Assessment Nx Diagnosis Planning Intervention Rationale Evaluation

Subjective: Impaired Verbal After 8 hours of Monitor vital signs. To establish After 8 hours of
Communication nursing baseline data. nursing
“Nahihirapan nga related to loss of intervention, the intervention, the
siyang magsalita eh, facial or oral muscle patient will Provide alternative To provide goal was met. The
simula nung na- tone establish method of methods of communication patient was able to
stroke siya.” As communication in communication like needs or desires establish method of
verbalized by the which needs can be pictures, visual based on individual communication in
patient’s daughter. expressed. cues, gestures, or situation or which needs can be
demonstrations. underlying deficit. expressed.
Objective:
Anticipate and Helpful in
- Vital signs taken provide for patient’s decreasing
as follows: needs. frustration when
 BP: dependent on others
 T: and unable to
 P: communicate to
 R: desires.

- Speaks with Talk directly to It reduces confusion

difficulty patient, speaking or anxiety and
- Difficult in slowly and directly. having to process
forming words or Use yes or no and respond to large
sentences question to begin amount of
- Difficult in with. information at one
expressing thoughts time.
verbally
- Use of nonverbal Speak in normal Patient is not
cues tones and avoid necessarily hearing
- Facial paralysis talking too fast. impaired and raising
- Muscle and facial Give patient ample voice may irritate or
tension time to respond. anger the patient.
Encourage family It is important for
members and family members to
visitors to persist continue talking to
efforts to the patient to reduce
communicate with patient’s isolation,
the patient. promote
establishment of
effective
communication and
maintain sense of
connectedness or
bonding with the
family.
 Assessment Nx Diagnosis Planning Intervention Rationale Evaluation

Subjective: Impaired Physical After 8 hours of Monitor vital signs. To establish After 8 hours of
Mobility related to nursing intervention baseline data. nursing intervention
neuromuscular
impairement

Objective: