Nursing diagnosis: deficient Knowledge [Learning Need] regarding condition, treatment, self-care, and discharge needs related to lack of information or unfamiliarity with information resources; information misinterpretation; lack of recall or cognitive limitation
Possibly evidenced by
Request for information
Statement of concerns and misconceptions
Inaccurate follow-through of instructions
Development of preventable complications
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Illness Care
Verbalize understanding of condition and disease process and treatment.
Identify relationship of current signs and symptoms to the disease process and correlate these with causative factors.
Initiate necessary lifestyle changes and participate in treatment regimen.
Nursing care plan intervention with rationale:
1. Explain and reinforce explanations of individual disease process, including factors that lead to exacerbation episodes. Encourage client and SO to ask questions.
Rationale: Understanding decreases anxiety and can lead to improved participation in treatment plan.
2. Identify individual environmental factors such as excessively dry air, wind, temperature extremes, pollen, tobacco smoke, aerosol sprays, and air pollution that may trigger or aggravate condition. Encourage client and SO to explore ways to control these factors in and around the home and work setting.
Rationale: These can induce or aggravate bronchial irritation, leading to increased secretion production and airway blockage.
3. Review the harmful effects of smoking, and strongly advise cessation of smoking by client and SO. Provide information on QUITLINES, support groups, nicotine substitutes, and other resources that aid in smoking cessation.
Rationale: Cessation of smoking may slow or halt progression of COPD. Even when client wants to stop smoking, support groups and medical monitoring may be needed. Note: Research studies suggest that sidestream or secondhand smoke can be as detrimental as actually smoking.
4. Provide information about benefits of regular exercise while addressing individual activity limitations.
Rationale: Having this knowledge can enable client and SO to make informed choices and decisions to reduce client’s dyspnea, maximize functional level, perform most desired activities, and prevent complications. This may include alternating activities with rest periods to prevent fatigue, conserving energy during activities by pulling instead of pushing articles, sitting instead of standing while performing tasks; using pursed-lip breathing, side-lying position, and possible need for supplemental oxygen during sexual activity.
5. Discuss importance of regular medical follow-up care, when to notify healthcare professional of changes in condition, and periodic spirometry testing, chest x-rays, and sputum cultures.
Rationale: Monitoring disease process allows for alterations in therapeutic regimen to meet changing needs and may help prevent complications.
6. Review oxygen requirements and dosage for client who is discharged on supplemental oxygen. Discuss safe use of oxygen and refer to supplier as indicated.
Rationale: Reduces risk of misuse—too little or too much—and resultant complications. Promotes environmental and physical safety.
7. Instruct client and SO in use of NIPPV as appropriate. Problemsolve possible side effects, and identify adverse signs and symptoms such as increased dyspnea, fatigue, daytime drowsiness, or headaches on awakening.
Rationale: NIPPV may be used at night and periodically during day to decrease CO2 level, improve quality of sleep, and enhance functional level during the day. Signs of increasing CO2 level indicate need for more aggressive therapy.
8. Instruct asthmatic client in use of peak flow meter as appropriate.
Rationale: Peak flow level can drop before client exhibits any signs and symptoms of asthma after the “first time” the client is exposed to a trigger. Regular use of the peak flow meter may reduce the severity of the attack because of earlier intervention.
9. Provide information and encourage participation in support groups sponsored by the American Lung Association and public health department.
Rationale: These clients and their SOs may experience anxiety, depression, and other reactions as they deal with a chronic disease that has an impact on their desired lifestyle. Support groups may be desired or needed to provide assistance, emotional support, and respite care.
10. Refer for evaluation of home care if indicated. Provide a detailed plan of care and baseline physical assessment to home care nurse as needed on discharge from acute care.
Rationale: Provides for continuity of care. May help reduce frequency of hospitalization.