Students Name: Ramos, Shelly Mae A.

Date: January
31,2012
Patients Initials: L.T.

NURSING CARE PLAN

ASSESSMENT DIAGNOSI BACKGROU PLANNIN INTERVENTIO RATIONAL EVALUATION

S ND G N E
KNOWLEDG
E
Subjective: Impaired The alveoli of After 2-3 INDEPENDENT: GOAL MET
gas the lungs are hours of >Noted current To After 2-3 hours
Nahihirapan determine of nursing
exchange responsible nursing situation of
akong factors intervention the
related to for gas intervention conditions that
huminga as affecting the patient was able
deficiency exchange. the patient can affect
verbalized by systemic to:
in Carbon It is will be able perfusion to all circulation. >Demonstrate
the client
oxygenation an elastic to: body systems improved
capacity at membrane ventilation and
the alveolar- which can >Demonstr >Elevated head adequate
Objective: capillary carry oxygen ate of bed and oxygenation of
membrane for exchange improved positioned the To maintain
>RBC : 37.76 tissues by ABGs
secondary with carbon ventilation airway
>Hematocrit : patient within the
to dioxide. and appropriately patients normal
24.8
pneumonia Pneumonia adequate limits
>Hemoglobin :
causes oxygenation >instructed
84.0
consolidation of tissues deep breathing
>Edema in Promotes >Verbalize
of secretions by ABGs and coughing optimal
lower understanding of
in the lungs. within the exercises chest
extremities causative factors
This patients expansion
grade 2 and appropriate
decreases the normal >Encourage interventions
exchange of limits adequate rest
Students Name: Ramos, Shelly Mae A. Date: January
31,2012
Patients Initials: L.T.

NURSING CARE PLAN

gases and and limit Helps limit

oxygenation >Verbalize activities to oxygen >Participate in
in the understandi within patients needs and treatment
consumptio regimen
alveolar- ng of tolerance
n
capillary causative
membrane. factors and
appropriate
intervention COLABORATIVE
s >administered
O2 2-3L/min as
>Participat prescribed To facilitate
e in better
oxygenation
treatment >Administer
regimen medications as
prescribed
To treat
underlying
conditions