outcomes are the results you expect to see when your nursing interventions have been implemented. your nursing interventions are supposed to directly address the patient's symptoms--those items following the aeb statement in your nursing diagnostic declaration. you list the following symptoms, or defining characteristics:
- exertional dyspnea
- shortness of breath upon coughing
- client stated "he felt fatigued"
yet, you only have one nursing intervention:
- ambulate client to the bathroom and back two times per day
which symptom is this intervention addressing? how is it helping or supporting the dyspnea? the fatigue? how does the cough figure into all this and what are you doing about the cough? does cough really have anything to do with activity intolerance?
you list 2 outcomes of:
- client will gradually increase activity by discharge
- client will assist with adl's by 3/31/08
is it realistic to expect that ambulating the patient to the bathroom and back twice a day is going to result in a gradual
increase in his activity? sounds like the same old activity day after day to me and not a gradual increase at all. it doesn't make any rational sense to me. now, a nursing intervention that directs the patient to "walk 20 feet twice a day daily, 25 feet bid 2 days later, 30 feet bid 4 days later unless he develops any sob" is gradual tolerance. and, "patient will be able to ambulate 30 feet without experiencing sob within a week" is an outcome that reflects that.
what adls are you going to be working on with the patient to achieve this outcome? none are even mentioned in any nursing interventions. was he assessed for these things? can he bathe, dress, wash, eat by himself? what kind and how much assistance is needed?
you need to hit the cardiac books and nursing articles to find information on activity tolerance and deconditioning and how therapeutic activities are gradually increased to tolerance to give you an idea of how it is done. the defining characteristics listed for this nursing diagnosis should give you an idea of the problem you are dealing with. then, you need to realize that in the world of patient care there are, in general, three possibilities to keep in mind when determining outcomes:
we would all like our patients to improve, but that isn't always an option. there are 4 types of nursing interventions for actual nursing problems so you should have at least 4 interventions for each defining characteristic:
- assess/monitor/evaluate/observe (to evaluate the patient's condition)
- care/perform/provide/assist (performing actual patient care)
- teach/educate/instruct/supervise (educating patient or caregiver)
- manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
there is a post on how to construct goal/outcome statements here: http://allnurses.com/forums/2509305-post157.html