St.

Anthony’s College
San Jose, Antique
Nursing Department
NAME:
AGE:
Dr.:
CC: NURSING CARE PLAN
CUES NURSING RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
SUBJECTIVE: GENERAL: INDEPENDENT:
Risk for impaired Client will  Inspect and monitor skin
skin integrity  Report altered condition at least once a
sensation or pain at day for color and
risk areas as soon as texture changes ,
noted redness, localized heat,
 Demonstrate edema or induration ,
understanding of pressure damage,
personal risk factors dermatological
for impaired skin conditions, or lesions
integrity and any incontinence-
OBJECTIVE:  Verbalize a personal associated dermatitis.
plan for preventing Determine whether the
impaired skin client is experiencing
integrity loss of sensation or
pain.
 Identify clients at risk
for impaired skin
integrity as a result of
immobility,
chronological age,
malnutrition,
incontinence,
compromised perfusion,
immunocompromised
status, or chronic
SPECIFIC: medical condition, such
as diabetes mellitus,
spinal cord injury, or
 renal failure.
 Monitor the client’s skin
care practices, noting
type of soap or other
cleansing agents used,
temperature of water,
and frequency of skin
cleansing.
 Cleanse the skin gently
with pH-balanced
cleansers. Avoid harsh
cleansing agents, hot
water, extreme friction
or force, or too-frequent
cleansing.

DEPENDENT: