Assessment Subjective Cues: Masakit ang aking operasyon hindi ako makapahinga ng maayos as verbalized by the client.

. Objective Cues: Restlessnes s Verbal reports discomfort Facial grimaces Muscle tension Irritability

Nursing Diagnosis Alteration in comfort related to Surgical incision of the Right Inguinal area due to Hernia as manifested by Restlessness, verbal reports of discomfort, Facial grimaces, Muscle tension and Irritability

Scientific Analysis Unpleasant feeling of comfort that is depriving any matter to promote comfort and sustain irritability

Planning

Intervention

Rationale

Evaluation Goal: Met After 10 minute of nursing care, client was able to demonstrat e relief of discomfort and promote comfort and relaxation after several manageme nt have been utilized for the client.

Short term goal: Independent: Psychomotor: After 10 minutes of nursing care, client will be able to demonstrate relief from discomfort Affective: After 10 minutes of nursing care, client behavior of irritability and restlessness will change to a more comfortable state. Place the client in To promote a semi-fowlers relaxation and position comfort to the client Practice Deep Breathing Exercises Provide comfort, quiet environment and calm activities Promote responses to pain Promote nonpharmacologic al pain management

Measurements: Vital Signs: BP= 130/70 PR= 77 bpm RR= 18 cpm T = 36.5 C

Note locations of May influence surgical the amount of procedures. post-operative Cognitive: pain that is After 10 minutes experienced. of nursing care, client will be Note any To assess if able to progress of ther are any understand the comfort changes in techniques and terms of the management to comfort that promote comfort the client experiences Monitor Vital To observe any Signs. changes due to discomfort Dependent: Source: Administer (Nurses Paracetamol IV Pocket Guide, as ordered. 11th Ed., Doegnes, M.E. et. al.,p. 498503)