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 verbalize an understanding of ways to prevent problems associated with continued decreased mobility.
Nursing Actions and Selected Purposes/Rationales
  1. Provide instructions regarding ways to prevent respiratory tract infection:
    1. avoid contact with persons having respiratory tract infections
    2. drink at least 10 glasses of liquid/day unless contraindicated
    3. continue with respiratory care (e.g. incentive spirometer, coughing and deep breathing) as long as mobility is impaired
    4. avoid smoking.
  2. Provide instructions regarding ways to prevent urinary tract infection:
    1. drink at least 10 glasses of liquid/day unless contraindicated
    2. void whenever the urge is felt
    3. wipe from front to back after urinating or defecating (if female) and keep perineal area clean.
  3. Provide instructions regarding ways to prevent urinary calcium stone formation:
    1. drink at least 10 glasses of liquid/day unless contraindicated
    2. void whenever the urge is felt
    3. avoid excessive intake of foods/fluids high in calcium (e.g. dairy products) and oxalate (e.g. tea, instant coffee, peanuts, chocolate, rhubarb, spinach).
  4. Provide instructions regarding ways to prevent a thromboembolism:
    1. drink at least 10 glasses of liquid/day unless contraindicated
    2. avoid placing pillows under knees, crossing legs, and prolonged sitting
    3. perform active foot and leg exercises every 1 - 2 hours during periods of inactivity
    4. wear elastic stockings as prescribed
    5. do not massage extremities.
  5. Provide instructions regarding ways to prevent fainting spells associated with position change:
    1. wear elastic stockings as prescribed
    2. change from a lying to sitting or standing position slowly.
  6. Provide instructions regarding ways to prevent skin breakdown:
    1. change position at least every 2 hours
    2. avoid pressure on any reddened or irritated area
    3. keep skin clean and dry
    4. place an alternating pressure pad or foam or gel cushion on bed and chair if prone to skin breakdown or if activity is severely limited.
  7. Provide instructions regarding ways to prevent contractures:
    1. continue with recommended exercises to increase muscle tone and joint mobility
    2. avoid sitting for prolonged periods
    3. use devices to keep feet in a neutral or slightly dorsiflexed position (e.g. high-topped tennis shoes, foam boots) if in bed for prolonged periods.
  8. Provide instructions regarding ways to reduce the risk for pathologic fractures:
    1. continue recommended weight-bearing activities
    2. take prescribed medications that inhibit bone resorption (e.g. estrogen, alendronate, calcitonin)
    3. avoid smoking and excessive intake of caffeine and alcohol
    4. maintain an adequate dietary intake of protein, vitamins, and calcium
    5. take precautions to reduce the risk for falls.
  9. Provide instructions regarding ways to prevent constipation:
    1. drink at least 10 glasses of liquid/day unless contraindicated
    2. increase intake of foods high in fiber (e.g. bran, whole-grain breads and cereals, fresh fruits and vegetables)
    3. defecate whenever the urge is felt
    4. assume a sitting position for defecation if possible.
Desired Outcome
The client will demonstrate techniques for meeting self-care needs.
Nursing Actions and Selected Purposes/Rationales
  1. Assist the client to identify techniques that will allow him/her to perform as much self-care as possible.
  2. Reinforce physical/occupational therapist's instructions about use of assistive devices.
  3. Allow time for return demonstration of self-care techniques and use of assistive devices.
Desired Outcome
The client will state signs and symptoms to report to the health care provider.
Nursing Actions and Selected Purposes/Rationales
  1. Instruct client to report the following signs and symptoms:
    1. temperature elevation lasting longer than 2 days
    2. skin breakdown
    3. cough productive of purulent, green, or rust-colored sputum
    4. pain or swelling in any extremity
    5. chest pain
    6. flank pain
    7. nausea and vomiting
    8. frequency, urgency, or burning on urination
    9. cloudy or foul-smelling urine
    10. increased restriction of any joint motion.
Desired Outcome
The client will identify community agencies that can provide assistance with home care and transportation.
Nursing Actions and Selected Purposes/Rationales
  1. Provide information about community agencies that can provide assistance to client with home care or transportation (e.g. home health agencies, Meals on Wheels, church groups, transportation agencies).
  2. Initiate a referral if indicated.
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 and physical therapist, exercise regimen, and medications prescribed.
Nursing Actions and Selected Purposes/Rationales
  1. Reinforce the importance of keeping follow-up appointments with health care provider and physical therapist.
  2. Reinforce physician's instructions regarding exercises and activity limitations.
  3. Explain the rationale for, side effects of, and importance of taking medications prescribed.
  4. 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 regarding scheduled appointments with health care provider and physical therapist, medications prescribed, and signs and symptoms to report.