ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONAL EVALUATION

N E
Subjective : Risk for After the 4 Independent: Level of
“Hindi sya impaired hours of Attainment:
masyadong ma swallowing r/t nursing -place patient in - -use -goal met
kakain ng inflammation intervention upright position appropriate AE
maayos” as of the throat the patient will during and after gravity to B: demonstration
verbalized by muscles and be : feeding. facilitate of strict aspiration
the mother pharynx swallowing precaution
- able to and reduces observed by the
Objective : demonstrate risk of watcher when
Afebrile feeding aspiration feeding the
methods patient.
- Don’t talk appropriate to -assist patient with - counteracts
when asked by individual head control, hyper
questions situation with support, and extension, Patient
aspiration position based on aiding in Outcome:
- With an IVF of prevention. specific prevention of -patient did not
D5IMB500ml dysfunction. aspiration and loss weight
@150 cc - Maintain enhancing
desired body ability to
- level and weight swallow.
regulated to63 Optimum
cc/H positioning
can
- weak facilitate
inappearanc intake and
reduce risk of
Vital sign as aspiration
taken

T : 38.3 F -provide pleasant - Promotes

P : 85.4 environment relaxation and
R : 23 free of allows patient
B: 110/90 destructions. focus on task
of eating and
swallowing

Collaborative:
- - inclusion of
coordinatemultidis dietitian,
ciplinary speech and
approachto occupational
develop treatment therapists can
planthat meets increase
individualneed effectiveness
of
long-term plan
and
significantly
reduced risk
of
silent
aspiration