VII.

NURSING CARE PLAN

CUES BACKGROUND
KNOWLEDGE
NURSING
DIAGNOSI
S
PLANNING INTERVENTIO
N
RATIONALE EVALUATION
SUBJECTIVE:
OBJECTIVE:
Pain scale=
6/10
(+) facial
griace
(+) facial
griace
!": 11#$%
P&s'(&%era'i)e
%ain as a res*l'
fr& s*rger+
*s*all+ 'ie(
lii'e, an,
s*$si,es -i'.
.ealing -.ic.
a+ $e
ass&cia'e, -i'.
'ac.+car,ia/
,ia%.&resis/ an,
increase in $l&&,
%ress*re -.ere
in %a'ien' s'a+e,
0a' &n $e, f&r
%r&l&ng %eri&, &f
'ie -.ic. a+
ca*se '.e '&
.a)e .ig. ris1 f&r
s1in $rea1,&-n
&r i%aire, s1in
in'egri'+
"is1 f&r
i%aire,
s1in
in'egri'+
sec&n,ar+
'& %.+sical
i&$ili'+
rela'e, '&
%&s'
&%era'i)e
%ain
2f'er 3 .&*rs
&f n*rsing
in'er)en'i&n
'.e %a'ien'
-ill $e a$le
'& i,en'if+
in,i)i,*al
ris1 fac'&rs
as
anifes'e,
$+
,e&ns'ra'i
&n &f
$e.a)i&rs/ &r
'ec.ni4*es5
'& %re)en'
s1in $rea1
,&-n
(
)er$ali6a'i&n
&f
*n,ers'an,i
ng '.e
'rea'en'/'.
era%e*'ic
regien
INDEPENDENT
:
(assess s1in
'.&r&*g.l+/
n&'.ing
&is'*re/ c&l&r
an, elas'ici'+
-.an,le clien'
gen'l+(el,erl+)
(Ins%ec' s1in
s*rfaces/%ress*
re %&in's
r&*'inel+
-assage $&n+
%r&inences
an, *se %r&%er
%&si'i&ning/
'*rning/ lif'ing/
an, 'ransferring
'ec.ni4*es
-.en &)ing
fric'i&n
(%r&)i,e
%r&'ec'i&n $+
*se &f %a,s/
%ill&-s/ f&a
a''ress/ -a'er
('.is in,ica'e s%eci7c
l&ca'i&n '.a' is
%ar'ic*lar )*lnera$le '&
s1in $rea1 ,&-n
(s1in &f '.e &l,er clien'
is als& '.in/ less elas'ic
an, %r&ne '& in8*r+ s*c.
as $r*ising an, s1in
'ears
(i' re,*ces &f
%r&gressi&n '& s1in
$rea1,&-n
('& %re)en' fric'i&n &r
s.ear in8*r+
('& increase circ*la'i&n
an, lii'/eliina'e
'iss*e %ress*re
('& en.ance circ*la'i&n
2f'er 3 .&*rs
&f n*rsing
in'er)en'i&n
'.e g&al -as
%ar'iall+ e'
as anifes'e,
$+ %a'ien'
)er$ali6e,
*n,ers'an,ing
'.e
'rea'en'/'.e
ra%e*'ic
regien $*'
,i,n5'
,e&ns'ra'e
$e.a)i&r/'ec.
ni4*e '&
%re)en' s1in
$rea1 ,&-n
$e,/ e'c
(rec&en,
ele)a'i&n &f
l&-er
e9'rei'ies:
(e%.asi6e
i%&r'ance &f
a,e4*a'e
n*'ri'i&nal/0*i,
in'a1e
DEPENDENT:
2,inis'er
analgesic
(Traa,&l/
Parace'a&l) as
&r,ere,:
(ain'ain general g&&,
.eal'. an, s1in '*g&r
(