ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS KNOWLEGDE
Subjective: Acute Pain The patient After 6 hours 1. Establish 1. To gain Goal is met.
“Dalawang araw na related to experiencing of Nursing Rapport trust from After 6 hours of
pong sumasakit ang pathological abdominal pain Intervention, the Nursing
tiyan ko.” As disease and still have the patient will patient. Intervention the
verbalized by the process fever of 40 verbalize relief 2. Observe or patient
patient. secondary to Degree Celsius pain from 6/10 monitor the 2. To prefer it verbalized relief
viral infection. associated of to 3/10. signs and to the pain from 6/10 to
Objective: colds, headache symptoms of physician 3/10.
- Pain and dizziness. the patient’s and give it
Pain scale: The abdominal pain. some pain
6/10 pain scale is remedies.
- Dizziness 6/10. 3. Assess the
- Chills patient her
- Loss of probable 3. To aware
appetite cause of the patient
- Restlessness pain. about
- Facial grimace his/her
condition.
4. Give some
health
teaching to
the patient. 4. To give
some idea
to the
patient
what
he/she
doing if
abdominal
pain
occurs.

ABDOMINAL PAIN
ASSESSMENT NURSING BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEGDE
Subjective Altered body Activates After 1-2 hours 1. Establish 1. To gain Goal is met.
“Giniginaw po temperature immune of Nursing Rapport trust to After 1-2 hours
ako at mainit related to response Intervention, the the of Nursing
ang pakiramdam infection as patient’s patient Intervention, the
ko” As manifested by Decreases WBC temperature will patient’s
verbalized by temperature of and neutrophils subside to 36.5 2. Monitor the 2. To temperature
the patient. 40 Degree Degree Celsius vital sign. check if subsides to 36.5
Celsius. Release of from 40 Degree the from 40 Degree
Objective: Pyrogen Celsius. patient is Celsius.
Temp: 40 stable or
Degree Celsius Reset of not.
BP: 120/70 hypothalamus 3. Assess the
P: 83 patient for 3. To guide
R: 23 Fever some health the
teachings. patient
Chills that will
Fatigue help to
Loss of appetite reduce
Restlessness her
fever.

FEVER