UNIVERSITY OF NEGROS OCCIDENTAL-RECOLETOS
Bacolod City
                                                                    COLLEGE OF ALLIED MEDICAL HEALTH SCIENCES | BS NURSING
             Name:         NECY TESSA C. ACOSTA                                 Year/ Section/ Group:         BSN N41, GROUP A                        Date:     09/17/2023
                                                                                     NURSING CARE PLAN
        Baseline Data of the Client:
        Name of the Patient: J.A. I                                                            Chief Complaint:       Fever and epigastric pain
        Age: 12 yrs. old                                                                       Medical Diagnosis: Dengue High Fever
         Sex: Male                                                                             Attending Physician:
    ASSESSMENT                  NURSING DIAGNOSIS             PATHOPHYSIOLOGY                DESIRED OUTCOME                    NURSING                 RATIONALE               EVALUATION
                                                                                                                             INTERVENTION
Subjective data:              Acute pain and               Aa. Aegypti female mosquito     After 8 hours of                Independent:            Independent:              After 8 hours of
                              discomfort related to         bite (transmitter of DENV)     nursing intervention,                                                             nursing
“Gasakit akon sulok-          dengue as evidenced by                                       client will be able to          Establish rapport.      To assess                 intervention, client
sulok”                        positive guarding                                            alleviate ta pain.                                      precipitating factors.    was able to:
                              behavior, elevated
                              respiratory rate (26 bpm),   Incubation on virus varying     Demonstrate use of                                                                a. Report that his
                              facial grimace, and              from 3 to 14 days.          relaxation skills and           Take record and                                   pain was relieved.
Objective data:               narrowed focus.                                              diversional activities          vital signs.            To obtain baseline
                                                                                           as indicated for                                        data.                     b. Demonstrate use
    •   (+) Guarding
                                                                                           individual situation                                                              of relaxation skills
        behaviour
                                                                                           like deep breathing.                                    To indicate the fluid     and proper deep
    •   Respiratory
                                                                                                                           Measuring Intake        balance of the            breathing
        rate of cycles
                                                            Early symptoms: Fever,                                         and output.             patient.                  technique.
        per minute.
                                                               rashes, abdominal
    •   Facial
                                                            discomfort and nausea,                                         Observations of         For accurate
        grimace
                                                                                                                           patient level of pain   intervention based
•   Narrowed   joint and musculoskeletal   (scale, frequency,   on the patient’s pain
    focus.               pain.             duration).           level (scale,
                                                                frequency, duration).
                                                                Refocused attention
                                           Teach patient        and improve ability
                                           relaxation           to cope with pain.
                                           techniques (deep
                                           breathing).
                                           Dependent:           Dependent:
                                           Administered         To provide epigastric
                                           omeprazole prn as    pain relief.
                                           ordered by the
                                           physician.