GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION INC.

Bulaong Subdivision. Barangay West, General Santos City 9500

Tel No.: (083) 302-3507, Tele Fax No.: (083) 552-9793

NCM: RLE EXPOSURE

Students Name: MAQUIDATO, ELOISA JOIE

Diagnosis: Urinary Tract Infection
Chief complaint: Lower back pain Year and Section: BSN 3A
Group: 3A

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective: The Deficient INDEPENDENT
client Knowledge GENERAL  Establish - To gain the -At the end of
verbalized that related to OBJECTIVE: rapport trust and the shift, goals
‘wala jud ko unfamiliarity with To recognize the cooperation fully met as
kabalo nganong lack of physiologic of the client. evidence by
nagka uti ko information responses of the client’s
nga wala man regarding body to disease  VS checked - To monitor responses to
ko gakaon og precipitating conditions and recorded VS interventions,
mga unhealthy factors and pathologic, teaching, and
 Bedside care - To prevent
foods pero prevention of UTI physiologic, and done, linens are the spread of actions
infection
ingon ni doc as evidenced by compensatory. straightened, Performed and
basig sa akong recurring tightened, and attainment or
hygienic infection. SPECIFIC tucked well. progress toward
practice pud OBJECTIVE: desired
kay nabusy na Inference: Within 8 hours of  Discuss client’s - To ensure outcome
sa daycare nursing intervention, understanding safety
center di nako Reference: the client will be able of current And Understood
makafocus sa Poor Hygienic to: situation to The importance
akong sarili’ practices determine of having
 Maintain areas that can lifestyle
responsibility be clarified or changes.
for planning strengthened.
and achieving  Encourage
Objective: Acquire Bacteria  To make
self-care communication
Received client (E.coli) sure that the
goals and among those
sitting on bed, client
general well- who are
fully awake, understand
being. involved in the
stable, the
 Verbalize client’s health
Infects urinary appropriate
conscious, alert understanding promotion.
tract given
and of condition,
responsive . information.
disease
ongoing IVF of process and
PNSS 1L at treatment -
100cc level; Understand
Initial V/S taken UTI the
as follows: importance of
BP:110/80 having
 Discuss the - So that the
mmhg lifestyle
Lack of client client feels
Temp: 36.6 changes.
information perception of competent
02Sat: 95%
regards UTI need. and
Pulse: 86
Related the respected
RR:20 cpm
information to
Weight: 51kg
Recurrence of the client's
Height: 175 cm
UTI personal
BMI:20. 73
Deficient desires, needs,
knowledge values, and
beliefs.
(Marilynn E.
Doenges, Mary
frances Moorhouse,
Alice C. Murr, 2017)

DEPENDENT
 - ensure that the
 Advise patient patient is content to
to strictly follow take the medicine
the medication as prescribed.
regimen as
prescribed by
the physician

Collaborative:
 To evaluate

 Reviewed prescribed

laboratory data. medication

as
prescribed.
Reference
(Marilynn E. Doenges, Mary frances Moorhouse, Alice C. Murr, 2017)