- Ineffective Breathing Pattern related to Impaired gas exchange and complications of cigarette smoking as evidenced by decreased expiratory and inspiratory pressure
- Ineffective Health Maintenance behaviours related to Competing demands and Conflict between cultural beliefs and health practices as evidenced by Failure to take action that reduces risks and Inadequate knowledge of basic health practices
- Risk-Prone Health Behaviour related to addictive behavior and social anxiety as evidenced by failure to achieve an optimal sense of control and continuing to smoke despite health effects
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Difficulty breathing; shortness of breath or dyspnea Anxiety in relation to breathing Objective data: Dyspnea -Abnormal respiratory rate; tachypnea or bradypnea -Poor oxygen saturation -Abnormal ABG results -Shallow breathing -Pursed-lip breathing -Accessory muscle use when breathing -Nasal flaring -Cough -Restlessness and anxiety -Decreased level of consciousness -Diaphoresis -Abnormal chest x-ray results | Ineffective Breathing Pattern related to Impaired gas exchange and complications of cigarette smoking as evidenced by Decreased expiratory and inspiratory pressure | Patient will deny shortness of breath. Patient will maintain an effective breathing pattern with normal respiratory rate, depth, and oxygen saturation. Patient will have ABG results within normal limits. Patient will incorporate breathing techniques to improve breathing pattern. Patient demonstrates the ability to complete ADLs without dyspnea. | 1. Apply oxygen. Apply the lowest amount of oxygen required to support ventilation. 2. Request Respiratory Therapist support. Respiratory therapists often manage patients with complex breathing issues. They are a wealth of knowledge regarding the correct oxygen therapy for each patient. 3. Reposition the patient. Patients who cannot reposition themselves may become slumped in bed which prevents proper expansion of the lungs. Elevate the head of the bed and keep the patient in Semi-Fowlers or High-fowler’s position as tolerated to promote oxygenation. 4. Teach the patient pursed-lip breathing. Pursed-lip breathing is a technique that allows for controlled ventilation. The breath is inhaled through the nose then slowly exhaled through pursed lips allowing for a prolonged expiration. This technique keeps the airways in the lungs open longer, preventing CO2 trapping. 5. Encourage the use of an incentive spirometer. Incentive spirometers promote taking slow, deep breaths and expanding the lungs. This can help prevent lung problems like pneumonia. 6. Keep a cool, calm, relaxing environment. The use of a fan blowing on the patient can decrease the feeling of dyspnea. Feeling overly hot can increase breathlessness so a cool room is usually preferred. The nurse can use relaxing techniques such as a quiet voice and soothing music to help with anxiety. 7. Medicate for pain or anxiety. Narcotics, especially morphine, decrease the work of breathing and can be an effective treatment for dyspnea. Anti-anxiety medications can also help prevent hyperventilation and promote relaxation. 8. Promote energy conservation. Teach the patient about performing the most taxing or important activities first, such as bathing, when energy is the highest. Rest as needed and take breaks between tasks to limit fatigue. 9. Encourage smoking cessation. Educate the patient on the correlation between smoking and respiratory function. Help the patient develop a plan and goals to quit smoking. 10. Suction secretions or administer expectorants. For patients who can cough effectively, expectorants can loosen mucus so the patient can more easily expel it. If the patient cannot cough on their own, they may need secretions suctioned frequently to prevent aspirating or poor ventilation. Anticholinergic medications can also dry up saliva and secretions. 11. Teach splinting of the chest & abdomen for deep breathing and coughing. Those with recent chest or abdominal surgery may need to splint their incision with a pillow when deep breathing or coughing. This helps support the area and provides comfort. | Patient maintained an effective breathing pattern with normal respiratory rate, depth, and oxygen saturation. Patient has ABG results within normal limits. Patient incorporated breathing techniques to improve breathing pattern. Patient demonstrated the ability to complete ADLs without dyspnea. |
| Subjective Data: Expressed disinterest in improving health -Expressed lack of knowledge or knowing where to start -Describes barriers to effective health maintenance Objective Data: -Worsening of health status -Demonstrated lack of knowledge -Demonstrated lack of adherence -History of lack of health-seeking behaviors -Lack of motivation due to depression, grieving, hopelessness, etc. -Inability to make decisions due to cognitive functioning -Inability to perform health maintenance behaviors due to physical impairment | Ineffective Health Maintenance behaviors related to Competing demands and Conflict between cultural beliefs and health practices as evidenced by Failure to take action that reduces risks and Inadequate knowledge of basic health practices | Patient will verbalize factors contributing to current health status/preventing improved health status. Patient will adopt lifestyle changes to support health goals (example: Patient will stop smoking by the end of the year to prevent worsening of asthma.) Patient will identify resources necessary to support health maintenance. | 1. Incorporate the patient in their health goals. A patient who does not understand the reason for changing or is not interested/ready to change will not do so. The nurse must meet the patient where they are in their health journey and focus on what is important to them and their current capabilities. 