NURSING CARE PLAN
Name of the Patient:
Civil Status: Religion:
Address:
Date of Admission: _____________________ Diagnosis: Diabetes Mellitus Type II
CUES
Subjective/ Objective
Subjective:
 The patient claims that
“the medicine is gone.”
Objective:
 The patient has a
cognitive decline, an
overdose of glimepiride
and metformin was
suspected, and the
drugs were
discontinued
Age: 90 years old Sex: Female
Rm/Bed No. _________________
NURSING DIAGNOSIS
Ineffective Health
Maintenance related to
Cognitive Impairment/Loss
 The patient claims that
“the medicine is gone.”
 The patient has a
cognitive decline, an
overdose of glimepiride
and metformin was
suspected, and the drugs
were discontinued
Scientific Explanation:
Ineffective health
maintenance
Inability to identify, manage,
and/or seek out
help to maintain health
NURSING OBJECTIVES
After 2 hours of
independent nursing
interventions, the client will
be able to:
 Identify necessary
health maintenance
plan/activities
 Verbalize
understanding of factors
contributing to current
situation.
 Adapt lifestyle changes
supporting individual
healthcare goals.
Name of Student: Casilao, Mike Arone H.
Area: Level/ Block: BSNIII-B
Date Submitted: May 22, 2022
Rating: ___________________________________________________
NURSING INTERVENTIONS RATIONALE EVALUATION
Independent Intervention: Independent Intervention: After 2 hours of rendering
independent nursing
 Establish rapport to the  To obtain trust on the client interventions, the goal was
client and to her guardian and guardian to allow them met as evidenced by:
be more comfortable
discussing or raising any  The client maintenance
issues. plan has been set and
 Assess client’s learning identified
needs and abilities; note  To determine how the client
barriers in accepting will accept and integrate the  The client verbalizes of
information. health education. the understanding to the
factors contributing to her
 Note client’s age (e.g., very  Client’s status may range situation
young or elderly); from complete dependence
cognitive, emotional, (dysfunctional) to partial or  The client was able to
physical, and relative independence and adapt in lifestyle changes
developmental status; and determines type of for her health lifestyles.
level of dependence and interventions/support needed.
independence.
 Requires more intensive or
 Determine whether long-lasting support and
impairment is an acute or interventions with progressive
sudden onset situation, or chronic conditions.
Reference:
Nurse’s pocket guide:
diagnoses, prioritized
interventions, and rationales /
Doenges Marilynn E.,
Moorhouse Mary Frances,
Murr Alice C.—Ed. 13
progressive illness, long-
term health problem, or
exacerbation or
complication of chronic
illness.
 Determine level of adaptive 
behavior, knowledge, and
skills about health
maintenance, environment,
and safety.
 Discuss with client/SO(s)
beliefs about health and
reasons for not following
prescribed plan of care.
 Develop plan with
significant other for self-
care.
 Refer to social services, as
indicated
 Arrange for hospice service 
for client with terminal
illness
.
Determines beginning point
for planning and interventions
to assist client in addressing
needs.
 Determines client’s view
about current situation and
potential for change.
 Allows for incorporating
existing disabilities with
client’s/SO’s desires and
ability to adapt and organize
care activities.
 For assistance with financial,
housing, or legal concerns
To help client and family deal
with end-of-life issues in a
positive manner.