CUES Nursing Diagnosis Inference Goals of Care Implementation Rationale Evaluation

S: “SINUKA KO Nausea and vomiting Growth of After 1 hour of - Assess vital signs - baseline After 1 hour of NSG
LAHAT NG related to disease bacteria in the NSG intervention data Interventions. Goals
KINAIN KO” process secondary to GI tract client will be - Elevate the - to prevent Was partially met.
as verbalized Food poisoning. ↓ demonstrating aspiration There is still
By the client. Gastric behavior in client’s head or in Presence of saliva
inflammation minimizing Accumulation in the
O: ↓ vomiting a semi-fowler’s Mouth that implies
Increased The possibility of
- Pallor swallowing position Vomiting may still
- Appears leading to - prevent Takes place.
weak ↓ - Increase fluid dehydration
- Restlessness vomiting - the client will be
- Choking intake able to sleep in long
- increased - for hygiene Terms.
Saliva - Provide oral care and comfort
and to reduce
the reoccurrence
of vomiting that
could be brought
by the after taste
of the vomit.