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Ilona 1 Ncp.................
Ilona 1 Ncp.................
A
Age: 1 year old
Diagnosis: Measles with Pneumonia
Assessment Nursing Planning Implementation Rationale for Evaluation
Diagnosis Goal and Nursing
Objective Intervention
Dependent:
administer drug
as ordered: - inhibits bacterial
Gentamycin synthesis.
40mg OD
- promotes good
Vitamin A eye sight
- to promote
• Promote wellness
childhood
immunization
program
Dependent:
administer drug
as ordered: - inhibits bacterial
Gentamycin synthesis.
40mg OD
- promotes good
Vitamin A eye sight
Specific Objectives:
After 45 minutes
of teaching, the
patients significant
other or family will
be able to:
3. Importance of
hand washing and
proper hygiene
4. Importance of
Immunization
Program
M edication
E xercise
T reatment
H ealth
O PD
D iet
S afety
Medication:
• Teach significant others about prescribed medication including action,
dosage, frequency of administration and side effects.
• Administer pharmaceutical agents, as indicated (pain relievers/
analgesics, nonsteroidal anti-inflammatory drug and antibiotic.)
• Review list of side effects and potential interactions with other OTC
drugs.
• Emphasize necessity of taking antivirals/antibiotics as directed
premature discontinuation of treatment when client begins to feel well
may result in return of infection and potentiate drug resistant strain.
Exercise:
Teach parents of Patient; mild exercises ( walking)
Treatment:
Procedure or Time Frequency Duration
Treatment
Proper wound care
technique. After taking a No standard Until the rashes
performing hand bath and before frequency for how healed and skin is
hygiene sleeping. often intact.
thoroughly in
adhering to
standard
precaution.
Monitor rashes
incision for S/S
of infection.
Health:
• Provide significant others with information regarding clients condition.
• Teach family members the importance of good hygiene and grooming.
• Review etiology and possible coping behavior.
• Review environmental factors that may require avoidance/modification
of lifestyle or environment to limit impact on the healing process.
• Importance of immunization program adheres on the standards.
• Taking of Nutritious and healthy foods to increase resistance.
OPD:
Instruct significant others to return to hospital for follow up checkups and if there
is any adverse effect after released from the hospital.
Diet:
Teach family members about the importance of drinking large amount of water.
Inform family members that eating a well balances meal each day will make the
body healthy, provide growth of tissue, boost the immune system, and make
the body stronger and healthier.
Safety:
Instruct client and family members about relaxation techniques and to keep
patient away from any dangerous surrounding.
Always secure for the safety of the client and understand her condition.
V. Evaluation
After 1 day of intervention, the student nurse observed certain changes from the
patient. The patient articulated decreased pain. The patient also exhibits unlabored
respirations; appear weak and tired, afebrile, v/s stable; urine output adequate. The patient
also performs active ROM correctly. The patients has no marked of respiratory distress.