infection by
adding curtains to
the window. She
verbalized, “Mas
mayo gid gale nga
may kurtina kag
damol ini, para man
malikawan ang
masakit nga hatag
ka aso”. Goal Met.
After 1 month of nursing
● Provide health edu care, the client and SO(s)
cation to the family ● To help client/SO(s) were able to:
about environment to create a safe, gr
1) Adopt techniques a
al setting owth-promoting en
nd lifestyle changes
vironment.
such as putting plan
ts inside and outsid
e of their house. Th
e mother of the clie
nt verbalized, “Mas
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 ● Encourage the fami ma-ayo gali kung m
ly to put plants insi ag butang mga tano
de and outside thei ● To increase the nu m sa sulod kag guha
r house. mber of plants insid sang panimalay no k
e and outside their ay maka bulig gid sa
home pag sal-ag sang mah
igko nga hangin nga
naga halin sa ulinga
n da ho”. Goal Met.

● Explain the contrib

ution of plants in fil
tering polluted air. ● Houseplants can ab
sorb harmful toxins
from the air

Collaborative Intervention
s:

● Coordinate plannin

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 g with the Baranga
y for appropriate a
ssistance. ● To help client/SO(s)
to maintain a safe,
growth-promoting
environment.

Assessment Nursing Diagnosis Pathophysiology Desired Outcome Nursing Intervention Rationale Evaluation

Subjective Cues: - Risk for imbalanced Predisposing Precipitating Short Term Goals: Independent Intervention After 4 hours of nursing

- 4 year - Availability
old of Food 9
- Female Supply
The Client’s moth nutrition less than th s: care, the client and SO(s)
er verbalized, “Pa e body requirements After 4 hours of nursing car were able to:
lakaon gid ni siya related to inadequat e, the client and SO(s) are e
utan labi na gid k e intake of nutrients xpected to:
ung upod nga ka
n-on galing hindi 1.) Verbalize understandin ● Note availability/u ● To assess causative 1) Verbalize
gid ni siya palaka Definition g of causative factors. se of financial reso factors. understanding of
on mga manok uk urces and support causative factors as
on baboy. Kis-a m At risk for an intake o systems. the mother said,
an lang ukon kun f nutrients that are in “Wala kami gabakal
g may okasyon la sufficient to meet me ● Discuss eating habi karne abi kay
ng kami ga bakal tabolic needs. ts, including food ● To assess contributi kamahal gid, indi
mga karne kay ka preferences, intole ve factors relating t kaigo ang amon nga
mahal.” rances/aversions. o the client’s like an budget sa isa ka
d dislike semana kung mag
karne kami, pero
Objective Cues: mayo gid kay
Vital Signs: Source: NANDA nahibal-an ko na
T- 36.8 C nga may mga
P- 105bpm alternatibo nga mga
R- 25 breaths/mi pagkaon gale nga
n barato kag pasok
BP- 80/70 mmHg gid sa gina
kinahanglan nga
sustansya sang
Strengths: lawas ka bata kag
Family Support pamilya ko.” Goal
Faith in God Met.

Weakness: can lead to

Independent Intervention
Financial Instabili s:
ty
Insufficient Intake of
Nutrients especially
Proteins
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 ● Provide informatio
2.) Identify necessary inter n regarding individ ● To promote wellnes
ventions. ual nutritional nee s. 2) Identify necessary
ds and ways to me interventions that
which can lead to et these needs wit would help promote
hin financial constr wellness to the
aints. family. The mother
Risk for Imbalanced
of the client
Nutrition: Less than ● Provide diet modi verbalized, “Para
Body Requirements fications by introd mas mayo aton nga
ucing cheap and h panglawason, dapat
ealthy alternatives ● To establish a nutriti gid gali nga mapili
for meat to increas onal plan that meet kita sang mga
e protein intake. s individual needs, e pagkaon nga puno
specially protein int sang sustansya kag
ake. bitamina, labi na gid
ang protina. Subong
ko lang nahibal-an
nga ang protina na
sustansya na ini
hindi lang gali ma
kuha sa mga manok
kag baboy? Pwede
man gali iban nga
mga pagkaon nga
barato na, healthy
pa.” Goal Met.
● Explain the need t
o meet the daily n
utritional require
ments especially in
3.) Recognize the importa consuming foods t ● To encourage and p
nce of a well-balanced, hat are high in pro ractice daily healthy 3) Recognize the

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 nutritious food intake. tein. food intake for the importance of
betterment of their nutritious and well-
health balanced food
intake as the
mother told her
daughter not to eat
a lot of junk foods
and finish her food
every meal. She also
promised to
consume the
suggested protein
alternative foods.
Goal Met.
Long Term Goals:
After 4 hours of nursing car ● Develop a behavio
e, the client and SO(s) are e r modification pro
xpected to: gram with client in
volvement approp
1.) Demonstrate behavior riate to specific ne
s, lifestyle changes to eds. ● To promote wellnes
maintain an appropriat s. 1) Demonstrate
e weight. behaviors in lifestyle
changes to maintain
an appropriate
weight by
manifesting an
appropriate weight
for her age,
weighing 15.1
kilograms. The
client’s mother also
mentioned that

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 they try their best
to maintain a
balanced meal for
all of them,
especially for their
daughter. Goal Met.

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