ASSESSMENT
|
DIAGNOSIS
|
GOAL
|
INTERVENTIONS
|
EVALUATIONS
|
|
ACTIVITY-REST
|
Only sleeps four hours a night
|
Insomnia
|
Patient will focus on increasing the number of hours of
sleep per night.
|
Patient should be prescribed with sleeping pills.
Patient should also be instructed to sleep in a dark and
quiet room.
|
Monthly evaluation should be used to reveal the number of
hours of sleep
|
O2-CO2
|
102 beats per minute
|
Tachycardia
|
Patient will work to reduce her beats per minute.
|
Patient should be taught techniques such as carotid sinus
massage, valsalva maneuver, and dive reflex.
|
The patient will be evaluated to determine her heart beats
per minute.
|
ELIMINATION
|
Little blood in vomit, dehydration
|
Stomach ulcer
|
Patient should drink more water to reduce the impact of
dehydration. Antibiotics should also be prescribed to treat the stomach
ulcers.
|
Patient will undergo several X-rays to determine the
extent of stomach ulcers.
|
|
INGESTIVE
|
Binging and purging, stomach pain, difficulty swallowing,
multiple dental caries, taking diuretics and laxatives
|
Bulimia
|
Patient will increase her daily food consumption.
|
Patient will be prescribed with multivitamins to increase
her appetite.
|
Patient’s weight will be measured to determine the extent
of bulimia.
|
AFFLIATIVE
|
Confused, no eye contact, no smile
|
Major Depressive Disorder
|
Patient will work on becoming more social.
|
Patient will be exposed to social gatherings to develop
and sustain social relationships.
|
Patient will be asked to reveal the number of new friends.
|
PHYSICAL INTEGRITY
|
Lethargic, obsessed with losing weight
|
Depression
|
Patient will cultivate greater self-esteem.
|
Patient should be sent to a counselor to build
self-esteem.
|
Patient will be asked to state what she likes about
herself.
|
Saturday, October 7, 2017
Care plan on nursing
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