ASSESSMENT NURSING DIAGNOSIS

RATIONALE GOALS AND OBJECTIVES

INTERVENTION RATIONALE EVALUATION

SUBJECTIVE CUES: Mother:

Risk for infection related to inadequate primary defenses (broken skin specifically referring to exposed umbilical cord)

The stump of the umbilical cord is an excellent medium for bacterial growth. Therefore, without proper cord care, the child is susceptible to cord infection.

Goal:After one day of nursing intervention, the mother will be able to give proper cord care for the baby.

Objectives:After one hour of intervention, the mother will learn how to give proper cord care by:

1. Giving the proper and hygienic method of cleaning the remaining umbilical cord.

Diagnostic:1. Note risk

factors for occurrence of infection.

2. Assess and document skin conditions around the base of the umbilical cord.

1. Identifying the area of which serves as a beneficial environment for bacterial growth will help the mother recognize areas that will need thorough cleaning.

2. Assessing the skin conditions around the base of the umbilical cord will enable the mother

3. Note signs and symptoms of fever.

Therapeutic:1. Stress proper

hand washing techniques.

2. Proper application of betadine and alcohol on the tip of the cord.

Health Education:1. Instruct client

how to protect the integrity of the skin and prevent spread of infection around the base of the umbilical cord.