Question aboutt interventions

Daytonite, BSN, RN · Mar 22, 2008

i don't recall if i have answered any care plan questions for you before. however, there are plenty of my previous posts around where i explain care planning to help you.

https://allnurses.com/forums/f50/help-care-plans-286986.html - assistance - help with care plans (in the general nursing discussion forum)

diagnosis: activity intolerance r/t decreased hemoglobin and lung capacity aeb shortness of breath on exertion.

nursing interventions are performed on the symptoms that support the nursing diagnosis. the patient symptom here is

shortness of breath on exertion

other symptoms which i think should have also been included and are much more specific of what is going on are:

the patient is able to sit in wheel chair for 30 minutes then wants to go to bed due to fatigue
the patient becomes extremely short of breath when he is assisted to the bathroom

these three things are what you develop nursing interventions for.

you want to look up information about shortness of breath (dyspnea) and activity intolerance in nursing texts

. don't blow this off. check the section on respiratory and heart diseases, particularly copd and congestive heart failure. look up "shortness of breath" or "dyspnea" in the index of a med/surg textbook. go to the library if you don't have a med/surg textbook yet. in general, you don't want to push a patient who is sob too hard. and, you do want to allow for short rest periods.

the related factors in the diagnostic statement are interesting. these usually reflect underlying disease pathophysiology that is causing the nursing problem (in this case, activity intolerance) in the physiologic nursing diagnoses. the "decreased hemoglobin" would suggest any number of problems that might be going on: (went to my lab reference to dig these up) anemia, hemorrhage of some kind, cancer, nutritional deficiency, kidney disease. the decreased lung capacity could be any lung disease like pneumonia, tb, asthma, one of the copds, a pneumothorax, pulmonary edema, history of lobectomy. treatment of the causes of one or two of these diseases may be reflected in the nature of the outcomes that are listed for the nursing diagnosis, so be aware of that. for example, monitoring hemoglobin results for decreasing levels is in order to watch for hypoxemia leading to sob on exertion.

you might also find some nursing intervention ideas on these web pages:

[color=#3366ff]activity intolerance

and

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=01

outcomes are what are predicted to happen when the interventions have been performed, so nursing interventions and outcomes are intimately linked. you will know if your interventions are correct if the outcomes sound like they would be the result of the interventions you are writing.

is there a book of interventions that i can buy?

nursing interventions classification (nic)

, by joanne mccloskey mccloskey dochterman, gloria m. bulechek, gloria m. bulechek. cost is $49.95. i believe the interventions are organized by nursing diagnosis or noc outcomes titles that are linked to the various nursing diagnoses.

blur411 · Mar 22, 2008

i appreciate your help, i know you have a lot going on right now and i'm keeping you in my prayers!

my follow up question is this:

i understand that you wouldnt want to push them too hard (this is actually a cancer patient that was on chemotherapy)

with that in mind, am i trying to get this patient to be able to tolerate more activity or am i trying to prevent further complications?

here is how the wkst is set up

diagnosis and goal (filled in for me)

activity intolerence r/t decreased hemoglobin and lung capacity aeb shortness of breath on exertion
pt will exhibit no increase in sob with exertion by-----

i write the intervention minimize cardiovascular deconditioning by positioning the client in an upright position several times daily(from the website you posted),

then the evaluation data is given for me as well:

*able to sit in wheel chair for 30 mintues then wants to go to bed due to fatigue

*becomes extremley short of breath when he is assisted to the bathroom

after i finish the intevention, i have to fill in a box that says "what next".

since the patient isnt really doing better, is there anything more we really can do for them? i'm assuming here we are concerned about the fact he is becoming more and more activity intolerant.

i looked up the info on decreased lung function and shortness of breath in an old med-surg book i bought off of craigslist (from 2002) and it pretty much said what you had said about not wanting to push them too hard and the information for most of the lung issues was to do breating exercises and administer oxygen.

again, i appreciate all of your help and anyone elses.

Daytonite, BSN, RN · Mar 22, 2008

ah, ha! the cancer and the chemotherapy add a lot more information. the chemo explains the low hemoglobin. did this guy have lung cancer or lung surgery?

we would all like to see patients get better, go home and live forever. but the reality is that they don't. one thing that hits you in the face when you work as a hospital nurse is that patients do three things:

improve
stabilize
deteriorate

while we would all like patients to improve and get well, the facts are that some will not. it is perfectly kosher to care plan for all three types of outcomes. deteriorating patients are probably the hardest for some nurses to care for. hospice nurses have it down to a science. i've seen enough respiratory patients to know that you just can't push them, particularly a cancer patient with compromised hemoglobin.

this patient is probably not going to improve. all you are going to do with your interventions is maintain his current level of functioning as safely as you can. in other words, supportive care only. pushing for improvement is probably not an option here.

some of the interventions you can do are monitor the patient for the signs and symptoms of activity intolerance when they are engaged in physical activity. watch for syncope. plan for the patient to do as many of their independent adls as possible in short periods of time with rest periods in between provided. evaluate for and incorporate the use of assistive devices. monitor pulse ox.

nursing interventions are of four types:

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)

you can knock yourself out developing several of each type!

minimize cardiovascular deconditioning by positioning the client in an upright position several times daily isn't an ideal way to write an intervention. i would say "have patient sit in an upright position three times a day for meals for at least 20 minutes." why? (1) it doesn't sound like i copied it directly from a book. (2) the scenario told me that the patient was able to sit in a wheel chair for 30 minutes then wanted to go to bed due to fatigue. he should be able to tolerate 20 minutes of sitting up. three times a day can be coordinated with meal times. that is how you customize the plan of care.

no more trips to the br because of the sob. he gets a bedside commode, starts using w/c transfer or using urinal or bedpan.

what comes after interventions in the care planning (nursing) process?

assessment
determination of the patient's problem(s)/nursing diagnosis
planning
implementation
evaluation

the interventions are implemented and then evaluated to see if the care plan is successful or needs changing.

blur411 · Mar 22, 2008

Awesome, I get it and thank you so much for your help!