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Assessment Diagnosis Interference Planning Intervention Rationale Evaluation

The nurse assessed a pregnant patient presenting with increased weight, headache, and abdominal pain. The diagnosis was preeclampsia, a common pregnancy complication marked by high blood pressure and protein in the urine after 20 weeks. The plan was for the patient to participate in activities to reduce blood pressure after 8 hours of monitoring and interventions. The evaluation found the patient able to engage

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MelDred Cajes Bolando
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1K views2 pages

Assessment Diagnosis Interference Planning Intervention Rationale Evaluation

The nurse assessed a pregnant patient presenting with increased weight, headache, and abdominal pain. The diagnosis was preeclampsia, a common pregnancy complication marked by high blood pressure and protein in the urine after 20 weeks. The plan was for the patient to participate in activities to reduce blood pressure after 8 hours of monitoring and interventions. The evaluation found the patient able to engage

Uploaded by

MelDred Cajes Bolando
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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ASSESSMENT DIAGNOSIS INTERFERENCE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Independent:
"Nakabantay ko nga Decrease cardiac Preeclampsia is a After 8 hrs. of nursing Monitor blood Comparison of After 8 hours of
bug-at na akung output r/t to decreased common problem interventions, the pressure of the pt. pressure provides a nursing interventions,
timbang unya, sakit venous return. during pregnancy. Th patient will participate ,while at rest, then more complete picture the patient was able to
akung tangkugo nga condition sometimes in activities that sitting, standing for pf vascular participate in activities
mura ko ug reffered to as reduce blood pressure initial evaluation. involvement pr scope that reduced blood
malipong." pregnancy induced or cardiac work load. of the problem. pressure or cardiac
As verbalized by the hypertension -- is workload.
patient. definitely by high Note depemdent or
Objectives: blood pressure amd general edema. May indicate heart
Variations in blood excess protein in the failure, renal or
pressure urine after 20 weeks vascular impartment.
edema of pregnancy. Often Provide calm, restful
V/S taken as follows: preeclampsia causes surroundings. Helps reduce
T: 36. 3 only modest increase sympathetic
P:82 in blood pressure. Left stimulation, promotes
R:19 untreated,however, Administer anti- relaxation.
BP:160/100 preeclampsia can lead hypertensive drug
to serious -- even maintenance theraphy To control tge blood
fatal -- complications (Methyldopa) as pressure and promotes
for both mother and ordered by the relaxation of
the baby. physician. cardiovascular smooth
muscle and helps
increase blood supply
to cerebrum, kidneys
kidneys, iterus and
placenta. and to
avoid further
complications.

Maintain activity
restrictions. Reduces physical
stress and tension that
affects blood pressure
Instruct in relaxation and coirse of
technique. hypertension.
Can reduce stressful
stimuli, produce
Collaborative: calming effect,
Implement dietary thereby reduce blood
sodium, fat and pressure.
cholesterol restrictions
as indicated. This restrictioms can
help mamage fluid
retention and with
associated
hypertensive
response, which
decreases cardiac
workload.

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