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Problem Nursing Diagnosis Outcome Plan Intervention Evaluation Subjective Short Term Independent

The nursing diagnosis was risk for injury related to a pathologic fracture from a tumor on the client's thigh near the knee. The short-term goal was for the client to understand factors contributing to injury risk within 5-8 hours. Planned interventions included monitoring vitals, instructing limited weight bearing, providing cushions, raising side rails, and range of motion exercises. The long-term goal was for the client to effectively use support systems to prevent injuries within 3-5 days. After 5 days, the goals were met as the client was free from signs of injury.

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316 views1 page

Problem Nursing Diagnosis Outcome Plan Intervention Evaluation Subjective Short Term Independent

The nursing diagnosis was risk for injury related to a pathologic fracture from a tumor on the client's thigh near the knee. The short-term goal was for the client to understand factors contributing to injury risk within 5-8 hours. Planned interventions included monitoring vitals, instructing limited weight bearing, providing cushions, raising side rails, and range of motion exercises. The long-term goal was for the client to effectively use support systems to prevent injuries within 3-5 days. After 5 days, the goals were met as the client was free from signs of injury.

Uploaded by

kyaw
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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PROBLEM NURSING OUTCOME PLAN INTERVENTION EVALUATION

DIAGNOSIS
Subjective Risk for injury After 3 to 5 Short Term Independent After 5 days of nursing
“Hindi ako makakilos pathologic fracture days of At the end of 5 - 8 hours of * Monitor vital signs. intervention , the client
ng maayos dahil dito sa related to tumor nursing nursing intervention, the - it will serve as baseline data. was free from any signs of
bukol sa may hita ko, intervention client will be able to * Instruct the client to avoid bearing injury.
malapit sa may tuhod”, the client will verbalize understanding of weight.
as verbalized by the be free from individual factors that - to prevent from pathologic fracture. Goal was met.
patient. injuries. contribute to possibility of * Provide pillows for cushion and
injury. support on the affected area.
Objective - to provide additional protection and
Palpable mass Long Term pathologic fracture
Large and distended At the end of 3 to 5 days of *Keep the side rails up all the time.
mass nursing intervention, the - to prevent potential injury
Warm and tender to client will be able to use * Place assistive devices.
touch resources/support system - to prevent errors in occurring that may
Limited ROM effectively and free from result to injury
Restlessness injuries. * Advice the client to do some ROM such
Vital signs: as flexion and extension in the
T: 37.6°C unaffected area.
PR: 88 beats/min - to regain range of motion
RR: 19 breaths/min
BP: 110/80

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