ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City

NCM 112 (RLE)

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

NURSING CARE PLAN (AGE)

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)

PRESENTED BY:

Coleen Mae C. Camarista BSN III - G

 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

ASSESSMENT NURSING OUTCOME INTERVENTION RATIONALE EVALUATION

DIAGNOSIS IDENTIFICATION
SUBJECTIVE:  Activity SHORT TERM INDEPENDENT: After 24 hours of
intolerance GOAL: - Monitor client’s - Fever that occurs with nursing
 He came to the related to vital signs. gastroenteritis intervention,
emergency generalized After 8 hours of increases fluid loss patient will
weakness AEB nursing through perspiration maintain fluid and
room with the
weak intervention, the and increased electrolyte
chief extremities, patient will be respiration. balance, increased
complaint of distended able to identify knowledge about
vomiting abdomen, negative factors the disease and
accompanied and weak affecting activity - Provide health - To enhance patient risk of
by body overall intolerance and teaching on the ability to participate in transmission, and
appearance eliminate or client regarding activity absence of
malaise as
reduce their the organization complications AEB:
verbalized by effects. and time
the patient. Rationale: management a. Temperature is
technique to within normal
LONG TERM: prevent while on range.
OBJECTIVE: Activity
After 24 hours of activity
intolerance is
nursing b. Blood culture
Temperature: insufficient
interventions the - Assist client with - To protect patient reports are
38.5 °C physiological or
patient will activity from injury and To negative.
psychological
participate prevent over-
a) Weak overall energy poor
willingly in exhaustion c. Fluid balance is
appearance endure or necessary or achieved.
b) Distended complete desired activities
abdomen required or as evidenced by: - Monitoring and - Bacteremia. E. coli,
c) Lower desired daily managing Salmonella, and
activities.
- Coleen Mae C. Camarista (10/5/2021)
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

extremities a. Temperature potential Shigella are organisms

are weak is within normal complications that can enter the
range. bloodstream and
disseminate to other
b. Blood culture organs. Shock
reports are associated with
negative. diarrheal diseases
demands accurate
c. Fluid balance intake and output
is achieved. assessment and
vigorous fluid
replacement.

DEPENDENT: - Oral rehydration

Administering
rehydration therapy
therapy should be
delivered frequently in
small amounts. When
patients are
persistently vomiting,
they often require
frequent
administration of
fluids by full-spoons.
IV therapy is necessary
for the patient who is
severely dehydrated
or in shock.

- Coleen Mae C. Camarista (10/5/2021)