care plan help!

[LiveYourDream]

Hi all, I'm writing a care plan for a patient and having such a difficult time.

The patient has COPD (emphysema), idiopathic pulmonary fibrosis, has just been diagnosed with CHF during this hospitalization (though with an ejection fraction of 10% he likely has had CHF for a while now). His admitting symptoms were non-radiating substernal chest pain, and in the days preceding his admission, dyspnea on exertion.

I have decided to use decreased cardiac output (he has an ejection fraction of 10%), and impaired gas exchange (secondary to emphysema) as my 2 nursing diagnoses. I am having a hard time coming up with realistic short and long term goals for him because recovery is not possible so I am trying to focus on quality of life (after consulting with my instructor). For his heart failure dx I tentatively have chosen as his short term goal to be able to resume activities of daily living before discharge, and the ability to return to work (he is self employed) after discharge. Im not sure what type of interventions to use though and how I could possibly evaluate them.

Anyone have input? Thanks

[J9G2008]

I would think that your short-term goals would have to be shorter than you're doing. For us, we have to focus on the things we can do while they're in the hospital, that we can directly intervene on. Like, on successive days, client will walk 10, 20, 30 feet down the hall w/o shortness of breath. Or teach them their medication regime-what their condition is, why the meds are being prescribed, etc. Or teaching pursed-lip breathing to reduce atelactasis. Just some thoughts.