CUES Subjective: > Di pa masyadong magaling yung sugat ko galing operasyon. As verbalized by the patient.

Objective: > Colostomy at LUQ of abdomen > Suture at midabdominal area.

NURSING DIAGNOSIS >Risk for infection r/t disruption in the continuity of primary defense.

SCIENTIFIC REASON >The patient has an

incision at his abdominal area, and he also has a colostomy attached to him, meaning there is openings on his skin, which makes the primary defense of the body compromised which increases the risk of the patient to have infection.

PLANNING Short Term Goal: >At the end of my shift, the patient will be free of signs of infection such as fever and purulent discharge at incision site.

NURSING INTERVENTION Independent: > Observe skin condition for signs of infection, like redness, swelling, purulent discharge. >To notice any abnormalities on the incision site. >Maintain proper aseptic technique at all times while handling the patient. >To prevent introduction of microorganisms to the site. >Stress to the patient and guardians that proper aseptic technique must be observed when handling the incision site. >To prevent introduction of microorganisms to the site. >Patient and guardian education about aseptic technique. >To prevent introduction of microorganisms to the site.

EVALUATION STANDARD CRITERIA > Patient is not at risk for infection. >The patients risk for infection was lessened.