NURSING DIAGNOSIS: Knowledge deficit, Ineffective management of therapeutic regimen, or Altered health maintenance*

*The nurse should select the diagnostic label that is most appropriate for the client's discharge teaching needs.

Desired Outcome
The client will identify ways to prevent postoperative infection.
Nursing Actions and Selected Purposes/Rationales
  1. Instruct client in ways to prevent postoperative infection:
    1. continue with coughing (unless contraindicated) and deep breathing every 2 hours while awake
    2. continue to use incentive spirometer if activity is limited
    3. increase activity as ordered
    4. avoid contact with persons who have infections
    5. avoid crowds during flu and cold seasons
    6. decrease or stop smoking
    7. drink at least 10 glasses of liquid/day unless contraindicated
    8. maintain a balanced nutritional intake
    9. maintain proper balance of rest and activity
    10. maintain good personal hygiene (especially oral care, handwashing, and perineal care)
    11. avoid touching any wound unless it is completely healed
    12. maintain sterile or clean technique as ordered during wound care.
Desired Outcome
The client will demonstrate the ability to perform wound care.
Nursing Actions and Selected Purposes/Rationales
  1. Discuss the rationale for, frequency of, and equipment necessary for the prescribed wound care.
  2. Provide client with the necessary supplies (e.g. dressings, irrigating solution, tape) for wound care and with names and addresses of places where additional supplies can be obtained.
  3. Demonstrate wound care and proper cleansing of any reusable equipment. Allow time for questions, clarification, and return demonstration.
Desired Outcome
The client will state signs and symptoms to report to the health care provider.
Nursing Actions and Selected Purposes/Rationales
  1. Instruct the client to report the following signs and symptoms:
    1. persistent low-grade or significantly elevated (38.3 °C [101 °F]) temperature
    2. difficulty breathing
    3. chest pain
    4. cough productive of purulent, green, or rust-colored sputum
    5. increasing weakness or inability to tolerate prescribed activity level
    6. increasing discomfort or discomfort not controlled by prescribed medications and treatments
    7. continued nausea or vomiting
    8. increasing abdominal distention and/or discomfort
    9. separation of wound edges
    10. increasing redness, warmth, pain, or swelling around wound
    11. unusual or excessive drainage from any wound site
    12. pain or swelling in calf of one or both legs
    13. urine retention
    14. frequency, urgency, or burning on urination
    15. cloudy or foul-smelling urine.
Desired Outcome
The client will verbalize an understanding of and a plan for adhering to recommended follow-up care including future appointments with health care provider, dietary modifications, activity level, treatments, and medications prescribed.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce importance of keeping scheduled follow-up appointments with the health care provider.
  2. Reinforce physician's instructions about dietary modifications. Obtain a dietary consult for client if needed.
  3. Reinforce physician's instructions on suggested activity level and treatment plan.
  4. Explain the rationale for, side effects of, and importance of taking medications prescribed. Inform client of pertinent food and drug interactions.
  5. Implement measures to improve client compliance:
    1. include significant others in teaching sessions if possible
    2. encourage questions and allow time for reinforcement and clarification of information provided
    3. provide written instructions on scheduled appointments with health care provider, dietary modifications, activity level, treatment plan, medications prescribed, and signs and symptoms to report.