NURSING CARE PLAN
Defining characteristics
Subjective
Objective
Temperature: 36.5℃
Pulse Rate: 140 bpm
Respiratory Rate: 48 bpm
Weight: 3,200 grams
Head circumference: 34 cm
Chest Circumference: 32 cm
Abdominal Circumference:
30 cm
Length: 47 cm
Nursing Outcome Identification Nursing intervention Rationale Evaluation
diagnosis
Risk for Long term: After a couple of months Independent The goal has been met
infection related of nursing intervention the newborn as the newborn
to immature 1. Review maternal record for 1. To ascertain whether the neonate may be
will be free from signs of infection remained free of
immunologic evidence of any risk factors. predisposed to infection.
and the area around cord is dry and infection while under
defenses and free of erythema. my care. Mother was
environmental 2. Provide prescribed eye 2. To prevent infection.
prophylaxis. able to demonstrate
exposure and
Short term: After 8 hours shift of 3. Monitor vital signs. 3. To identify early possible evidence of proper hand hygienic
cord stump.
nursing intervention, the newborn: infection, especially temperature instability. method of cleaning the
RATIONALE: 1. Newborn remain free of 4. Have all care providers, including 4. To prevent spread of infection. umbilical cord and
Note: Nursing infection, as evidenced by parents, practice good hand-washing caring for infant.
diagnosis should normal vital signs and techniques before handling newborn.
be based on absence of signs and 5. Keep genital area clean and dry 5. To prevent skin irritation, cross-
(NANDA- symptoms of infection. using proper cleansing techniques. contamination, and infection.
American 2. Mother will be able to give 6. Keep umbilical stump clean and 6. To allow to dry and minimize chance of
Nursing proper cord care for the baby. dry and keep exposed to air. infection.
Diagnosis) 3. Mother will demonstrate 7. Teach parents to keep neonate 7. To reduce potential sources of infection.
proper hygienic methos of away from crowds and
cleaning the remaining environmental irritants.
umbilical cord.