Nursing Diagnosis : Chronic reactive air disease or ineffective airway clearance that is evidenced by breathing difficulty, mucus production, bronchospasm, paroxysmal cough, and abnormal breath sounds such as wheezes.
Goal: the goal for this condition is to maintain airway patency with clear breath sounds. Also, show patient techniques on how to practice airway clearance without exacerbating the episodes. The patient will practice the right pulmonary hygiene.
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Interventions and Rationales
Airway patency/management: one has to auscultate for breath sounds to determine adventitious breath sounds such as wheezes as complained by the client. It will help in delineating if there are expiratory wheezes or absent breath sounds. Teach patient in the best possible position that facilitate breathing, because head elevation improves respiratory function due to gravity (Marklew, 2006).Also, teach on oral hygiene after using an inhaler because of the possibility of candidiasis. Patient expected to increase fluid intake to approximately 2,000-3,000 mL/day according to her cardiac tolerance.This intake is to help hydrate the secretions by reducing the degree of viscosity. When the viscosity of secretions is reduced expectoration becomes easy for the patient. A recommendation of tepid or warm liquids between meals rather than during meal periods is necessary. Warm water may minimize bronchospasm and liquids between meals will not exert pressure on the diaphragm thereby eliciting a reaction. Environmental pollutants or allergens should be reduced to the minimum level, to prevent allergic respiratory response that may trigger acute episodes.
Nursing Diagnosis: Partial Right Ear Hearing Loss
The defining features of partial hearing loss include poor response to auditory stimuli, impairment in communication, and sensory distortion.A normal pneumatic otoscopy and type A tympanogram will reveal middle ear disease that may lead to hearing loss. A correct diagnosis of middle ear disease depends on inspection of the TM and indirect measurement of its status through pneumatic otoscopy and tympanometry.
Goals: Discuss the impact of partial hearing on life and interactions with people. Ensure patient has the feeling of security and comfort. Also, recommend hearing compensation behavior.
Interventions and Rationales
Give patient opportunity to talk about how she feels about the partial hearing impairment; this will demonstrate the degree of concern that the patient has on how it affects her communication. One can use other senses in communicating with the patient as compensation mechanisms because the senses compensate each other. The determination of how patient's life functions are affected by hearing loss will indicate or demonstrate the need for the right hearing aid.
Nursing Diagnosis (Risk for) : the patient is at risk for chronic obstructive pulmonary disease (COPD) because of smoking. Thus, the patient has a risk-inclined behavior, which prevents actions that may lead to a reduction of health complications.This behavior may be related to an inadequate social support system, disease comprehension, attitude towards health management, and a distorted self-efficacy.
Goals : the patient is expected to initiate a psychosocial adjust to a new life free of smoking. The patient is to identify coping mechanism, be centrally involved in care regimen and demonstrate sufficient understanding of the risk-prone behavior and existing illness. Patient has to show adaptation ability and integrate learning to the expected health status.
Interventions and Rationales
Create an enabling environment that fosters positive decision-making, and teach patient quitting skills. This approach is necessary because it enhances adjustment and compliance efforts. Encourage and reassure that behavioral transformation is possible; it will cause patient to discover their abilities and independence in the therapeutic process (Telford, 2006). Demonstrate care to the patient by empathy and emotional management. It will inform the patient that one cares. Allow loved ones or social system to be part of the process, given the approval of the patient. Introduce counseling by first suggesting to the patient the need. Someone with a similar experience will be a suitable person to help the patient overcome risk-prone behavior. This individual will create a supportive environment.
Impaired religiosity characterized by ineffective coping and support structure reveals a belief conflict in a patient. Thus, smoking as a lifestyle behavior conflicts with the sense of spirituality. The patient should accept a recommendation for counseling with a professional in spirituality. This approach will assist in achieving optimal smoking cessation intervention. It should be done in a nonjudgmental manner so that professional ethical standards are upheld in the process. Ascertaining appropriate religious needs of the patients to include in the attitudinal change care plan will reinforce whatever positive decision made by the patient. The identification of family members' belief pattern may help in the therapeutic program. Family members can help one another if they have a common belief. The patient should undertake spiritual growth and support opportunities to resolve existing behavior and any internal conflict that may interfere with treatment regimen (Elipoulos, 2005). A faith-based community nurse will be the most appropriate individual to engage in a referral that takes into account the spiritual issues of the patient. Furthermore, the patient will be encouraged to participate in self-help group that focuses on stopping the smoking habit.
References
Elipoulos, E. (2005). Belief as the foundation for health. Health Ministry Journal, 1 (3), 5–13.
Marklew, A. (2006). Body positioning and its effect on oxygenation—A literature review. Nursing in Critical Care, 11 (1), 16–22.
Telford, K., et al. (2006). Acceptance and denial: Implications for people adapting to chronic illness: Literature review. Journal of AdvancedNursing, 55 (4), 457–464.
