Public Display of Affection

nurse Care Plan Student Name/Date __Nicole Reinke/ Week 5_____________ treat Diagnosis expect Outcomes Nursing Interventions/Rationale Outcome Evaluation (Dx, related to to, & as evidence by) (Short term (8-48 hr. ) reasonable expectations List every interventions for from each one nsg. dx (include patient/family (Patient outgrowth noted as met or unmet/responses stated in measurable, behavioral terms, i. . , teaching) described) serve verbs) luck for injury r/t seizures amb tread and balance Client volition remain free from exceeds period in the shield leave make sure that the chatter wake richly is always in reach so This outcome of remaining sink free was met speckle disorders. hospital. that the client does not have to be interested about not knowing I was at the hospital. Everytime I went into the where the call light is when needing protagonist. room I made sure the call light was on her table Nure will send a High Risk for Falls sign a bove clients bed soand the baby buggy was next to the bed.Client in any case that any person that comes into the room to help assist is aware reported no falls. of the safety measures that need to be taken. Nurse will determine risk for falls using the evaluation tool which includes client history of atrial fibrillation. Nurse will place the baby buggy near the bed to remind client to put on walker when getting up to go to the bathroom. Nurse will explain how to use the walker, by moving walker first and then move consistency to make sure client knows how to use the walker. Nurse will also teach the client the importance of using the walker when walking by means of the halls in order to prevent future This outcome of using the walker was partially Client will use a walker while in the hospital tofalls, this will also help promote military action and will give the met. When reminded the client would use the get to the bathroom in order to maintain safety. client something else to do instead of laying in bed all day. walker however admitted not using it all the time. After teaching her the importance of using the walker and what could happen if she fell she said she would try to make it a habit. Nursing Diagnosis Expected Outcomes Nursing Interventions/Rationale Outcome Evaluation (Dx, related to, & as evidenced by) (Short term (8-48 hr. ) reasonable expectations List all interventions for each nsg. dx (include patient/family(Patient outcome noted as met or unmet/responses stated in measurable, behavioral terms, i. e. teaching) described) action verbs) 3. Client will be educated on how to reduce Nurse will assess for additonal factors leading to risk for This outcome was not fully met. I asked about risk of falls at home. falls because sometimes medications can increase risk for her house and the hazards that were there for falls. falls but I wasnt able to talk about using 2.Nurse will teach the client the benefit of using nonskid nonskid rugs or bathroom devices. But she rugs and safety devices in the bathroom. This is important to understands the importance and will ask her teach so that the client can recognize mares nest and slippery fille and physican when she is discharged. floors. 3. Nurse will instruct client and daughter how to correct identified hazards to make sure everything that could cause a fall is prevented.