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ASSESTMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Decreased cardiac output SHORT TERM GOAL: -Keep client on bed and in -To promote adequate rest SHORTTERM GOAL:

“bumibilis nga tibok ng related to altered heart rate After 4 hrs of nursing position of comfort Goal Met

puso ko” verbalized by the (84 bpm) pt’s report of intervention, the patient within 4 hrs. of nursing

patient palpations will display hemodynamic -Decrease stimuli; provide -To reduce anxiety intervention the pt. HR

OBJECTIVE: stability (heart rate will quiet env’t decreased from 111 bpm to

-tenderness of abdominal decrease from 84 bpm to 70 100 bpm, BP from 140/100

-facial grimaces bpm, BP from 150/110 to -Encouraged deep -To decreases oxygen to 120/80 (Normal BP)

120/80) breathing exercise consumption


-BP= 150/110 mmhg

-RR= 19 cycles per min. -Encouraged changing -to reduce risk for

positions slowly orthostatic hypotension


-PR= 84 bpm
-give information about -to provide encouragement

positive signs of

improvement
LONG TERM GOAL: -to prevent in changes in LONG TERM GOAL:
After 2 weeks of nursing -Instruct client to avoid or cardiac pressures or impede Goal met the client is able to

intervention Client delivers limit activities blow flow maintain pregnacy to term

healthy, term neonate with

minimal to no complications.

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