BSN121 Group 83
• Apply
lotion/ointment
or petroleum
jelly as skin
barrier, as
needed.
• Provide dry To keep the area
linen, as dry because
necessary. moisture can
adhere skin
• Expose
breakdown
perineum/
buttocks to air;
use heat lamp
with caustion, if
needed.
To promote return
to normal bowel
functioning
• Increase oral
fluid intake and
return to
normal diet, as
tolerated. Diarrhea maybe
• Encourage result of
nonirritating aggravated by
liquids. intolerance to
• Discuss specific formula.
possible change
in infant To restore normal
formula. flora
• Recommend
products such
as natural fiber,
plain natural
yogurt,
Lactinex.
To prevent
Promote wellness diarrhea from
recurring
• Review
causative
factors and
appropriate
interventions.
• Evaluate/identif
y individual
To prevent
stress factors
bacterial growth/
and coping
contamination
behavior.
• Review food
preparation,
emphasizing
To prevent spread
adequate
infectious causes
cooking time
of diarrhea such as
and proper
C. defficile or S.
refrigeration/st
aureus
orage.
• Emphasize the
importance of
hand washing. Therapies can
include treatment
Dependent: of fever, pain, and
• Assist in infectious toxic
treatment of agents,
underlying rehydration, and
conditions (e.g., oral feeding, etc.
infections,
malabsorption
syndrome, and
cancer) and
complications
of diarrhea.
• Review
laboratory
studies for To decrease
abnormalities. gastrointestinal
• Administer motility and
enteral and IV minimize fluid
fluids as losses.
indicated.
• Administer anti-
To treat infectious
diarrheal
process, decrease
medications, as
motility, and/or
indicated
absorb water.
• Administer
medications, as
ordered.
Nursing Diagnosis/ Analysis Goal and Intervention Rationale Evaluation
Cues Objectives
Impaired oral Goal: Independent:
mucous After 5 days of • Routinely
membrane r/t nursing inspect oral
trauma interventions, the cavity and
patient will show throat for
Subjective:
a decrease in inflammation,
• The mother
state: “Me signs and sores, lesions,
singaw siya sa symptoms as and/or
bibig, minsan noted in defining bleeding.
umiiyak siya characteristics. Determine if
pag patient is
pinpapakain ko Objectives: experiencing
siya at minsan • After 2 hours pain or painful To prevent dry
dinudura niya of discussion, swallowing. mouth and
at umiiyak” dehydration.
the parent will • Encourage
Objective:
verbalize adequate
• Single
ulceration on understanding fluids.
the mucosal of causative To reduce
wall noted. factors. discomfort/
After 2 hours of • Provide improve intake
discussion, the dietary and promote
parent will modifications healing
demonstrate (e.g., food of
techniques to comfortable
restore/maintain texture,
integrity of oral temperature,
density) and
mucosa.
adequate
nutrients and
vitamins.
• Avoid
irritating
foods/fluids,
temperature
extremes;
provide soft or
pureed diet as
required. To correct
• Assist/ provide deficiencies and
oral care, as encourage proper
indicated. care.
• Review
current oral
hygiene
patterns and
provide Encourage early
information initiation of good
about oral oral health
health as practice and
required/desir timely
ed. intervention for
• Instruct treatable
parents in oral problems.
hygiene
techniques
and proper
dental care
for
infants/childre
n (e.g., use of
pacifier,
brushing of
teeth and
gums, Altered immune
avoidance of response can
teeth and affect the oral
gums, mucosa.
avoidance of
sweet drinks To correct
and candy, deficiencies,
recognition reduce irritation/
and treatment gum disease,
of thrush.) prevent dental
• Promote carries.
general/
mental health.
To prevent bottle
• Provide syndrome with
nutrional decaying of
information. teeth.
• Stress
importance of
limiting night When infection is
time regimen present
of bottle of
milk for infant
in bed.
Suggest
pacifier or use
of water
during night.
Dependent:
• Administer
antibiotics, as
ordered
• Review
information
regarding
drug
regimen , use
of local
anesthetics.