ASSESSMENTS NURSING DIAGNOSIS PLANNING INT5ERVENTIONS RATIONALE EVALUATION

Activity intolerance related STO: INDEPENDENT The patient was able to

Subjective: to imbalanced in oxygen  Determine factors maintain:
“ Kapoy kayo akong lawas” supply and demand After 3-4 hours of contributing to fatigue
 Provide comparative
nursing intervention  Evaluate client’s perceived  No complaints of
baseline data
Objective: the client will limitations by asking past DOB and fatigue
participate willingly activities and present  Warm skin
 DOB in necessary and factors  Limit activities
 To reduce oxygen
 Body weakness desired activities  Encourage to limit
demand
 Pallor activities  To prevent orthostatic
 Cool clammy skin LTO:  Encourage to slowly wake hypotension
 Pale nail beds up in morning
After or within 12  Encourage complete bed  Provide an increase
hours of nursing rest oxygen supply
interventions the
client will emphasize DEPENDENT:  Reduces myocardial
the importance of workload
desired activation  Provide and monitor
response to
supplemental oxygen
 Administer prescribed
meds

Isosorbidemononitrate30mg/tab, 2tab
BID  Relaxes vascular smooth
muscle with a resultant
Collaborative: decrease in venous return
and decrease in arterial
Nutrition diet ( Low fat, low BP, which reduces left
carbs ) ventricular workload and
decrease myocardial of
oxygen consumption.