NURSING SCIENTIFIC SCIENTIFIC

CUES PLANNING IMPLEMENTATION

DIAGNOSIS EXPLANATION RATIONALE EVALUATION

Pain r/t labor process Labor process INDEPENDENT

OBJECTIVE: as evidenced by pain ↓ Discharged Outcome: > asses the pain - increase pain Discharged Outcome:
scale of 9/10. Stimulus intensity, duration intensity, duration
“ansakit ng babang ↓ After 1 week of interval, and frequency. interval, and frequency After 1 week of
parte ng likod ko at Noccireceptor discharged outcome the may indicate true labor discharged outcome the
humihilab na ang aking ↓ patient will be able to > asses and monitor - pain can cause patient was able to
tiyan na prang relieved from pain and V/S and fetal heart rate increase in V/S due to relieved from pain and
manganganak na ako” Peripheral nerve demonstrate lifestyle compensatory demonstrate lifestyle
as verbalized by the afferent pain fibers change regarding mechanism and also to change regarding
patient. ↓ motherly hood. determine the motherly hood.
Synapse condition of the baby.
↓ > place the patient in a - to promote comfort
SUBJECTIVE: Spinal desociation Short term Outcome: comfortable position Short term Outcome:
↓ > provide quiet - to promote comfort
Reticular formation After 8 hour of nursing environment and and preventing external After 8 hour of nursing
> pain scale of 9/10 ↓ intervention the patient prevent external stimuli stimuli may alleviate intervention the patient
> pain @ lower back Thalamus will be able to: the contributing factors was able to:
radiates @ the ↓ to pain.
abdomen. Somatosensory cortex > verbalized > teach patient - to promote non- > verbalized
>increase pain parietal lobe understanding about regarding relaxation pharmacologic method understanding about
intensity, duration, ↓ the situation she techniques (e.g., deep and promotes comfort the situation she
interval and frequency hypothalamus experiencing. breathing exercises, experiencing.
> LMP = 3/27/2010 ↓ guided imagery taking
> Primigravida Limbic system > demonstrate at least 2 rest, and etc) > demonstrate at least 2
> mucus plug/show( +) ↓ out of 3 relaxation > turn the patient side - to promote comfort out of 3 relaxation
>ruptured membrane Pain percieves techniques. to side if pain radiates. techniques.
> contractions
>globularly enlarged COLLABORATIVE
abdomen >insert IVF line as - to replenish fluid &
indicated electrolytes loss during
labor & delivery
> refer to an OB - for further assessment

LOUIJE P. MOMBAEL
BSN-4L3