NURSING CARE PLAN!

By: James Albert C. Montañez

 CUES
• Subjective:
– “ dili ko ganahan mag lihok kay kapoy” as
verbalized by the patient.
 Cues
• Objective
- patient always sleeping and rarely sit up
-pale skin

Diagnostic
-hemoglobin L 86 g/l
-hematocrit L 0.26 %
 NURSING DIAGNOSIS

FATIGUE RELATED TO DECREASED HEMOGLOBIN

 SCIENTIFIC BASIS
• An overwhelming sustained sense of
exhaustion and decreased capacity for
physical and mental work at usual level.
 GOAL OF CARE
• After 24 hrs of the nurse client interaction, the
client will be able to retain energy conservation
technique and be able to know different types
of food that is rich in IRON as evidenced by.
• Client verbalize use of energy conservation
principles.
• Client will verbalize reduction of fatigue as
evidenced by reports of increased energy and
Ability to perform desired activities.
 GOAL OF CARE
• Client will be able to eat the recommended
food regarding with the situation she’s in.
 NURSING INTERVENTION
• Assist the client in developing a schedule for daily
activity and rest-Stress the importance of frequent
rest periods.

• Rationale:
– Energy reserves ma be depleted unless the client
respects the body’s need for increase rest. A plan that
balances periods of activity with periods of rest can
help the client complete desired activities without
adding levels of fatigue.
 NURSING INTERVENTIONS
• Monitor hemoglobin hematocrit, RBC counts,
and reticulocyte counts
• Rationale:
– Decreased RBC indexes are associated oxygen-
carrying capacity of the blood. It is Critical to
compare serial laboratory values to evaluate
progression or determination in the client and to
identify changes before they become pontentially
life- threatening.
 NURSING INTERVENTION
• Educate energy conservation techniques
• Rationale:
organization and time management can help
the client conserve and reduce fatigue.
 NURSING INTERVENTION
• Anticipate the need fir the transfusion of
packed RBCs.

• Rationale
– Packed RBCs. Increase oxygen carrying capacity of
the blood.
 NURSING INTERVENTION
• Encourage patient to increase fluid intake.

• Rationale:
– To keep Hydrated.
 EVALUATION
• After 24 hours of nurse client interaction the client will
be able to retain energy- concentration technique and
be able to know what are the different type of foods
that are rich in IRON.
• Client verbalizes use of energy conservation principles.
• Client will verbalize reduction of fatigue of evidenced
by reports of increased energy and ability to energy
and ability to perform desired activities.
• Client will be able to eat the recommended food
regarding or that are rich in iron.