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Lyceum of the Philippines University

College of Nursing

Focus Data Action Response

Nausea and - Client stated that she - Consulted with a dietician - Client express relief
vomiting was nauseated and and nutritionist for meal of nausea
vomited frequently plan - No report of vomiting
throughout the day - Parenteral fluids given after intervention
- Weight from 55.7 to - Instructed client to eat - No signs of
53kg small meals but frequently dehydration
- BP of 88/60 mmhg - Advised client to remain in - Client is awake and
- HR of 120 bpm upright position after eating alert when asked
- Low electrolytes - Monitored laboratory about her feelings
results - Progression of
- Monitored FHR and fetal weight gain
activity

Activity - Client stated that - Determined whether the - Client demonstrated


Intolerance she’s unable to go to pregnant client requires measurable increase
work nor perform any more assistance at home in tolerance to activity
normal daily activities - Ensured that the client - Client was able to
- Sunken eyelids eats healthy foods and have perform simple
- Weak in appearance enough nutrients activities of daily living
- Provide client with comfort
measures
- Educate client on
appropriate
exercises/activities

Submitted by:
Juanitas, Jade Dianne A.

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