Ineffective Health Maintenance

Daytonite, BSN, RN · Feb 22, 2008

Even though NANDA doesn't list "lack of desire" as a related factor for this particular diagnosis, I think that it fits in with the spirit of it and will work fine.

Eirene, ASN, RN · Feb 23, 2008

Thanks Daytonite.

I'm having an issue with a few things. I hope you can help me.

I have to tie in a few medical interventions; a vital sign intervention, and a medication intervention.

Should I assess vitals before the discussion of health maintenance? I did that as part of my assessment, but I'm unsure how to include that and a rationale behind it.

I have the following interventions:

Assess Mrs. S's feelings, values, and reasons for not following the prescribed plan of care.
Assess Mrs. S. for family patterns, economic issues, and cultural patterns that influence compliance with a given medical regimen.
Help Mrs. S. how to arrange a daily schedule that incorporates the new health care regimen.
Refer Mrs. S. to social services for financial assistance.
Identify support groups related to the disease process.
Help Mrs. S. to choose a healthy lifestyle and to have appropriate diagnostic screening tests.
Identify complimentary healing modalities such as healing touch or yoga. (We discussed prayer-- would this be a complimentary healing modalitity?)
Obtain or design educational material that is appropriate for Mrs. S; use pictures if possible.
Ensure that follow-up appointments are scheduled before Mrs. S. is discharged; discuss a way to ensure that appointments are kept.
Discuss symptoms of daily living in addition to COPD.
Recognize resistance to change in lifelong patterns of personal healthcare.
Discuss with Mrs. S. realistic goals for changes in health maintenance.
Validate Mrs. S's feelings regarding the impact of health states on current lifestyle.

The three goals I'm writing are:

Mrs. S. identifies resources available to her.
Mrs. S. will verbalize one short-term goal.
Mrs. S. will verbalize one long-term goal.

She has multiple medications, but none affect her mental-health/depression (for ineffective health maintenance). She's on several antibiotics, theophylline, steriods, and antidiabetic agents.

Thank you so much for any help you can give me.

Dani. :redbeathe

kgh31386, BSN, MSN, RN · Feb 23, 2008

Another dx could be "Risk for injury r/t BMI of 48". But if you want to stick with your current dx that sounds fine. You could also word it differently and say, "ineffective health maintenance r/t ...well lots of stuff,"improper diet consumption, lack of activity, etc". AEB BMI of 48. But you would check her vital signs before anything because since she's morbidly obese with COPD, her heart may be beating irregularly and her BP may be really high ; because if she turns out to be really hypertensive, you wouldn't want to give her a medication that might raise her BP or HR. You should check what her drugs are for and what the side effects might be before you give them. What do you think a good intervention for medication would be?

kgh31386, BSN, MSN, RN · Feb 23, 2008

I forgot to say something about her meds.. from what I see, she's on steroids(they suppress the immune system and this can lead to infection so check her lung sounds for bad sounds), theophylline for her COPD(this can increase her heart rate a lot and interact with other drugs..and the side effects are increased by antibiotics( so it a has high drug interaction), and she's on antibiotics to fight infection...

Daytonite, BSN, RN · Feb 23, 2008

for your medical intervention it seems to me that scheduling follow up appointments and having some kind of way to make sure they are kept would work, but following her drug and treatment regimen should also qualify since these are collaborative interventions that require physician orders anyway.

don't know what to tell you about a vital sign intervention. if she has any kind of home health assistance, they will take a set of vital signs with every visit. you could add an intervention that she record her heart rate after every breathing treatment (if she does one).

medication interventions can be discussion about what a medication is for, what it is expected to do for her, signs and symptoms of side effects and any special considerations connected with them.

i wouldn't consider prayer a complimentary healing modality, but i would leave that in the care plan if it's something the patient is agreeable to doing. if she has church ties, maybe contacting people at her church and getting them to visit and check in on her can help to get her to follow her regimen of care.

your goals sound ok, but can you make them a little more specific?

another dx could be "risk for injury r/t bmi of 48". but if you want to stick with your current dx that sounds fine. you could also word it differently and say, "ineffective health maintenance r/t ...well lots of stuff,"improper diet consumption, lack of activity, etc". aeb bmi of 48.

ineffective health maintenance r/t ...well lots of stuff,"improper diet consumption, lack of activity, etc is an improperly worded nursing diagnostic statement. "improper diet consumption, lack of activity, etc " are symptoms, not etiologies and do not belong in the "related to" part of the diagnostic statement. they belong in the "aeb" part of the diagnostic statement. only the etiology, underlying main reason for the symptoms and the problem, goes with the "related to" part of the diagnostic statement. read the nanda taxonomy. it's very clear as to what the related causes are for almost all the nursing diagnoses and "improper diet consumption, lack of activity, etc " is not listed for ineffective health maintenance (here's a weblink that contains that nanda information: [color=#3366ff]ineffective health maintenance)

another dx could be "risk for injury r/t bmi of 48".

what injury did you have in mind here? you never write a diagnosis like this without having some specific injury in mind because the goal and nursing interventions are to monitor for signs and symptoms of it and to perform care to prevent it. it is the "invisible" aeb part of the nursing diagnostic statement that isn't seen, but should always be in the back of your mind when using a anticipatory diagnosis.

kgh31386, BSN, MSN, RN · Feb 23, 2008

yep i got some practice to do. i didn't look in my NANDA when i did those, i thought they were just throwing out ideas. i know it's the problem, etiology, signs and symptoms. it's only my first semester, so i guess i should think it out more before i say it. but is what i said about what the meds for right at all?

Eirene, ASN, RN · Feb 23, 2008

Thanks again. I swear I'm going to pass nursing school on your help alone.

How does this goal sound?

"Mrs. S. will display health-seeking behavior and exhibit optimistic health beliefs AEB:

Mrs. S. identifies at least one resource available to her (overeaters anonymous)
Mrs. S. will verbalize one short-term goal (this happened to be "to breathe easier)
Mrs. S. will verbalize one long-term goal (to lose 50 pounds)

Thank you,

Dani

Daytonite, BSN, RN · Feb 23, 2008

better and more specific. make sure you have nursing interventions to match these goals (ex: she will begin to attend overeaters anonymous meetings every monday afternoon). see this post on how to write goal statements: https://allnurses.com/forums/2509305-post157.html