- Decreased Cardiac Output related to Elevated blood glucose levels and reduced cardiac oxygenation as evidenced by reduced oxygen saturation and Hypotension
- Deficient Knowledge related to Inadequate information and Misinterpretation of information as evidenced by Inaccurate follow-through of instructions and Uncontrolled glucose levels
- Ineffective Health Maintenance related to Conflict between cultural beliefs and health practices and Ineffective coping strategies as evidenced by Failure to take action that prevents health problems and a pattern of lack of health-seeking behavior
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalizes Fatigue and tired Objective Data: -Tachycardia -Tachypnoea -Dyspnoea -Orthopnoea -Reduced oxygen saturation -Hypotension -Fatigue -Anxiety/Restlessness -Decreased activity tolerance -Weak peripheral pulses -Oliguria | Decreased Cardiac Output related to Elevated blood glucose levels and reduced cardiac oxygenation as evidenced by reduced oxygen saturation and Hypotension | Patient will manifest adequate cardiac output as evidenced by the following: Stable vital signs Urine output 0.5 to 1.5 cc/kg/hour Absence of arrhythmia | 1. Discuss cholesterol numbers. Hyperglycaemia increases the risk of hypercholesterolemia. Discuss optimal LDL, HDL, and triglyceride levels with the patient and ensure patients receive screenings as instructed. 2. Obtain an EKG. An EKG can detect dysrhythmias like STEMI that require immediate intervention. 3. Advise on adherence to all medications. Along with insulin and antidiabetic drugs, patients must strictly adhere to their regimen of antihypertensives, vasodilators, diuretics, and statins to reduce the risk of cardiac complications. 4. Educate on symptoms of heart disease or heart failure. The patient should address new or worsening symptoms with their healthcare provider: Chest pain Dyspnoea Dizziness Syncope Edema Activity intolerance | Patient manifested adequate cardiac output as evidenced by the following: Stable vital signs Urine output 0.5 to 1.5 cc/kg/hour Absence of arrhythmia |
| Subjective data: Verbalizes poor understanding Seeks additional information Objective data: -Inaccurate demonstration or teach-back of instructions -Inability to recall instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition -Avoiding eye contact or remaining silent during teaching | Deficient Knowledge related to Inadequate information and Misinterpretation of information as evidenced by Inaccurate follow-through of instructions and Uncontrolled glucose levels | The following are common nursing care planning goals and expected outcomes for a knowledge deficit: Patient will identify risk factors of their disease process and how to prevent worsening of symptoms. Patient will participate in the learning process. Patient will demonstrate the proper execution self-care skills such as wound care/insulin administration/blood pressure monitoring/etc. Patient will identify barriers to their learning and recognize potential solutions to these barriers where possible. | 1. Create a quiet learning environment. Teaching should not be attempted in certain situations. If a patient is in pain, worried, upset, or tired, they may not be in a state of mind to retain information. The nurse should wait until the patient can concentrate on what is presented to them without interruption when possible. 2. Include the patient in their plan. Telling a patient what they should or shouldn’t do will not necessarily guarantee adherence. The nurse can co-create a plan for self-care with the patient. Creating a plan that fits the client’s lifestyle will ensure the highest chance of adherence and motivation. 3. Use multiple learning modalities. After establishing how the patient learns best, offer choices. Verbal instructions along with written materials, instructional videos, and illustrations, are a few options. 4. Repetition is key. When patients are dealing with stressful illnesses and procedures, they may not always recall or completely comprehend teaching. Repetition and reinforcement is a strategy that solidifies information. 5. Don’t overload. Too much information at once can be confusing and overwhelming. Present small chunks of information over time. 6. Establish priorities. A patient may be dealing with a new diagnosis, diet, medications, and post-surgical instructions all at once. This is a large amount of information, and the nurse should consider what is most urgent as well as what the patient is capable of implementing at this time. 7. Include family as requested. Some patients may depend on family members and spouses for support. Identify the support person or caregiver that will benefit the most from teaching. However, the nurse should check with the patient before involving family members. 8. Use translation services and interpreters. Providing educational materials in a patient’s preferred language or using an interpreter will ensure the best comprehension. Avoid using family members, friends or other healthcare providers. With important health information, a professional interpreter should be used. 9. Provide positive reinforcement. When a patient displays adequate learning, such as recalling the action of a medication or demonstrating how to use a device, the nurse should provide positive reinforcement and praise. 10. Provide additional resources. To support continued learning, the nurse may offer additional resources such as websites, support groups, and community resources. 11. Encourage questions. Patients should feel safe to ask questions without judgment or fear of embarrassment. Sitting down, maintaining eye contact, appearing calm and unrushed, and encouraging questions will give the patient confidence to engage. It should also be emphasized that there is no such thing as a “bad” question. | Patient identified risk factors of their disease process and how to prevent worsening of symptoms. Patient will participate in the learning process. Patient demonstrated the proper execution self-care skills such as wound care/insulin administration/blood pressure monitoring/etc. Patient identified barriers to their learning and recognize potential solutions to these barriers where possible. |
| 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 related to Conflict between cultural beliefs and health practices and Ineffective coping strategies as evidenced by Failure to take action that prevents health problems and a pattern of lack of health-seeking behavior | 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. |