Assessment Objective: Fatigue.

Greater need for sleep and rest

Diagnosis Activity intolerance related to imbalance between oxygen supply (delivery) and demand.

Objective Short term: After 8 hours of nursing interventions the patient will: Report an increase in activity tolerance including activities of daily living. Demonstrate a decrease in physiological signs of intolerance. Display laboratory values within acceptable range. Long term: After months of nursing interventions, the patient: Is free form weakness and risk for complications has been prevented.

Intervention Independent: Assess patients ability to perform normal task or activities of daily living. Note changes in balance/ gait disturbance, muscle weakness. Recommend quiet atmosphere, bed rest if indicated. Elevate the head of the bed as tolerated. Provide or recommend assistance with activities or ambulation as necessary, allowing patient to do as much as possible.

Rationale Influences choice of interventions or needed assistance. May indicate neurological changes associated with vitamin B12 deficiency, affecting patient safety or risk of injury. Enhances rest to lower bodys oxygen requirements, and reduces strain on the heart and lungs. Enhances lung expansion to maximize oxygenation for cellular uptake. Although help may be necessary, self esteem is enhanced when patient does some things for self

Evaluation Patient reveals an increase in activity tolerance, demonstrating a reduction in physiological signs of intolerance and laboratory values within normal range

Kenny John Nadela Group 5- BN31 Bahay Consuelo Nursing Diagnosis Cues and Evidences Goals Objective Nursing Intervention Rationale Evaluation

Anxiety

Subjective cues: excessive sweating shaking if hands

Patient will be able to: lessen her anxiety relax

After 3-5 minutes of nursepatient interaction. Patient will be able to: lessen her anxiety relax

introduced self established rapport talk to the patient and explain further the procedure

introducing your self will lessen the anxiety of the patient. Establishing rapport an develop patients trust explaining the procedure can develop patients understanding

After 5 minutes of nursing intervention s, the patient was able to relax and the anxiety was lessen.