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NURSING N.I.

PROBLEM CUES DIAGNOSIS GOALS AND NURSING RATIONALE EVALUATION


AND OBJECTIVES INTERVENTIONS WITH
RATIONALE REFERNECES

#2 Subjective: Disturbed After 2 shifts, Assessed sleep - High After 2 shifts,


sleeping pattern the patient will pattern percentage of the patient
Inadequate sleep “Ang hirap r/t interruptions achieve optimal disturbances that sleep verbalized:
matulog sa for therapeutics, amount of sleep are associated with disturbances are “Medyo humaba
gabi, hindi rin monitoring, as evidenced by specific underlying affected by na ang tulog ko
ako makatulog other generated rested illnesses. illnesses. sa gabi. Hindi na
kahit sa umaga awakening, and appearance, rin ako
kasi lagi akong excessive verbalization of Observed and - To determine masyadong
minomonitor”. stimulation feeling rested, obtained feedback usual sleep mahina sa
As verbalized (noise and and from clients pattern and umaga.”
by the pt. lighting) improvement in regarding usual provide
sleep pattern. bedtime, routines, # appropriate
“Lagi nalang of hours of sleep, intervention.
maaga ako and environmental
nagigising at needs.
late
nakakatulog”. Did as much care - To avoid
As verbalized as possible without disturbances
by the pt. waking the client, during sleep, and
and did as much to maximize
“Naiistorbo ako care as possible sleeping process.
sa pagtulog kasi while the patient is
oras na ng pag still awake.
inom ng
gamot”. As Explained - So that patient
verbalized by necessity of will have an
the patient. disturbances for understanding of
monitoring VS and the importance
Objective: care when of care being
hospitalized. done to him.
-Dark circles Minimizes
under eyes complaints.
-Restlessness
-Irritability
-Dozing Encouraged - To enhance
-Yawning wearing eye cover, ability to fall
-Difficulty in drinking warm asleep.
arousal milk, and sleeping
-Change in at the same time