SIR ARTHUR LEWIS COMMUNITY COLLEGE

DEPARTMENT OF HEALTH SCIENCES

NURSING CARE PLAN

Client’s Initials: A.S. Age: 60 years Medical Diagnosis: Severe Anemia secondary to UGI bleeds.
Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand.
Expected Outcome (Client Nursing Interventions Rational/Scientific Principles Evaluation
orientation)
✓ Assess the physical ✓ Provides baseline ➢ By the end of 2 to 3
activity level and information for hours patient exhibited
➢ By the end of 2 to 3 mobility of the patient. formulating nursing tolerance during
hours patient will goals. physical activity as
exhibit tolerance during Discontinue the activity if the evidenced by a normal
physical activity as patient responds with: fluctuation of vital signs
evidenced by a normal o chest pain during physical activity.
fluctuation of vital signs o vertigo
during physical activity. o dizziness
o decreased pulse rate
o decreased systemic
blood pressure
o decreased respiratory
response

✓ Use portable pulse ✓ Help determine whether

oximetry to assess for
oxygen desaturation
during activity.
the use of supplemental
oxygen is needed to
compensate for the
increased oxygen
demands during
physical activity.
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Expected Outcome (Client Nursing Interventions Rational/Scientific Principles Evaluation
orientation)
✓ Observe and document ✓ Observations will serve
response to activity. as a guide for the best
nursing interventions
that should be taken.

✓ Assess emotional ✓ Frustration over the

response to limitations inability to perform
in physical activity. activities can be a
source of stress and
depression.

DHS: Rev 01/02 Page 2/2