Health Maintenance, Altered
NANDA: Inability to identify, manage, and/or seek help to
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.
- Presence of mental retardation, illness, organic brain
- Presence of physical disabilities or challenges
- Presence of adverse personal habits:
- Poor diet selection
- Morbid obesity
- Alcohol abuse
- Drug abuse
- Poor hygiene
- Lack of exercise
- Evidence of impaired perception
- Low income
- Lack of knowledge
- Poor housing conditions
- Risk-taking behaviors
- Inability to communicate needs adequately (e.g., deafness,
- Dramatic change in health status
- Lack of support systems
- Denial of need to change current habits
- Demonstrated lack of knowledge
- Failure to keep appointments
- Expressed interest in improving behaviors
- Failure to recognize or respond to important symptoms
reflective of changing health state
- Inability to follow instructions or programs for health
- Body or mouth odor
- Unusual skin color, pallor
- Poor hygiene
- Soiled clothing
- Frequent infections (e.g., upper respiratory infection [URI],
urinary tract infection [UTI])
- Frequent toothaches
- Obesity or anorexia
- Chronic fatigue
- Apathetic attitude
- Substance abuse
- Patient describes positive health maintenance behaviors such
as keeping scheduled appointments, participating in smoking and substance abuse
programs, making diet and exercise changes, improving home environment, and
following treatment regimen.
- Patient identifies available resources.
- Patient uses available resources.
- (i) independent
- (i) Assess for physical defining
- 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
- 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
- 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
- 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
- (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
- (i) Determine whether the patient's manual
dexterity or lack of mobility is a factor in patient's altered capacity for
- 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
- (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
- (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.
- (i) independent
- (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
- (i) Compliment patient on positive
- To reinforce behaviors.
- (i) Involve family and friends in health
- To focus plan of care in the direction that is most
important to the patient. This enables the patient to maintain a sense of
- (i) Provide assistive devices (i.e., walker,
cane, wheelchair) as necessary.
- To promote independence and a sense of autonomy.
Education/Continuity of Care
- (i) independent
- (i) Provide patient with rationale for
importance of behaviors such as the following:
- Balanced diet low in cholesterol
- To prevent vascular disease.
- Smoking cessation
- Smoking has been directly linked to cancer and heart
- Cessation of alcohol and drug abuse.
- In addition to physical addictions and the social
consequences, the physical consequences of substance abuse mitigate against
- Regular exercise
- To promote weight loss and increase agility and
- Proper hygiene
- To decrease risk of infection and promote maintenance
and integrity of skin and teeth.
- Regular physical and dental checkups
- To identify and treat problems early.
- Reporting of unusual symptoms to a health professional
- To initiate early treatment.
- Proper nutrition
- Regular inoculations
- Early and regular prenatal care
- (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
- Coordinated efforts are more meaningful and effective.
Health System Guidance; Support system Enhancement; Discharge
Planning; Health Screening; Risk Identification
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