Assessment Nursing Rationale Planning Interventions Rationale Evaluation

Diagnosis
Objective: Readiness for Vaccines are a. Assess a. Response Goal met
enhanced administered After 1 hour of client’s may vary After 1 hour of
 (+) German immunization to induce nursing intervention, history of widely nursing
measles status immunity the client will be able immunization depending on intervention, the
vaccination thereby to: s client’s age client was able to:
 (+) causing the (infant to
Deworming recipient’s  Express the adult), cultural  Express the
(drenching) immune importance of influences, importance
system to immunization travel history, of
Subjective: react to the s family beliefs immunizatio
Secondary Source: vaccine that  Develop plan about ns
Mother produces to obtain immunization,  Develop
antibodies to appropriate and medical plan to
“Nagpabakuna ako fight immunization conditions. obtain
ng German Measles infection. s appropriate
sakanya nung Vaccination b. Helps to immunizatio
nakaraang taon s promote b. Address clarify plans ns
(2014)” health and client’s and deal with
protect concerns misconceptions
“Nakasali siya sa children or myths.
deworming program from disease
sa school niya” – causing c. To
agents. c. Review document
parent’s status, plan for
(Public knowledge boosters,
Health regarding and/or discuss
Nursing in immunization appropriate
the s intervals for
Philippines, recommended follow-up
10th edition,
page 142) d. Viruses and
d. Review bacteria that
reasons to cause vaccine-
continue preventable
immunization disease and
programs death still exist
and can be
passed on to
people who are
not protected,
thus increasing
medical, social
and economic
costs.

(Nurse’s
Pocket Guide
Diagnoses,
Prioritized
Interventions,
and
Rationales;
Marilynn E.
Doenges,
Mary Frances
Moorhouse,
Alice C. Murr.
12th Edition)