LICEO DE CAGAYAN UNIVERSITY

Paseo del Rio Campus, Macasandig, Cagayan de Oro City

COLLEGE OF NURSING
First Semester, Academic Year 2023-2024
CHN 2 – RLE Group 2 (Block C)

NURSING CARE PLAN (Hypertensive)

Name of Client: MENDIOLA Student Nurse: Justine Paul O. Gaitera
Date: October 3, 2023 Yr.&Sec.: NUR-3C (Group 2)
CUES NURSING DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
Subjective: Risk for falls related After the 8 hours of Dependent: Dependent: After the 8 hours of
“Galabad akong ulo inig present condition as nursing interventions, 1. Perform a 1. Assessment and nursing interventions,
trabaho unya malipong evidenced by headache the client will comprehensive monitoring help the client was able to
ko kung maghangad ug and dizziness. demonstrate selective assessment of in identifying the demonstrate selective
dungo.” prevention measures the patient's underlying prevention measures
and relate the intent to medical history, causes of and relate the intent to
Objective: use safety measures to including any dizziness and use safety measures to
BP: 140/90 mmHg prevent falls. prior falls, headaches. prevent falls.
RR: 24/bpm medications, and
HR: 68/bpm comorbid 2. Medication
O2Sat: 98% conditions. management can
help alleviate the
2. Review the symptoms of
patient's dizziness and
medication list headache,
and assess for reducing the risk
any medications of falls.
that could
contribute to 3. Patient education
dizziness or promotes
headache, such awareness and
as self-management
antihypertensives of symptoms,
or opioids reducing the risk
LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
First Semester, Academic Year 2023-2024
CHN 2 – RLE Group 2 (Block C)

of falls.
3. Educate the
patient about the 4. Creating a safe
potential hazards environment is
of dizziness and crucial in
headache, and preventing falls,
the risk of falls. especially for
individuals at risk
4. Assess the due to dizziness.
patient's
environment for 5. Using mobility
potential hazards, aids and
such as loose assistance with
rugs, clutter, or transfers can
wet floors. enhance stability
and reduce the
5. Encourage the risk of falls.
patient to use
mobility aids,
such as a walker
or cane, if
necessary.
Independent:
Independent: 1. To maintain
1. Encourage client blood glucose
to take medicine level within the
or maintenance client’s normal
drug prescribe by range to prevent
the doctor. possible risk for
LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
First Semester, Academic Year 2023-2024
CHN 2 – RLE Group 2 (Block C)

infection when
complications
occur.