ASSESSMENT

Subjective Cues:
Objective Cues:

Needs assistance to
stand, transfer to
bed from chair and
going to the
bathroom.

DIAGNOSIS

BACKGROUND OF
STUDY

FATIGUE may be
related to decreased
metabolic energy
production; state of
discomfort.

PLANNING

INTERVENTION

EVALUATION

After 8 hours of
nursing intervention,
the patient will be
able to report
improved sense of
energy.

Independent:
Encourage
bedrest, assume a
position of comfort,
and provide a quiet
environment, limit
visitors as needed.
Do necessary
task quickly and at one
time as tolerated.
Encourage use
of stress management
techniques: progressive
relaxation,
visualization, engage in
diversional activities:
TV, reading.

After 8 hours of
nursing intervention,
the patient was able
to report improved
sense of energy.

Dependent:
Monitor serial
liver enzymes levels.
Administer
medications as
indicated.

ASSESSMENT
Subjective Cues:

DIAGNOSIS
Risk for Impaired Skin

BACKGROUND OF
STUDY

PLANNING
After 8 hours of

INTERVENTION
Independent:

EVALUATION
After 8 hours of

Objective Cues:
yellowish
discoloration of the
skin and icteric sclera

Integrity may be
related to bile salt
accumulation in the
tissues

nursing intervention,
the patient will be
able to report
decreased or absence
of pruritus and
display intact skin.

Encourage use
of cool showers and
baking soda or starch
baths; apply calamine
lotion as indicated.
Provide
diversional activities.
Observe skin
are for redness, or
breakdown.

nursing intervention,
the patient verbalized
absence of pruritus,
with intact skin.

Dependent:
Administer
medications as
ordered by the
physician.

ASSESSMENT
Subjective Cues:
Objective Cues:

DIAGNOSIS
Risk for Infection may
be related to
inadequate
secondary defences
and
immunosuppresion.

BACKGROUND OF
STUDY

PLANNING

INTERVENTION

After 8 hours of
Independent:
nursing intervention,
Establish
the patient will be
isolation techniques
able to verbalize
for enteric and
understanding of
respiratory infections
individual risk factors, according to infection
and initiating lifestyle guidelines/ policy.
change to avoid
Demostrate
reinfection or
and encourage
transmission to
effective
others.
handwashing
technique.

EVALUATION
After 8 hours of
nursing intervention,
the patient was able
to verbalize
understanding of
individual risk factors,
and initiating lifestyle
change to avoid
reinfection or
transmission to
others.

 Stress the
need to monitor or
restrict visitors as
indicated.
Dependent:
Administer
medications such as
antibiotics as ordered
by the physician.