2. Simplify their treatment plan. If medication adherence is an issue, discuss with the provider ways to increase adherence by suggesting once-daily pills instead of divided doses or telehealth visits when appropriate. 3. Coordinate resources. The nurse is vital in advocating and coordinating on behalf of the patient. Patients who lack knowledge of available resources or how to set them up will benefit from support. The nurse can begin communication with community resources such as food pantries, free dental clinics, or patient assistance programs as necessary to support effective health maintenance. 4. Offer mental health support. Patients struggling with coping with their illnesses, instances of abuse, depression, or complicated grief may require mental health intervention. Patients cannot focus on health maintenance activities if they do not feel safe or mentally well. 5. Educate about the detriment of health behaviors. Patients may not understand the consequences of certain behaviors. Without instilling unnecessary fear, the nurse can present facts that the patient may have been unaware of. For example, a pregnant patient that has multiple sexual partners may not understand the risk of sexually transmitted diseases that can be transmitted to her child. It is important that the nurse provides accurate health information without shaming the patient. 6. Help the patient see a trend when making positive changes. For patients that may need visual reminders, the nurse can suggest keeping a log or journal. A patient who can visualize their blood pressure normalizing or staying on track with their diet is more likely to continue and create a positive habit. 7. Use motivational interviewing. Motivational interviewing (MI) is an evidence-based approach to behavior change. The nurse can use the acronym OARS to help explore the patient’s thoughts and feelings. O – Open-ended questions (Encourages the patient to think deeper) A – Affirmations (Build the patient’s confidence and their ability to succeed) R – Reflective listening (Show the patient you are listening and give them a chance to correct or elaborate) S – Summarize (Tie up the plan, goals, and next steps) 8. Involve family as applicable. Patients may not want family members involved, or they may lack support. Some family members may also lack an understanding or awareness of the severity of a situation. In this case, the nurse can invite family members to appointments or have conferences to support positive health maintenance. 9. Refer to social workers or home health. The nurse can request referrals to other clinicians such as social workers or home health nurses for continued follow-up. These professionals may be able to assess for further barriers at home and make recommendations. 10. Consider alternatives and get creative. Nurses can think outside the box to overcome barriers. A bed-bound patient may require virtual care or home visits by a provider. A patient who lacks transportation may need their medications delivered. Patients with memory loss or who miss appointments frequently can be sent text reminders. 11. Discuss programs for substance misuse or smoking cessation. A patient who appears interested in overcoming addiction may seek out help. Offer phone numbers to Narcotics/Alcoholics Anonymous or programs that support smoking cessation. 12. Assist in setting up appointments for preventive health. The best health maintenance begins with prevention. Remind and, if necessary, set up appointments for breast cancer screenings, pap smears, and vaccinations. Make sure the patient understands the reasoning and importance for better adherence. | Patient verbalized factors contributing to current health status/preventing improved health status. Patient adopted lifestyle changes to support health goals (example: Patient will stop smoking by the end of the year to prevent worsening of asthma.) Patient identified resources necessary to support health maintenance. |
| Subjective Data: Verbalizes unable to leave smoking habits Objective Data: -Failure to achieve an optimal sense of control -Failure to take action that prevents health problems -Minimizes health status change -Continuing to smoke despite health effects -Substance misuse | Risk-Prone Health Behaviour related to addictive behavior and Social anxiety as evidenced by failure to achieve an optimal sense of control and continuing to smoke despite health effects | The patient will verbalize acceptance of health status changes and the need to quit smoking The patient will verbalize two strategies to quit smoking | 1. Discuss with the patient current health goals. Smoking is addictive and without an established goal to change this unhealthy behavior, smoking cessation cannot be achieved. 2. Help the patient recognize the influence of others. If the patient’s family and peers also smoke, it can make quitting much more difficult. Help the patient recognize who they spend their time with and how they may be able to limit interactions to reduce the influence of smoking. 3. Explore previous attempts to quit. Discuss what the patient has tried in the past if they attempted quitting. This can help the nurse offer tips and resources to successfully quit smoking. 4. Refer the patient to support programs. Many states have tobacco quit programs that provide free counselling, resources, and medications to quit smoking. | The patient verbalized acceptance of health status changes and the need to quit smoking The patient verbalized two strategies to quit smoking |