Assessment Nursing Scientific Objectives Nursing Rationale Expected

Diagnosis Explanation intervention Outcome

S= “Nung Hyperthermia Pyrogens After 3 hours Independent: - To help in After 3 hours of
pangalawan related to cause a rise of effective reducing effective nursing
g araw infection as in body nursing -Provide and temperature and intervention, the
namin, evidenced by temperature intervention, apply tepid also to enhance patient’s
mainit yung increased it also acts the patient’s sponge bath. heat loss by temperature shall
anak ko” as respiratory as antigen temperature evaporation and have returned to
stated by the rate and hot, triggering will return to conduction normal as
SO. flushed skin, immune normal as manifested by:
system manifested by: - Monitoring helps
O= - Monitor the nurse to
responses.
temperature identify the a. Temperature
- Flushed The within normal
a. Temperatur development of
skin with hypothalamu e within range (35-36 ˚
s reacts to the patient’s
body normal C per axilla)
raise the set temperature.
temperature range (35-
of 37.9 ᴼC point and the 36 ˚ C per b. Relief of signs
body axilla) of discomfort
per axilla such as
producing - Place a cool - To give a
b. Relief of grimacing and
- Respiratory heat, cloth (not ice) cooling sensation;
signs of crying
rate of : 76 on the infant’s comforting to the
discomfort
breaths per such as forehead. infant
minute grimacing
- Promote - Promotes heat
and crying
-Skin is surface cooling loss by radiation
warm to by means of and conduction.
touch undressing or
wearing light-
weight clothing.
-Facial Dependent:
grimacing
and crying - Give - To lower body
antipyretic temperature by
medication as blocking the
prescribed synthesis of
prostaglandins
that act in the
hypothalamus.