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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Health Maintenance, Altered
Deidra Gradishar, RNC, BS

NANDA: Inability to identify, manage, and/or seek help to maintain health

Altered health maintenance reflects a change in an individual's ability to perform the functions necessary to maintain health or wellness. That individual may already manifest symptoms of existing or impending physical ailment or display behaviors that are strongly or certainly linked to disease. The nurse's role is to identify factors that contribute to an individual's inability to maintain healthy behavior and implement measures that will result in improved health maintenance activities. The nurse may encounter patients who are experiencing an alteration in their ability to maintain health either in the hospital or community but the increased presence of the nurse in the community and in home health settings improves his or her ability to assess patients in their own environment. The patients who are most likely to experience more than transient alterations in their ability to maintain their health are those whose age or infirmity (either physical or emotional) absorb much of their resources. The task before the nurse is to identify measures which will be successful in empowering the patient to maintain their own health within the limits of their ability.

Related Factors

Defining Characteristics


Behavioral characteristics Physical characteristics

Expected Outcomes

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Assess for physical defining characteristics.
Changing ability or interest in performing the normal activities of daily living (ADLs) may be an indicator that commitment to health and well-being is waning.
(i) Assess patient's knowledge of health maintenance behaviors.
Patients may know that certain unhealthy behaviors can result in poor health outcomes but continue the behavior despite this knowledge. The health care provider needs to ensure that the patient has all of the information needed to make good lifestyle choices.
(i) Assess health history over past 5 years.
This may give some perspective on whether poor health habits are recent or chronic in nature.
(i) Assess to what degree environmental, social, intrafamilial disruptions or changes have correlated with poor health behaviors.
These changes may be precipitating factors or may be early fallout from a generalized condition reflecting decline.
(i) Determine patient's specific questions related to health maintenance.
Patients may have health education needs; meeting these needs may be helpful in mobilizing the patient.
(i) Determine patient's motives for failing to report symptoms reflecting changes in health status.
Patient may not want to "bother" the provider, or may minimize the importance of the symptoms.
(i) Discuss noncompliance with instructions or programs with patient to determine rationale for failure.
Patient may be experiencing obstacles in compliance that can be resolved.
(i) Assess the patient's educational preparation and ability to integrate and relate to information.
Patients may not have understood information because of a sensory impairment or the inability to read or understand information. Culture or age may impair a patient's ability to comply with the established treatment plan.
(i) Assess history of other adverse personal habits, including the following: smoking, obesity, lack of exercise, and alcohol or substance abuse.
Long-standing habits may be difficult to break; once established, patients may feel that nothing positive can come from a change in behavior.
(i) Determine whether the patient's manual dexterity or lack of mobility is a factor in patient's altered capacity for health maintenance.
Patients may need assistive devices for ambulation or to complete tasks of daily living.
(i) Determine to what degree patient's cultural beliefs and personality contribute to altered health habits.
Health teaching may need to be modified to be consistent with cultural or religious beliefs.
(i) Determine whether the required health maintenance facilities/equipment (e.g., access ramps, motor vehicle modifications, shower bar or chair, and others) are available to patient.
With adequate assistive devices, the patient may be able to effect enormous changes in maintaining his or her personal health.
(i) Assess whether economic problems present a barrier to maintaining health behaviors.
Patients may be too proud to ask for assistance or be unaware that social security, medicare or insurance benefits could be helpful to them.
(i) Assess hearing, and orientation to time, place, and person to determine the patient's perceptual abilities.
Perceptual handicaps may impair an individual's ability to maintain healthy behaviors.
(i) Make a home visit to determine safety, accessibility, and quality of living conditions
To identify and solve problems that complicate health maintenance.
(i) Assess patient's experience of stress and disruptors as they relate to health habits.
If stressors can be relieved, patients may again be able to resume their self-care activities.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Follow-up on clinic visits with telephone or home visits.
To develop an ongoing relationship with patient and to provide ongoing support.
(i) Provide patient with a means of contacting health care providers
Who are available for questions or problem resolution.
(i) Compliment patient on positive accomplishments.
To reinforce behaviors.
(i) Involve family and friends in health planning conferences.
To focus plan of care in the direction that is most important to the patient. This enables the patient to maintain a sense of autonomy.
(i) Provide assistive devices (i.e., walker, cane, wheelchair) as necessary.
To promote independence and a sense of autonomy.

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Provide patient with rationale for importance of behaviors such as the following:
(c) Ensure that other agencies, Department of Children and Family Services (DCFS), Social Services, Visiting Nurse Association (VNA), Meals-on-Wheels, and others are following through with plans.
Coordinated efforts are more meaningful and effective.

NIC

Health System Guidance; Support system Enhancement; Discharge Planning; Health Screening; Risk Identification

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