NURSING DIAGNOSIS: Ineffective management of therapeutic regimen

1. Assess for indications that the client may be unable to effectively manage the therapeutic regimen:
   1. statements reflecting inability to manage care at home
   2. failure to adhere to treatment plan (e.g. not adhering to dietary modifications and fluid restrictions, refusing medications)
   3. statements reflecting a lack of understanding of the factors that will cause further progression of liver failure
   4. statements reflecting an unwillingness or inability to modify personal habits and integrate necessary treatments into lifestyle
   5. statements reflecting the view that cirrhosis has resolved once he/she is feeling better or that there is no way to control the disease and efforts to comply with treatments are useless.
2. Implement measures to promote effective management of the therapeutic regimen:
   1. explain cirrhosis in terms the client can understand; stress that cirrhosis is a chronic disease and adherence to the treatment plan is necessary in order to delay and/or prevent complications
   2. encourage questions and clarify misconceptions client has about cirrhosis and its effects
   3. encourage client to participate in the treatment plan
   4. initiate and reinforce the discharge teaching outlined in Diagnosis 14 in order to promote a sense of control and self-reliance
   5. provide instructions on weighing self and calculating dietary sodium and protein content; allow time for return demonstration; determine areas of difficulty and misunderstanding and reinforce teaching as necessary
   6. provide client with written instructions about scheduled appointments with health care provider, medications, signs and symptoms to report, weighing self, and dietary modifications
   7. assist client to identify ways treatments can be incorporated into lifestyle; focus on modifications of lifestyle rather than complete change
   8. encourage client to discuss concerns about the cost of hospitalization, medications, and lifelong follow-up care; obtain a social service consult to assist with financial planning and to obtain financial aid if indicated
   9. provide information about and encourage utilization of community resources that can assist client to make necessary lifestyle changes (e.g. drug and alcohol rehabilitation programs)
   10. reinforce behaviors suggesting future compliance with the therapeutic regimen (e.g. statements reflecting plans for integrating treatments into lifestyle, participation in diet planning, statements reflecting an understanding of the importance of eliminating alcohol intake)
   11. include significant others in explanations and teaching sessions and encourage their support; reinforce the need for client to assume responsibility for managing as much of care as possible.
3. Consult appropriate health care provider (e.g. social worker, physician) about referrals to community agencies if continued instruction, support, or supervision is needed.