Nursing 109

N109: Foundations in Nursing Practice Study Guide

Planning During the planning phase, expected outcomes are determined, which must be based on the assessment and prioritized nursing diagnoses. They should be created in collaboration with the chronically ill individual and family/caregivers. These expected outcomes will define how the team will know if the interventions and plan are successful. These patient-centered goals must be based on standards of care and evidence-based practice. It is important for the nurse to consider medication implications, patient advocacy, and environmental safety in the care plan. Implementation Interventions appropriate to an individual with a chronic illness might include: • Modifying the home environment to assist with mobility • Obtaining necessary durable medical equipment (DME), such as assistive devices and oxygen to promote the individual’s self-care ability • Providing for the individual’s safety by removing trip and slip hazards • Providing education for the ill individual, caregiver, and family to ensure understanding of limitations and probable course of the illness • The chronically ill person may seek alternative or complementary treatments, which may be helpful to the person. Some of these treatments may include biofeedback, massage, relaxation therapy, therapeutic touch, imagery, and the use of herbs. Most of these treatments may be helpful in relaxing the person, but the individual’s primary care provider should be aware of any alternative treatments being used. Herbs, in particular, may have synergistic (increasing) or antagonistic (decreasing) effects when used in combination with prescribedmedications. As interventions are implemented, the nurse must constantly reassess the individual and family to ensure that the interventions are producing the desired outcomes. Safety of the individual must be the first priority and the nurse must ensure that the family understands modifications that must be implemented and changes that should be reported. The nurse may help the family obtain needed financial and other social support, including support groups that might help the individual and family learn to cope with the chronic illness. Medication education and management become critical as the chronically ill person is prescribed more and more complex medicine regimens. The nurse is responsible for supervising any patient care activities assigned to other healthcare team members. Evaluation Finally, the nurse and team should evaluate the effectiveness of the interventions. The success or failure of the interventions must be judged against the nursing diagnoses and expected outcomes identified during the planning stage of the nursing process. As the evaluation occurs, the nurse must document findings and readjust the plan of care and interventions. The evaluation should include any care proved by other members of the healthcare team. Particularly in the case of chronic illness, interventions may be aimed at maintaining, rather than improving functionality.

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