BUKIDNON STATE UNIVERSITY
FORTICH ST. SAYRE HIGHWAY,
MALAYBALAY CITY, BUKIDNON
Name of Client: Letecia Garcia
NURSING CARE PLAN
Date Formulated: February 25, 2022
Problem 1 (PE Format): Risk for ineffective childbearing process related to unplanned/unwanted pregnancy
Level of Prioritization: High Priority
Cause Analysis: Most unwanted pregnancies result from not using contraception, or from using contraceptives inconsistently or incorrectly, pressure on proving their fertility,
and inadequate sex education.
Goals: The patient will be able to accept her pregnancy and will develop an effective and healthy childbearing process.
CUES DESIRED OUTCOMES INTERVENTIONS RATIONALE EVALUATION
Subjective: Short term: Independent: This provides information to assist
The patient steamed up and The client will be able to Evaluate current knowledge in identifying needs and creating Short term:
strongly denied that she is verbalized understanding of regarding physiological and an individual plan of care. Goal met. The client will Engage
psychological changes associated
pregnant, she is also kept care requirements to in activities to prepare for birth
with pregnancy. This helps clarify whether or not
on screaming and telling promote health of self and process and care of newborn.
the father is likely to be
the physician that she is not infant. Identify involvement/response of
supportive or has the potential of
pregnant. child’s father to pregnancy.
posing a threat to the safety and
well-being of mother/fetus.
Determine individual family To identify necessary referrals.
Objective: Long term: stressors, economic Long term:
Anxious Demonstrate healthy situation/financial needs, and The client’s/couple’s coping skills
Goal met. the client will
Irritable pregnancy free of availability/use of resources are more challenged during the
active and transitional phases as Experience complication-free
Kept on screaming preventable complications.
Ascertain the client’s contractions become increasingly labor and childbirth and
Hides her pregnancy by
understanding and expectations of intense. Lack of knowledge, Acknowledge and address
wearing large pants and the labor process and who will misconceptions, or unrealistic individual risk factors.
shirts participate/provide support. expectations can have a negative
impact on coping abilities.
Reference: Student’s Name and Signature: Ralph Jules A. Simbo
This is important to facilitate
Determine the plan for discharge discharge and ensure client/infant
after delivery and home care needs will be met.
support/needs.
This identifies potential risk
Assess the mother’s strengths and factors that may influence the
needs, noting age, relationship client’s/ couple’s ability to
status, and reactions of family assume the role of parenthood.
members. For example, an adolescent still
formulating goals and identity
may have difficulty accepting the
infant as a person. The single
parent who lacks support systems
may have difficulty assuming sole
Emphasize the importance of responsibility for parenting.
maternal well-being including
discussion of nutrition, regular Fetal well being is directly related
moderate exercise, comfort to maternal health, especially
measures, rest, breast care, and during the first trimester, when
sexual activity. developing organ systems are
most vulnerable to injury from
environmental or hereditary
Encourage moderate exercise such factors
as walking or non-weightbearing
activities (e.g., swimming, Exercise tends to shorten labor,
bicycling) in accordance with the increases likelihood of a
client’s physical condition and spontaneous vaginal delivery, and
cultural beliefs. decreases need for oxytocin
augmentation.
Collaborative:
Monitor labor progress and
maternal and fetal well-being per Fear of abandonment can
protocol. Provide continuous intensify as labor progresses,and
intrapartal professional client may experience increased
support/doula. anxiety and or loss of control
when left unattended
Reference: Student’s Name and Signature: Ralph Jules A. Simbo
Reference: Student’s Name and Signature: Ralph Jules A. Simbo