ASSESSMENT NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
Objective: Deficient Short Term Diagnostic: STO:
Gravida 1 Para knowledge on Objectives: Assess client’s Acts as a guide in PARTIALLY
0 pregnancy After 4 hours baseline knowledge establishing learning MET, The
process of nursing and expectations needs and set patient was
Client and related to first intervention, during pregnancy. priorities. able to
partner time client will actively
appear pregnancy demonstrate Determine patient's Some persons may participate
apprehensive appropriate learning style, prefer written over however did
and closely breathing and especially if patient visual materials, or not correctly
watch the relaxation has learned and they may prefer demonstrate 1
monitor techniques to retained new group versus relaxation
manage her information in the individual technique
Subjective: labour pains past. instruction. properly and
Verbalized Matching the only partially
pain in back After 4 hours learner's preferred adapted the
than abdomen of health style with the pain
““like my teaching, the educational method management
spine is client would will facilitate success techniques
tearing apart.” be able to in mastery of taught.
correctly knowledge.
Was put on demonstrate
NPO but asked health-related Review appropriate Provides guidelines LTO: FULLY
to eat to “keep procedures: activity levels and for client to make MET, the
up strength pain safety precautions, appropriate patient was
management whether client informed choices; able to
Husband techniques remains in hospital allows client to actively
verbalized that are or returns home engage in safe participate in
concern on appropriate to diversional activities the decision-
why the her condition to refocus attention. making
delivery process
process is Therapeutic: throughout
taking too her
long Long Term INDEPENDENT: hospitalization
Objective: Provide and discuss Active participation and was able
options for care of the client/couple to identify 5
Client will be during the labor is important in the trusted
able to actively process. Provide decision-making resources to
participate in information about process. learn more
decision- birthing alternatives, about her
making if available and condition.
process appropriate.
throughout
her stay at the Provide information Prenatal education
hospital about procedures can facilitate the
(especially fetal labor and delivery
monitor) and normal process, assist the
After progression of labor client in maintaining
discharge, the control during labor,
client would help promote a
be able to positive attitude,
identify at and may decrease
least 5 trusted reliance on
resources that medication.
can be used for
more COLLABORATIVE:
information or Involve the patient’s It is often beneficial
support family in the when family and
regarding her learning process friends are involved
condition in the care and,
therefore, in the
learning process.
Having someone
familiar present
during challenging
times provides a
feeling of comfort
for the patient.
Provide an
atmosphere of This is especially
respect, openness, important when
trust, and providing education
collaboration. to patients with
different values and
beliefs about health
and illness.

Educative:
Educate the client
about breathing and
relaxation
techniques
appropriate to each
phase of labor Unprepared couples
need to learn coping
Teach and review mechanisms on
pushing positions for admission to help
stage II. reduce stress and
anxiety. Couples
Instruct patient to do with prior
relaxation preparation can
techniques: deep and benefit from review
slow breathing, and reinforcement.
distraction
behaviors,
visualization, guided
imagery. Assist as
needed.