PCAP

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NURSING CARE PLAN

Name of Patient: ___________________________________________________ Age: ______ Sex: _____ Room: ________ Date: __________________________
Pediatric Community Acquired Pneumonia
Admitting Diagnosis: _______________________________________________ Attending Physician: _________________________ Diet: __________________

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation


Subjective: Ineffective air way Short term: 1. Establish rapport to the 1. To gain trust and After 8 hours of duty the
“Nahihirapan po siya clearance relater to -At the end of my 8 patient. cooperation. patient was able to
huminga dahil sa ubo Impaired gas exchange hours shift, the patient’s maintained airway
nya” verbalized by the condition will lighten and 2. Demonstrated good skin 2. Maintaining clean, dry patency.
patient’s mother. minimal formation of hygiene, e.g., wash skin provides a barrier to
secretion will only occur. thoroughly and pat dry infection. Patting skin
Objective: carefully dry instead of rubbing
-Dyspnea Long term: reduces risk of dermal
-Tachycardia -After hospital trauma to fragile skin.
-VS taken as follows: confinement patient will
be free of secretion 3. Instructed family to 3. Skin friction caused
T: 37.6 enabling condition of maintain clean, dry clothes, by stiff or rough clothes
PR: 43 cpm oxygen exchange preferably cotton fabric leads to irritation of
CR: 140 bpm normally. fragile skin and
increases risk for
infection.

4. Emphasized importance of 4. Improved nutrition and


adequate nutrition and fluid hydration will improve
intake. skin condition.

Bibliography: _________________________________________________________________________________________________________________________
http://www.scribd.com/doc/89818287/NCP-PCAP
____________________________________________________________________________________________________________________________________
Submitted By: Submitted to:
___________________________________ ___________________________________
Student Nurse Clinical Instructor
NURSING CARE PLAN
Name of Patient: ___________________________________________________ Age: ______ Sex: _____ Room: ________ Date: __________________________
Pediatric Community Acquired Pneumonia
Admitting Diagnosis: _______________________________________________ Attending Physician: _________________________ Diet: __________________

Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation


5. Instructed family to clip and 5. Long and rough nails
file nails regularly. increase risk of skin
damage.

6. Advised patient to wear 6. To protect the wound


socks

7. Advised patient to use closed 7. For the protection of the


slippers or sandals wound and to avoid further
infection.
8. Elevate head of the bed and
change position frequently. 8. Promotes expectoration,
clearing or infection.
9. Limit visitor as indicated
9. Reduces likelihood of
exposure to other
infectious pathogens.
10. Provided and applied
wound dressing carefully 10. Wound dressing
protect the wound and the
surrounding tissue

Bibliography: _________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Submitted By: Submitted to:
___________________________________ ___________________________________
Student Nurse Clinical Instructor

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