NCM 102

NCP
NAME: ___________Ryan J. YR & SEC: ___________BSN II-B3_________
Pan__________________________________ DATE: _________12-01-09______

CUES/NEEDS NURSING RATIONALE GOALS AND NURSING EVALUATION

DIAGNOSIS OBJECTIVES INTERVENTIONS
- Malaise, - Infection,risk - Inadequate After 24 hours - Identify/screen After 24 hours
fatique for primary of nursing for prenatal of nursing
- Generalized maternal/feta defences intervention, infection intervention,
weakness l. (e.g.,broken the nurse will : - Assess client’s the nurse will :
- Temperature skin, stasis of cultural
elevation body fluids), - Verbalize background for - Verbalized
dependent on inadequate understandi risk factors understand
type of secondary ng of - Monitor ing of
infection defences individual progressive individual
- Fundal height (e.g., causative/ri growth of causative/ri
may not be decreased sk factors fundal height sk factors
AGA, possibly hemoglobin, based on
indicating immunosupp ultrasonograph
IUGR resion), - Review y. - Reviewed
associated inadequate techniques - Obtain techniques
with rubella acquired and lifestyle approproiate and
or immunity, changes to specimens and lifestyle
toxoplasmosi environment reduce laboratory/diag changes to
s, or may al exposure, infection nostic studies reduce
correspond malnutrition, as indicated: infection
with rupture of
gestational amniotic - Achieve Rubella titer
age of less membranes.) timely - Achieved
than 37 wk, healing, timely
indicating free of healing,
risk for GBS complicatio free of
ns. complicatio
ns.