13

IV. NURSING CARE PLAN

This chapter presents the Nursing Care Plan utilized by the student-nurse following the Nursing Process.

4.1 Nursing Care Plan for Fatigue

ASSESSMENT OBJECTIVES OF CARE PLANNED RATIONALE IMPLEMENTATION EVALUATION
Goals Expected INTERVENTION
Outcomes
Subjective cues: Short term: Short term: Independent Independent After 1 hour of
“Angkarayih aku pag • The client • The client Nursing Actions: Nursing Actions: nursing intervention:
hapusun iban byah will acquire verbalizes • Evaluate the • Using an appropriate • Evaluated the • Client verbalized
kulang in kusug ku; knowledge correct client’s description quantitative scoring scale, client’s description of correct knowledge on
Daran aku magkahilu; on the knowledge on of fatigue: severity, 1 to 10 for example, can fatigue: severity, the principles of
Magsigpit da isab principles of the principles, changes in severity aid the client formulate the changes in severity energy conservation
daghal ku.” (Translation: energy concepts, and over time, amount of fatigue over time, aggregating as evidenced by:
I easily get tired and I conservation. methods of aggregating factors experienced. factors or alleviating a.) enumerating the
feel like I lack energy; I energy or alleviating factors. factors. five (5) general
often get dizzy; I also Long term: conservation. principles of
get chest tightness). • The client • Assess the client’s • Fatigue can restrict the • Assessed the client’s energy
will attain Long term: ability to perform client’s ability to ability to perform conservation;
Objective cues: reduced • The client ADLs, instrumental participate in self-care and ADLs, instrumental b.) giving at least two
Diagnosed with iron- fatigue. verbalizes activities of daily do his or her role activities of daily living (2) concepts under
deficiency anemia; pale reduction of living (IADLs), and responsibilities in the (IADLs), and each principle of
skin; presence of • The client fatigue through demands of daily family and society, such demands of daily energy
periorbital will comply reports of living (DDLs). as working outside the living (DDLs). conservation, and;
hyperpigmentation; with the use increased home. c.) discussing at least
palms slightly cold to of methods energy and • Evaluated the five (5) examples
touch; Temp: 35.5°C; provided for enhanced • Evaluate the • These will promote client’s outlook for of methods of
energy endurance in client’s outlook for active participation in fatigue relief, energy
conservation. performing fatigue relief, planning, implementing, eagerness to conservation.
Analysis: activities and eagerness to and evaluating therapeutic participate in
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Fatigue related to demands of participate in management to alleviate strategies to reduce After 1 week of
reduced oxygen- daily living. strategies to reduce fatigue. Social support will fatigue, and level of nursing intervention:
carrying capacity of fatigue, and level of be essential to assist the family and social
blood from decreased • The client family and social client put into practice support. • The client verbalized
number of Red Blood verbalizes support. changes to decrease reduction of fatigue as
Cells (RBCs) as compliance with fatigue. • Taught the client and evidenced by reports
evidenced by report of using methods family about energy of increased energy
fatigue, lack of energy, for energy conservation and enhanced
frequent dizziness, and conservation. • Teach the client • Clients need to learn principles and endurance in
exertional discomfort. and family about skills for delegating tasks methods. performing activities
energy conservation to others, setting priorities, and demands of daily
principles and and clustering care to use living. “Kiyananaman
methods. available energy to • Discussed with the ku bukun na aku
complete desired client and family about daran paghapusun
activities. task organization iban dih na aku tuud
methods and time magkahilu. Mas
• Discuss with the • Organization and time organization methods. matatas na aku
client and family management can help the maghinang sin mga
about task client conserve energy • Assisted the client kagunahan ku
organization and and reduce fatigue. with setting priorities hinangun.”
time management for preferred activities (Translation: I feel that
methods. and role I do not get tired that
responsibilities. often anymore and I
• Assist the client • Setting priorities is one don’t get dizzy that
with setting priorities sort of an energy • Aided the client with often. I also have
for preferred conservation method that developing a schedule better endurance in
activities and role permits the client to utilize for daily activity and doing the things I
responsibilities. available energy to rest. Emphasized the have to do.)
complete important importance of
activities. Attaining frequent rest periods. • The client verbalized
desired goals can develop compliance with using
the client’s mood and • Encouraged the methods for energy
sense of emotional health. client to maintain a conservation. (Daran
24-hour fatigue or na aku maglingkud
• Aid the client with • A plan that balances activity log for at least bang manjari iban
developing a periods of activity with 1 week, indicating magpangayuh tabang

