Nursing Care Plan
Student Name/Date: __Nicole Reinke/ Week 5_____________
| Nursing Diagnosis |Expected Outcomes |Nursing Interventions/Rationale |Outcome Evaluation | |(Dx, related to, & as evidenced by) |(Short term (8-48 hr.) reasonable expectations |List all interventions for each nsg. dx (include patient/family |(Patient outcome noted as met or unmet/responses | | |stated in measurable, behavioral terms, i.e., |teaching) |described) | | |action verbs) | | | |Risk for injury r/t seizures amb gait and balance |Client will remain free from falls while in the |Nurse will make sure that the call light is always in reach so |This outcome of remaining fall free was met while | |disorders. |hospital. |that the client does not have to be concerned about not knowing |I was at the hospital. Everytime I went into the | | | |where the call light is when needing help. |room I made sure the call light was on her table | | | |Nure will place a “High Risk for Falls” sign above client’s bed so|and the walker was next to the bed. Client also | | | |that any person that comes into the room to help assist is aware |reported no falls. | | | |of the safety measures that need to be taken. | | | | |Nurse will determine risk for falls using the evaluation tool | | | | |which includes client history of atrial fibrillation. | | | | | | | | | |Nurse will place the walker near the bed to remind client to use | | | | |walker when getting up to go to the bathroom. | | | | |Nurse will explain how to use the walker, by moving walker first | | | | |and then move body to make sure client knows how to use the | | | |...
Please join StudyMode to read the full document