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NURSING CARE PLAN CUES Subjective cues: Di man kami maaram kun paano iton niya nakuha nga

sakitas verbalized by the patients grandmother. Deri namon ini hiya iguin dadara ha clinic o hospital kay na itatambal man namon hiya, sugad han sipon ug ubo, iguin papatumar namon hiya hin Mucosolvan Tempra Paracetamol na iguin tutumar NURSING DIAGNOSIS Deficient knowledge regarding condition, related to lack of exposure. RATIONALE Health literacy is the ability to read, understand, and act on health information, including such tasks as comprehending prescription labels, interpreting appointment slips, completing, health insurance forms, and following instructions for diagnostic tests. Limited health literacy skills are often greater among certain groups: older adults, people with limited education, poor people, minority population, and people with OBJECTIVES After 3-4 hours of nursing interventions, the family of the patient will be able to: NURSING INTERVENTIONS 1. Establish rapport. a. Introduce self. b. Explain purpose. 2. Select a variety of teaching strategies (e.g., pamphlets, visual aids, hand-outs) Assessment 1. Assess readiness to learn and individual learning needs: a. Ascertain level of knowledge, including anticipatory needs. b. Determine familys ability or readiness and barriers to learning. RATIONALE To ensure compliance of the patient. Use of different means of accessing information promotes learner retention. EVALUATION
After 3-4 hours of nursing interventions, the goals and objectives have been met and the family of the patient were able to:

1. Participate in the learning process. 2. State at least 3 factors that can cause PSGN: a. Modifiable 1. Diet 2. Sanitation b. Non-modifiable 1. Age 2. Environment 3. Economic Status 3. Verbalize in his/her own understanding the disease process. 4. Verbalize in his/her own understanding of therapeutic needs. 5. Demonstrate,

1. Participate attentively in the learning process. 2. State 3 factors that can cause PSGN.

Individual may not be physically, emotionally, or mental capable at this time. SO may need to suffer consequences of lack of knowledge before he or she is ready to accept information. Motivation may be positive or negative.

c. Be alert to signs of avoidance.

3. Verbalize the nursing process on his own understanding. 4. Verbalize in his own understanding of therapeutic needs.

2. Assess the SOs motivation: a. Identify motivating factors for the individuals.

5. Demonstrate, properly

nakaka-usa kada adlaw hasta maupay an sakit.As verbalized by the mother. Objective cues: History of Past Illness: Hospitalization and Surgeries. The patient has no history of either minor or major surgeries. No other hospitalization s done except for current admission of PSGN. Educational level of the father: College undergradu ate Educational

limited English proficiency. Low health literacy skills are associated with poor health outcomes and higher health costs. For example, a client may not be able to read a prescription. Clients with low literacy skills have less information about health promotion and/or management of a disease process for themselves and their families because they are unable to read the educational materials. As a result, they have higher rates of hospitalization than people with adequate health

properly check and monitor the patient's blood pressure.

b. Provide information relevant only to the situation.

To prevent overload.

check and monitor the patients blood pressure. 6. Enumerate 3 ways on how to prevent the recurrence of the disease.

6. Enumerate at least 3 c. Provide positive reinforcement. ways on how to prevent the recurrence of the Health Teaching disease. 1. Review disease process/ prognosis at familys level of a. Proper hygiene understanding. b. Proper hand a. Etiology washing b. Risk Factors c. Diet modification c. Disease Process d. Proper environmental sanitation 2. Instruct and demonstrate to 7. Initiate necessary lifestyle changes and participate in treatment regimen.

Can enforce continuation of efforts. Provides knowledge base from which client cam make informed choice.

the family the correct technique for monitoring blood pressure.

3. Explain prescribed medications along with their rationale, dosage and expected or adverse side effects.

It is vital that blood pressure be controlled to prevent further renal damage. Adequate understanding that side effects are common and often subside with time and can enhance cooperation with treatment plan. Antibiotic; Killing bacteria that cause

7. Initiate necessary lifestyle changes and participate in treatment regimen.

a. Co-amoxiclav 457 mg/5mL, BID

level of the mother: High school graduate Age of patient: 4 years old, pre-primary pupil


Reference: Fundamentals of Nursing by Kozier & Erb 8th Ed, page 496

infections. It contains two different medicines called amoxicillin and clavulanic acid. Amoxicillin belongs to a group of medicines called "penicillins" that can sometimes be stopped from working (made inactive). The other active component (clavulanic acid) stops this from happening. Adverse Effects: Hypersensitivity, dizziness, headache b. Furosemide , 20mg 1 tab, q6h Loop diuretic; Inhibits the reabsorption of sodium and chloride from the ascending limb of the loop of Henle, proximal and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium,

potassium, and calcium Adverse Effects: blurred vision, dizziness anorexia, constipation, diarrhea, dry mouth, excessive urination, dehydration, headache c. Captopril, 25 mg/tab tab ACE inhibitor; ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation. Adverse Effects: Dizziness, Drowsiness,

Fatigue, Headache, Insomnia Cough, Dyspnea Hypotension, Chest Pain, Edema, Tachycardia Abdominal Pain, Anorexia, Constipation, Diarrhea, Nausea, Vomiting d. Benzyl PCN, 800,00 IU IVTT q6H Bactericidal; The penicillins and penicillinaseresistant antibiotics produce bactericidal effects by interfering with the ability of susceptible bacteria to build their cell walls when they are dividing. These drugs prevent the bacteria from biosynthesizing the framework of the cell wall, and bacteria with weakened cell walls swell and then burst from osmotic pressure within the

cell. Because human cells do not use the biochemical process that bacteria use to form the cell wall, this effect is a selective toxicity. Adverse Effects: Hypersensitivity reactions including uticaria; fever; joint pains; rashes; convulsions; diarrhea; Anaphylaxis e. Dopamine side drip @ 6 gtts/min Vasopressors; stimulate dopaminergic receptors, producing renal vasodilation. Adverse Effects: Headache, Dyspnea, Arrhythmias, Hypotension Nausea, Vomiting, Irritation at IV Site

4. Encourage proper hygiene.

Edema interferes

with cellular nutrition, which makes the client more susceptible to skin breakdown; good hygiene is an intervention to prevent this complication. -Impetigo: Teach control of contagion: thorough hand washing, separate laundry for clients linens, separate washing of clients dishes, hand-washing before and after contact with patient. Impetigo is contagious. Infection is present as long as skin lesions are present. Hand washing: To reduce the risk of crosscontamination among clients.

5. Discuss dietary plan. - Low Protein, High Calorie Diet

This diet is designed to avoid protein catabolism and enables the kidney to rest because it handles fewer protein molecules and metabolites. Sodium is

- Low Salt Diet

restricted, depending on the amount of edema noted. - TFR: 495 mL/day Fluid intake is usually restricted. Nightingale believed that the environment was the major component creating illness in a patient; she regarded disease as the reaction of kindly nature against the conditions in which we have placed ourselves.

6. Emphasize the importance of a clean and healthy environment.