Assessment | Diagnosis | Planning | Implementation | Evaluation |
Subjective data: “I’m cold, I want something warm in my body,” as stated by thepatient. Objective data: - Temperature (390C) - Sweating - Decreased appetite - Flushed skin - Lethargy - Malaise | Alter in body temperature related to the presence of bacteria in the blood as manifested by above normal temperature (390C) and increase in white blood cell. | - After an hour of nursing intervention, the patient’s body temperature will be decreased from 390C to 37.60C. - There will be decreased sweating of the client - After a day of nursing interventions, there will be an increase in the client’s appetite | - Assess body temperature ever 20 min - Provide a quiet environment for the patient to rest well - Perform tepid sponge bath to decrease the patient’s body temperature - Increase fluid intake to prevent dehydration - Remove excess clothing or blankets that make the patient feel hotter or uncomfortable | - After an hour of nursing intervention, the client’s body temperature decreased from 390C to 37.60C. - The patient underwent decreased of sweating after half an hour of nursing intervention - There was an increase in the client’s appetite after a day of nursing interventions - The goals were met, therefore, the plan should not anymore be revised |
Categories:
Nursing Care Plan