NURSING Explanation of the (SMART) GOALS/ NURSING INTERVENTIONS RATIONALE FOR EVALUATION

PROBLEM with problem OBJECTIVES INTERVENTIONS

CUES

Platelets play an Short term goal: 1. Assessed and monitored 1. Increased heart rate and Short term goal:
Subjective: important role in vital signs. orthostatic changes accompany
clotting and Within the 8 hours of bleeding. (NCP. 3rd ed., Goal partially met.
bleeding. In people nursing interventions, Schroeder & Jones, 1994, p 389) After 8 hours shift, patient risk for
with a low platelet patients risk for bleeding is bleeding was reduced as evidenced by
count, bleeding is reduced as evidenced by 2. Assessed for any signs of 2. Bleeding may be obvious vital signs within normal range,
Objective: more likely to occur, vital signs within normal bleeding. (bruises/ petechiae epistaxis, absence of narrowed pulse pressure
even after a slight range, absence of narrowed bleeding gums, abdominal pain, and diminished signs of bleeding
Hematology: injury. Low platelet pulse pressure and hematemesis, melena, (epistaxis, hematemesis, hematuria,
-Platelet: 130 count may result in diminished signs of hematuria). (NCP. 3rd ed., melena)
-wbc: 3.4 spontaneous bleeding (bruises/ Schroeder & Jones, 1994, p 389,
V/S as follows: bleeding. petechiae, epistaxis, 422) Nov. 29, 2009
-T: 37.2 (Merck Manual, bleeding gums, abdominal V/S as follows:
-HR: 86 bpm 2009, Sec. 3, chapter pain, hematemesis, 3. Monitored platelet count. 3. Spontaneous bleeding can occur BP 100/70 mmHg
-RR: 29 bpm 49) hematuria, melena). at platelet count <50,000/mm3 T 36. 1 C
-BP: HR 119 bpm
110/90mmHg Long term goal: 4. Avoided IV /SC injections 4. Can stimulate bleeding; to RR 30 bpm
and rectal procedures reduce unnecessary trauma.
Within 2-3 days of nursing (such as enemas and rectal (NCP. 3rd ed., Mc McCarthy &
interventions, patient will temperature taking) as Schroeder, 1994, p 383, 423) Long term goal:
maintain reduced risk of necessary.
bleeding as evidence by Goal partially met.
normal platelet count and After 3 days of nursing interventions,
absence of any signs of 5. Placed sign over patients 5. As reminder of bleeding patient maintained reduced risk for
bleeding (bruises/petechiae) bed. precautions and to apply pressure bleeding as evidenced by diminished
after venipunctures. (NCP. 3rd signs of bleeding (bruises/petechiae).
ed., Puzas, 1994, p 425)
Dec. 3, 2009
6. Maintained safe 6. To prevent falls/ injury.(NCP. 3rd Hematology:
environment for patient. ed., Schroeder, 1994, p 422) Platelet = 10 x 103/UL
Hgb- 0.28
 Hct- 0.96
7. Transfused PRBC as 7. To restore Hgb/Hct level and to
prescribed. replace blood lost. (NCP. 3rd ed.,
Schroeder & Jones, 1994, p 389)

8. Communicated anticipated 8. To assure availability and

need for platelet support to readiness of platelets when
transfusion center. needed. (NCP. 3rd ed., Schroeder,
1994, p 406)