NURSING CARE PLAN

Assessment Nursing Scientific Planning Intervention Rationale Evaluation

Diagnosis Inference

S: “Sumasakit ang Acute pain External and After 8 hours of  Assess the client’s  To identify the After 8 hours of nursing
aking tiyan” as related to internal factors nursing pain scale and intensity, onset, interventions, goals are
verbalized by the inflammation aggravates the interventions, perception duration, location partially met as evidenced by:
client. of appendix nerve endings in the client should and quality of pain
the lower manifest a ↓ pain scale from 5/10 to
Pain Scale: 6/10 extremity decrease in the  Encourage verbal  Pain is highly 3/10
causing the pain scale of report during and subjective and to
As 0 is the lowest production of 5/10 to a after the nursing identify the No pain and discomfort
and 10 is the prostaglandin, manageable interventions effectiveness of the
highest bradykinin, level of 3/10. (+) verbal report of the client
interventions
during the evaluation
histamine and  Monitor V/S and
With the pain progesterone to pain scale  Obtain baseline V/S,
characteristics of react on the V/S changes during
moderate pain specific region onset of pain, for
causing pain future comparison
O:
sensation felt by after interventions
- With facial  Teach client
the client.
grimace activities that can
- Verbal report of  To divert client’s
divert his/her attention from pain
acute pain attention
- Guarding
behavior on the
 Advise breathing  To allow proper
left lower
exercise oxygen supply in the
extremity
body, clients tend to
stop breathing during
pain

 Administer  Relive the client of

Etoricoxib pain using
60mg/tab as pharmacologic
prescribed by the intervention
physician