NURSING CARE PLAN
Ineffective Tissue Perfusion Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION
INTERVENTIONS RATIO
Subjective Data: Alteration in comfort After 30 minutes of Independent:
● The patient related to post- nursing interventions,
verbalized, operative ERCP the patient will be able ● Explained procedure ● For
“Masakit lang dito procedure as to express decrease done to the patient. bet
sa lalamunan, evidenced by in pain. on
tsaka dito sa tiyan verbalized reports of the
[referring to right pain.
upper quadrant].” ● Performed a ● The
● The patient rated comprehensive exp
his pain as 4 on a assessment of pain. the
10-point scale. Determined the sou
location, abo
Objective Data: characteristics, onset, Ass
● Patient recently duration, frequency, aid
underwent ERCP quality, and severity of opt
procedure. pain via assessment. ma
● Facial grimace stra
noted. ● Determined factors
that alleviate pain. ● Info
alle
can
pla
pai
● Provided non-
pharmacological ● The
measures to relieve inv
pain, such as one
distraction. upo
stim
one
● Assisted patient in a exp
comfortable position
such as supine or ● To
semi-fowler. ten
bod
abd
● Encouraged patient to ER
do relaxation
techniques such as ● To
deep breathing abd
exercises.
● Encouraged patient to
do early ambulation
after ERCP as ● Thi
tolerated. flow
fun
● Encourage patient to wit
minimize talking.
● To
ent
and
● Evaluated the patient’s pai
response to pain and
management ● To
strategies. pai
stra
NURSING CARE PLAN
Impaired Oral Mucous Membrane Nursing Care Plan
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION
INTERVENTIONS RATIO
Subjective Data: Alteration in comfort After 30 minutes of Independent:
● The patient related to post- nursing interventions,
verbalized, operative ERCP the patient will be able ● Explained procedure ● For
“Masakit lang dito procedure as to express decrease done to the patient. bet
sa lalamunan, evidenced by in pain. on
tsaka dito sa tiyan verbalized reports of the
[referring to right pain.
upper quadrant].” ● Performed a ● The
● The patient rated comprehensive exp
his pain as 4 on a assessment of pain. the
10-point scale. Determined the sou
location, abo
Objective Data: characteristics, onset, Ass
● Patient recently duration, frequency, aid
underwent ERCP quality, and severity of opt
procedure. pain via assessment. ma
● Facial grimace stra
noted. ● Determined factors
that alleviate pain. ● Info
alle
can
pla
pai
● Provided non-
pharmacological ● The
measures to relieve inv
pain, such as one
distraction. upo
stim
one
● Assisted patient in a exp
comfortable position
such as supine or ● To
semi-fowler. ten
bod
abd
● Encouraged patient to ER
do relaxation
techniques such as ● To
deep breathing abd
exercises.
● Encouraged patient to
do early ambulation
after ERCP as ● Thi
tolerated. flow
fun
● Encourage patient to wit
minimize talking.
● To
ent
and
● Evaluated the patient’s pai
response to pain and
management ● To
strategies. pai
stra