schedule for daily periods of rest can aid the
activity and rest. client complete preferred
Emphasize the activities without
importance of contributing to levels of
frequent rest fatigue.
periods.
• Encourage the • Recognizing
client to maintain a relationships between
24-hour fatigue or specific activities and
activity log for at levels of fatigue can aid
least 1 week, the client recognize
indicating times of unnecessary energy
day when the client outflow. This information
feels the least can help the client make
fatigued. choices about setting his
or her activities to take
advantage of episodes of
high energy levels.
• Instruct the client Vivid lighting, noise,
to restrict visitors, numerous
environmental distractions, and litter in
stimuli, especially the client’s physical
during planned surroundings can limit
times for rest and relaxation, disturb rest or
sleep. sleep, and contribute to
fatigue.
15
times of day when the bang awun dugaing
client feels the least tau makatabang
fatigued. kakuh. Paghinangun
ku ra isab in control
• Instructed the client ha pagnapas iban
to restrict byah pagmaintain sin
environmental stimuli, body posture.
especially during Narayaw ku na rin in
planned times for rest cabinet ku iban pag
and sleep. agarun ku in hinang ta
schedule.”
(Translation: I always
sit when permissible
and I always ask for
assistance when
someone is available.
I also do the breathing
control exercises and
maintaining my body
posture. I also
organized my cabinet
and I follow the
schedule we made.”)
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APPENDIX A.
HEALTH TEACHING PLAN

ASSESSMENT OF LEARNING NEEDS

Learning Needs Readiness to Learn (Assess PEEK) Learning Styles

Subjective Cues: “Daran aku magkahilu; angkarayih aku pag P – No presence of physical barriers to Visual and auditory
hapusun; magsigpit in daghal ku; Magsigpit in daghal ku; Dih ku learning such as sensory deficit. No
kaingatan unu na in hinangun ku bat ini umuli (Translation: I often get environmental barriers such as noise is
dizzy; I easily get tired; I experience chest tightness; I do not know present. Environment is conducive to
how to manage these conditions) learning.

E – Client expressed willingness to

Objective Cues: pale skin; dark circles under the eyes; height is learn.
157cm; weight is 42kg; BMI score is 17.0kg/m2; blood pressure is
100/70 E – Client has no previous learning
experience about managing fatigue.

Learning Diagnosis: Knowledge deficit on management of fatigue K – The client is well-oriented with time,
related to reduced oxygen-carrying capacity of blood from decreased place, and people; has good vocabulary
number of Red Blood Cells (RBCs) as evidenced by report of fatigue, in Tausug; has good attention span; and
lack of energy, frequent dizziness, and exertional discomfort. responds to questions appropriately.
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HEALTH TEACHING PLAN

Learning Content Outline Method/s of Time Resources/ Method/s of
Objectives Teaching Allotment Instructional Evaluation
Materials
At the end of 45 minutes teaching session, the client and parent should be able to:
1. Define fatigue. Fatigue is a feeling of tiredness, lack of energy, and Small group 2 minutes Pamphlet Direct questioning
motivation (both physical and mental) that has a gradual discussion
onset.

References:
Gandevia, S. C. (February 1992). "Some central
and peripheral factors affecting human motoneuronal
output in neuromuscular fatigue". Sports Medicine. 13 (2):
93–8. doi:10.2165/00007256-199213020-00004. PMID
1561512.

