1. Planning

2. Planning A deliberative Systematic phase Decision making
Problem solving
Develop goals, desired outcomes and nursing interventions to prevent, reduce, or alleviate the client’s health problem.

4. Types of planning Initial (admission) Ongoing (Beginning of the shift)
Discharge (needs after discharge)

5. A 75-year-old patient who has had elective surgery to replace an arthritic hip. The patient was admitted directly to the surgery unit and is now back to his room on orthopedic floor several hours after being discharged from recovery room. Which type of planning performed during this first post-op shift?

6. Nursing Care Plans Informal Formal
Standardised (for groups of patients with common needs)
Individualised (meet specific needs)

7. Planning Process

8. Setting Priorities Pain Dry skin Nausea Constipation
Potential for wound infection

9. Establishing goals/desired outcomes
Subject
Verb
Conditions or modifiers
Criterion of desired performance
Realistic
Client response (not nurse activity) (maintain client hydration)…..(Client will drink 100 cc of water per hour)
Derived from nursing Dx.

10. Goals /Desired outcomes
Client performs leg ROM exercises as taught Q 8 hrs time.
Client administers correct insulin dose using aseptic technique

11. Risk for impaired skin integrity r/to immobility, dry skin and surgical incision represents which of the following goals:
Change position Q 2 hrs
Applying lotions and skin barrier creams
Not develop skin break down during
hospitalisation
Use a pressure-reducing mattress.

12. Selecting Nursing Interventions and activities
Independent interventions/ nurse licensed to practice (Physical care, teaching, ongoing assessment, emotional support, making referrals(
Dependent (medication prescription, diagnostic tests)

13. Writing nursing order Date Action verb Content area Time element
22/02/2008 : Instruct the patient to avoid drinking liquids with meals if nausea occurs in evening shift.
Saleh.M, RN

14. “ 21/02/2008 : Measure client’s fluid intake and output.
Sara. F, RN