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NCP Fever

The nursing care plan summarizes a patient presenting with a fever. Vital signs showed an elevated temperature of 37.8 C, tachycardia, and tachypnea. The nursing diagnosis is altered body temperature related to an underlying illness as evidenced by the increased temperature. The plan is to monitor vital signs, perform tepid sponge baths and apply cold compresses to reduce the fever. Increased fluids and light clothing are also recommended to help lower the temperature.

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Luis Romnic Vinuya
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3K views

NCP Fever

The nursing care plan summarizes a patient presenting with a fever. Vital signs showed an elevated temperature of 37.8 C, tachycardia, and tachypnea. The nursing diagnosis is altered body temperature related to an underlying illness as evidenced by the increased temperature. The plan is to monitor vital signs, perform tepid sponge baths and apply cold compresses to reduce the fever. Increased fluids and light clothing are also recommended to help lower the temperature.

Uploaded by

Luis Romnic Vinuya
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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NURSING CARE PLAN FEVER ASSESSMENT S: Nilalagnat ako, verbalized by the patient.

O: warm to touch flushed skin Vital Signs: BP = unstable RR= 25bpm (tachycardia) PR = 120bpm (tachypnea) T= 37.8 C NURSING DIAGNOSIS as Altered Body Temperature R/T Presence of Illness AEB Increase in Body Temperature Above Normal Range PLANNING INTERVENTIONS RATIONALE STO: 1. To have a baseline data. EVALUATION

STO: INDEPENDENT: Within 30 minutes of nursing and 1. Monitored Vital Signs medical interventions, patient will be able to decrease a body temperature from 38.3 C to 37 C. 2. Do tepid sponge bath

Goal partially met. After 30 minutes of nursing and medical interventions, patient was 2. Helps reduce body temperature. able to decrease a body temperature from 38.3 C to 37.5 3.Application of cold compress 3. Decrease body temperature. C. on forehead, axillae, inner thigh 4. Increased fluid intake 4. To prevent dehydration 5. It provides heat loss. 6. To determine possibility of dehydration.

Pathophysiology: Formation of the Gallstones Dislodgement of Gallstones Obstruction of the Common bile Duct Inflammation of the Gall Bladder Bacteria in the Bile Leukocytosis Release Interlukin 1 & TNF Prostaglandin synthesis Hypothalamus stimulated to reset temperature set point Fever

LTO: Throughout hospitalization, the 5. Light clothing patient will be able to maintain a normal range of temperature. 6. Monitored I/O status

LTO: DEPENDENT: Fully met. 1. Administered paracetamol 1. Help to restore normal body After course of hospitalization, as needed function. the patient was able to maintain a normal range of body 2. Administered antibiotics 2. To treat undergoing infection. temperature. as indicated

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