CEBU INSTITUTE OF TECHNOLOGY - UNIVERSITY

COLLEGE OF NURSING

NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS SCIENTIFIC ANALYSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

(Subjective & (Dependent,
Objective) Independent &
Collaborative)
Subjective: Impaired gas exchange Pneumonia is an excess After 4 hours of nursing Independent:  Manifestation After 4 hours of nursing
“Maglisod ug ginhawa related to collection of fluid in the lungs interventions, the  Monitor V/S of respiratory interventions, the
akong baby” as secretions affecting resulting from an patient will achieve distress is patient has achieved
verbalized by the oxygen exchange inflammatory process. timely resolution of indicative of timely resolution of
mother. across alveolar Infectious pneumonia current infection the degree of infection without any
membrane. are categorized as without complications. lung complications.
Objective: community acquired. involvement
 Dyspnea
 Tachypnea Source: Medical  Limit Visitors as  Reduce
 Diminished and Surgical Nursing 13th indicated exposure to
adventitious edition by Kerry H. other infectious
breath sound Cheever pathogens.
(crackles)
 Respiratory  Instill isolation  To protect and
rate 62 cpm precaution. prevent spread
of other
infectious
process.
  Assist with  Facilitates
nebulizer liquefaction
treatments. and removal of
secretions.
Collaborative

 Administer  Used to combat

antimicrobials most of the
as prescribed. microbial
pneumonias.