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NCP FOR ANXIETY

Assessment:

Subjective:

“Natatakot ako na baka pag nasanggi yung dede ko ay lalo lumala kaya
iniingatan ko talaga, hindi tuloy ako masyado makatulog” as verbalized by patient.

Objective:

VITAL SIGNS

• Bp: 110/80

• Pulse Rate: 82

• Respiratory Rate: 24

• Temperature: 36.3

Pale skin, ongoing worry, restlessness.

Diagnosis:

• Anxiety related to repetitive thoughts as evidence by restlessness.

Planning:

• Patient will reduce anxiety after therapeutic approaches

• Patient will achieve full rest

Interventions:

• Identify client’s perception of the threat represented by the situation

• Monitor vital signs to identify physical responses associated with both


medical and emotional conditions.

• Establish a therapeutic relationship, coveying empathy and unconditional


positive regard

• Assist client to develop a self-awareness of verbal and non-verbal behaviors


Evaluation:

• Appear relaxed and anxiety is reduced to a manageable level

NCP FOR KNOWLEDGE DEFICIT

Assessment:

Subjective:

The patient verbalized “Di ko po nagawa ang tamang pangangalaga”

“Nagsimula ito ng nagpasuso ako at nagkasugat”

“Tuwing nababangga ang suso ko sumasakit ito”

Objective:

VITAL SIGNS:

Temp: 36.3

Pulse Rate: 82

Respiratory Rate: 24

BP: 110/80

Laboratory Results:

CBC: increase WBC

FBS: 109

X-Ray: T-C, Pneumonia, left lower lobe

DIAGNOSIS

• Knowledge deficit related to lack of information about disease as evidenced


by blank stare.

PLANNING
• After 2 hours of intervention through health teaching the patient will be able
to have knowledge about the disease process and will gain the patient’s
trust.

INTERVENTION

• Ascertain level of knowledge, including anticipatory needs

• Identify patient’s support persons(parents, caregiver, spouse)

• Be alert to signs of avoidance

• Client may need to supper consequences of lack knowledge before her or she
is ready to accept information

• Identify support person- SO requiring information(parents, caregiver, spouse

EVALUATION

• The patient had gained knowledge about the disease process.

• Gained the trust of the patient.

• Goal met.