ASSESSMENT NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS

S> Acute pain After 2 days of • Encourage • Promotes After 2 days of nursing
nursing patient to cooperation from interventions, the client
Client interventions, the verbalize about the client. was free from
complains of client will be free pain. experiencing pain
flank pain from experiencing
pain • This calms and
• Provide soothes the After 3 hours of nursing
O> comfort patient. interventions:
After 3 hours of measures such Client stated 3 ways of
VS as follows: nursing as deep relieving pain such as
BP:150/100 interventions: breathing imagery, application of
PR:82 RR: 21 The client will exercises like hot and cold compress
temp:36.6 state 3 ways of yoga and • To divert attention and therapeutic touch.
relieving pain meditation. from pain.
Lymphocytes: such as
0.43 (normal: imagery, • Encourage
0.25-0.40) application of diversional
hot and cold activities
compress and (TV/radio, • To relieve pain in
therapeutic socialization the muscle area.
touch. with others,
imagery)

• Provide • To promote feeling

application of of comfort.
hot and cold
compress.

• Provide
therapeutic
touch.

Theory: Sister Callista Roy’s Adaptation Model

 My theory is based on the Adaptation Model of Callista Roy which speaks of six interrelated subsystems; one of which is
focused on the body sensation so that means when the patient is being affected by a painful stimulus, it will affect his coping
process and will affect his behavior.