Professional Documents
Culture Documents
• Administer • To support
replacement circulating
fluids and volume and
electrolytes tissue perfusion.
CUES NURSING RATIONALE NURSING NURSING RATIONALE EVALUATION
DIAGNOSIS GOAL INTERVENTION
Subjective: Impaired Skin The rash is After 1-2 days Independent The goal was
Integrity due to caused by of nursing met as evidenced
“Bakit may mga presence of small blood intervention, the • Assess patient • To determine by absence of
pantal siya sa vessels in the skin thoroughly. if rashes
katawan”, as rashes. patient will have rashes.
skin leaking developed in
patient’s blood into the improved skin other parts of
guardian tissues, where integrity as the body.
verbalized. the blood forms evidenced by
a small red reduction of • Maintain strict • To maintain
Objective: patch with rashes. hygiene. skin integrity at
irregular shape optimal level.
• Presence of but quite sharp
maculo- edges. As the • Monitor • Clotting
papular rash color is from laboratory factors may
on truck and red blood cells results pertinent show abnormal
lower that are unable to causative result that may
to move, factors. increase the
extremities.
pressing on the patient risk.
• (+) LATS skin does not
change their • Promote • Rashes may
color. patient’s cause itchiness.
comfort.
Collaborative
• Give • To relieve
medications as any discomfort.
prescribed.