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ASSESSMENT DIAGNOSIS PLAN INTERVENTION EVALUATION

Subjective: Health seeking After 2 hours of INDEPENDENT: Goal partially met


•“I do not know the behavior related nursing 1.Assess specific as evidenced by
appropriate diet and to guidelines for intervention the concerns, habits, or client’s ability to
activities during nutrition and patient will: issues client desires to initiate diet pattern.
pregnancy.” activity during change. (to be able to
pregnancy. •Be able to determine client’s
Objective: express desire to willingness to
•Observed intake participate in nursing
unfamiliarity with appropriate diet interventions.)
wellness community and activity 2. Determine Client’s
resources. pattern to current health status
•Demonstrated lack achieve optimal and perception of
of knowledge in health during possible threats to
health promotion pregnancy. health. (to reassess
behaviors. •Participate in client’s knowledge of
planning for possible changes in
change. health promotion.)
3. Use therapeutic
communication
skills.(to provide
support for undesired
changes.)
4. Note
cultural/religious
beliefs and practices
that impact
perceptions of health
status and
expectations of
change. (to assess
client’s preference in
activities suited for
their beliefs.)

COLLABORATIVE:
1.Make necessary
referral to dietitian. (to
address specific
concerns.)
2. Identify and refer
client to health
resources for basic
health services. (to
facilitate long-term
attention to health
issues.)
ASSESSMENT DIAGNOSIS PLAN INTERVENTION EVALUATION
SUBJECTIVE: Deficient knowledge After 2 hours of INDEPENDENT: Goal partially met as
“I am 13 weeks regarding exposure to nursing intervention 1.Determine client’s evidenced by client’s
pregnant. Gumagamit teratogens during the patient will: ability/readiness and ability to reiterate the
ako ng vape at minsan pregnancy. barriers to learning. (to acquired knowledge
umiinom ng slight na •Participate in the assess readiness to and verbalized
alak. Sabi kasi okay learning process learn and individual initiation of non-
lang hanngang 3 •Verbalize learning needs) exposure to
months buntis yung understanding of 2. Identify motivating teratogens.
alak kung slight lang condition and discuss factors for the
at okay lang ang vape proper treatment and individual (to assess
pag buntis.” lifestyle during client’s motivation)
pregnancy. 3. Identify outcomes to
OBJECTIVE: •Note and be able to be achieved. (to
•Lack of source of initiate necessary develop learner’s
information lifestyle changes. objectives)
•Verbalizes •Be able to express 4.Provide necessary
statements reflecting desire in changing of health education (to
misconception lifestyle practices. inform client about the
•Be able to verbalize effects of teratogen
the learning of exposure to her fetus.)
adjusting from non-
pregnancy to
pregnancy. COLLABORATIVE:
•Provide access
information for contact
person. (to answer
questions and validate
information)
•Identify available
community resources/
support groups. (to
promote wellness and
facilitate in lifestyle
changing)