Cues Nursing Scientific Objectives Nursing Rationale Evaluation

diagnosis explanation Intervention

S:“Bigla na lang Activity Preterm labor After 8hoursof -Assessed -Assessment -After 2 hours
humilabangtiyan intolerance is defined as nursing status of the provides a of nursing
ko, parang related to uterine interventions, the client and baseline date interventio
manganganak muscle or contractions patient will use fetus. for future ns, the
na ko” ( cellular occurring after identified -Encouraged comparisons. patient
I feel a sudden hypersensitivity 20 weeks of techniques to bed rest with was able
contraction, I gestation and enhance activity patient in side -Bed rest to use
thought I am in before 37 intolerance lying position. relieves identified
labor completed -Applyed pressure of the techniques
) as verbalized weeks of external fetus on the to enhance
by patient. gestation. Risk uterine and cervix. activity
Objective: factors include fetal intoleranc
multiple monitoring. -Uterine and e.
Continued geatation, -Monitored fetal
uterine history of patient’s vital monitoring
contraction. previous signs closely, provides
preterm labor every 15 evidence of
Facial mask of of delivery, minutes. maternal and
pain. abdominal -Instructed fetal well
surgery during patient to being.
Irritability. current report any
pregnancy, feelings of -Maternal
V/S taken as uterine difficulty of pulse over 120
follows:T anomaly, breathing or beats per
chest pain, minute or
dizziness, persistent
nervousness tachycardia or
and irregular tachypnea,
heart beats. chest pain,
dyspnea and
-Monitored adventitious
uterine breath sounds
contractions, may indicate
including impending
frequency and pulmonary
domain. edema.

-Early
recognition of
possible
adverse effects
allows for
prompt
intervention