Hawley, J.A.; Reilly, T. (1997). "Fatigue revisited". Journal

of Sports Sciences. 15 (3): 245–6.
doi:10.1080/026404197367245. PMID 9232549.

2. Enumerate the The following are the general principles of energy 3 minutes
general principles of conservation:
energy conservation.  Pacing
 Planning
 Prioritizing
 Posture
 Proficiency

Reference:
The Lung Association (2005). Breathe Easy –
Management of COPD: Coping strategies, conserve your
energy. Lung Association [Electronic version]. Available:
http://www.lung.ca/copd/management/coping/energy.html
 18

3. Give at least two (2) Below are the concepts under each general principle of 10 minutes
concepts under each energy conservation:
principle of energy
conservation.  Pacing:
 Balance activities and rest
 Steady work results to decreased efficiency
 Periodic breaks lead to maintained efficiency
 Rest following meals
 Use slow rhythmic movements

 Planning:
 Time management is important
 Develop a healthy schedule

 Prioritizing:
 Set priorities
 Eliminate unnecessary tasks
 Ask for assistance

 Posture:
 Make correct use of your body in all tasks
 Keep your work within easy range
 Change positions frequently
 Make sure your work is at the proper height

 Proficiency:
 Organization is essential
 Use equipment that is best suited to the job, and
which requires the least amount of work.

Reference:
The Lung Association (2005). Breathe Easy –
Management of COPD: Coping strategies, conserve your
energy. Lung Association [Electronic version]. Available:
http://www.lung.ca/copd/management/coping/energy.html
 19

4. Discuss at least five Below are some specific methods or ways to conserve 30 minutes Pamphlets,
(5) examples of energy: audio-visual
methods of energy  Control Your Breathing presentation
conservation.  Use breathing control during activities to help (video, pictures)
reduce shortness of breath and fatigue. Exhale
during the strenuous part of an activity and use
pursed-lip and diaphragmatic breathing.

 Eliminate Unnecessary Activities

 For instance, allow dishes to air dry after washing;
sit for as many activities as possible. Sitting uses
25% less energy than standing.

 Get Assistance
 Do not be afraid to ask for assistance when
necessary. Some jobs may be too difficult to do
alone. Asking for help does not mean you are
dependent; it means you are using your energy to
its best advantage.

 Organize Your Time

 Plan daily and weekly schedules so you are doing
the most energy-consuming activities at the time
of day or time of week when you have the most
energy. Alternate difficult and easy tasks. Take
planned rest periods. Keep your schedule flexible
and allow for the unexpected.

 Organize Your Methods

 Repetition of new methods will allow things to
become automatic, and the more proficient you
are, the more energy you save.

 Organize Your Space

 Organize your most used items in drawers or
shelves that are between waist and shoulder
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level, so you won’t have to stoop or stretch to

reach them.

 Pace Yourself
 A slow, steady pace consumes less energy. Do
one activity at a time and use slow, smooth
movements.

 Maintain a Good Posture

 Avoid bending. Avoid lifting. Push, pull or slide
instead. If you must lift and carry, use both hands
and carry close to your body.

 Relax
 Relaxation can help restore energy. Sit in a
comfortable chair with your back supported,
shoulders relaxed, arms resting in your lap with
elbows slightly bent and palms up and feet flat on
the floor. Remember: tension uses energy.

 Use Proper Equipment

 Use the right tool to do the job. For example, use
long-handled equipment to avoid reaching or
bending, use equipment to stabilize items in order
to avoid holding, and use trolleys or bundle
buggies to do your carrying.

Reference:
The Lung Association (2005). Breathe Easy –
Management of COPD: Coping strategies, conserve your
energy. Lung Association [Electronic version]. Available:
http://www.lung.ca/copd/management/coping/energy.html