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Medical Diagnoses: Knowledge deficient: disease states, treatments, community resources, nutrition, and wellness. Activities, R/T information misinterpretation, unfamiliarity with information resources and lack of exposure as evidenced by verbalized deficiency in knowledge, inaccurate perceptions of health status and failure to correctly perform prescribed health behaviors.

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders

Evaluation

Goals

Interventions

     

Knowledge deficient: disease states, treatments, community resources, nutrition, and wellness activities r/t information misinterpretation, unfamiliarity with information resources and lack of exposure as evidenced by verbalized deficiency in knowledge, inaccurate perceptions of health status and failure to correctly perform prescribed health behaviors.



Short term goals:

1.        Client will demonstrate motivation to learn as measured by verbalization of desire and asking questions related to health by 15:00 on [Month] 14, [Year].

2.        Client will identify perceived learning needs as measured by verbalization of at least 2 topics by 15:00 on [Month] 14, [Year].

Long term goals:

1.        Client will understand disease processes, causes and factors contributing to symptoms as measured by verbalization of knowledge by 15:00 on [Month] 21st, [Year].

2.        Client will identify medications used for symptom control of each medical condition as measured by verbalization of accurate knowledge by 15:00 on [Month] 21, [Year].

3.        Client will understand how to incorporate new health regimens into lifestyle measured by verbalization of knowledge 15:00 on [Month] 28th, [Year].

4.        Client will demonstrate knowledge of community resources via verbalization by [Month] 28th, [Year].

  

·         Asses the client’s ability, readiness to learn and previous knowledge r/t health preservation, medication management, disease states and community resources.  Learning best occurs when learners are motivated and when instruction is tailored to the client’s cognitive ability (Olinzock, 2004).

·         Assess personal context and meaning of illness including perceived changes in lifestyle, financial concerns and impact on culture.  Providing interventions that incorporate personal perspectives and meaning of illness results in improved symptom management and client satisfaction (Hornsten, Lundman, Stenlund, & Sandstrom, 2005).

·         Provide information to support self-efficacy, self-regulation and self-management by focusing on problem solving and decision making.  Educational programs based on empowerment have demonstrated effectiveness (Deakin, McShane, Cade, & Williams, 2005).

·         Tailor the delivery of instruction to the client’s cognitive level by using visual aids (medication chart, brochures on Oak & Acorn and Elderserve’s Companion Program) and accessible word choices.  Clients with lower literacy benefit from well-tailored materials (DeWalt, et al., 2004).

·         Evaluate learning outcomes using patient verbalizations.  Evaluation serves as an assessment of the effectiveness of care and allows opportunity for adjustments to the plan of care (Ackley & Ladwig, [Year]).

  



Short term goals:

1.        Goal met.  Client asked questions related to the purpose of her medications, what they treated and expressed desire for reference materials.  Client also expressed desire to learn of community resources and ways to “not see the doctor.”

2.        Goal met.  Client identified learning needs as:  medication information and management, community resources, and nutrition suggestions.

Long term goals:

1.        Goal not met. The client has made no progress towards this goal. Evaluation of knowledge r/t disease processes, causes and factors set for 15:00, [Month] 21, [Year].

2.        Goal partially met.  Client identified Ativan as her sleeping medication.  Continued education required.  Evaluation set for 15:00 on [Month] 21, [Year].

3.        Goal not met.  The client has made no progress towards this goal. Client has not described how to incorporate new health regimens into her lifestyle.  Evaluation set for 15:00 on [Month] 21, [Year].

4.        Goal not met.  The client has made no progress towards this goal. Client has not demonstrated knowledge of community resources.  Continued identification of resources required. Evaluation set for 15:00 on [Month] 28, [Year].

     

·         Assessment of client’s abilities, readiness to learn and previous knowledge performed.  Client expressed desire to learn and identified baseline knowledge.  Client is not interested in smoking or alcohol cessation information, but is motivated to learn wellness behaviors, medication information and community resources.  Client is unable to read and write, but is able to retain verbal information and understands visual aids. 

·         Assessment of personal context and meaning of illness performed.  Client expressed difficulty with incorporating “good” food choices for health conditions due to finances, lack of knowledge and unfamiliarity with certain foods.  She cited financial strain as a reason for not refilling medications promptly. Client expressed fear of others in the community and uncertainty of minimum exercise recommendations for her age and health.

·         Continuation of providing information to support self-efficacy, self-management and self-regulation required.  Client identified a few ways she could maintain health (“walk more”) and solve specific health problems (“use my breathing machine when it’s hot” as a solution to difficulty breathing), more progress is achievable.

·         Continuation of tailoring of instruction required.  Provided medication information verbally and in writing, however reinforcement is required.  Procured brochure for Elderserve Companion program, referral still required.  Procured information on Oak & Acorn, referral and disclosure of information to client still required.

·         Continued evaluation of intervention efficacy still required.

       

     



       

Assessment

       

Subjective Data:

Verbalizations indicating lack of knowledge including:

“I forget what all is wrong with me.  I know I got hernia and I take stuff for it.”on oas evidenced by I remember,""r medications are used to treat, their side effects, and IADLS)friendships, fear of

I don’t know what all of these (medications) are for, I just take them when I have the money for them.  I take most of them for my hernia and one for my sleeping.”

“There’s nothing to do and they don’t do the craft anymore, I don’t know why.  I got no place to go to do anything.”

       

Objective Data

Client asks questions regarding health conditions.

Nonverbal behaviors indicate attentiveness and concern for knowing.

     


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References

    

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*Deakin, T. A., McShane, C. E., Cade, J. E., & Williams, R. (2005). Group based training for self-management strategies in people with type 2 diabetes mellitus. The Cochrane Collaboration. Hoboken, NJ: John Wiley and Sons, Ltd.

DeWalt, D. A., Pignone, M., Malone, R., Rawls, C., Kosnar, M. C., George, G., et al. (2004). Development and pilot testing of a disease management program for low literacy patients with heart failure. Patient Education Counseling , 55 (1), 78-86.

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Puentes, W. J. (2002). Simple reminiscence: a stress-adaptation model of the phenomenon. Issues in Mental Health Nursing , 23 (5), 497-511.

Raak, R., Hurtig, I., & Wahren, L. K. (2003). Coping strategies and life satisfaction in subgrouped fibromyalgia patients. Biological Research Nursing , 4 (3), 193-202.

Resnick, B. (2001, January 1). Geriatric Health Promotion: Alcohol, Smoking, and Diet. Retrieved [Month] 18, [Year], from Medscape Today: http://www.medscape.com/viewarticle/408406_8

Sateia, M. J., Doghramji, K., Hauri, P. J., & Morin, C. M. (2000). Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep , 23 (2), 243.

Townsend, M. C. (2004). Nursing Diagnosis in Psychiatric Nursing. Philadelphia: F.A. Davis Company.

Wallace, B. C. ([Year], February 27). Our World, Our Community: Building Bridges for Health Equality. Retrieved [Month] 18, [Year], from Minority Health Project to Eliminate Disparities: http://www.minority.unc.edu/sph/minconf/[Year]/materials/BarbaraWallaceKeynoteLectureAndCurriculumTool[Year]0227.pdf

Wassem, R., Beckham, N., & Dudley, W. (2001). Test of a nursing intervention to promote adjustment to fibromyalgia. Orthopedic Nursing , 20 (3), 33-45.


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