PRIORITIZED NURSING PROBLEM FOR ANEMIA

Nursing Diagnosis Nursing Intervention Rationale

1. ACTIVITY Independent
INTOLERANCE Establish guidelines and goals Motivation and cooperation are
of activity with the patient enhanced if the patient
and/or SO. participates in goal setting.
Evaluate the need for additional Coordinated efforts are more
help at home. meaningful and effective in
Have the patient perform the assisting the patient in
activity more slowly, in a conserving energy.
longer time with more rest or Helps in increasing the tolerance
pauses, or with assistance if for the activity.
necessary. Gradual progression of the
Gradually increase activity with activity prevents overexertion.
active range-of-motion Prevents orthostatic hypotension.
exercises in bed, increasing to Patient with limited activity
sitting and then standing. tolerance need to prioritize
Dangle the legs from the bed important taks first.
side for 10 to 15 minutes. Assisting the patient with ADLs
Refrain from performing allows conservation of energy.
nonessential activities or Carefully balance provision of
procedures. assistance; facilitating
Assist with ADLs while progressive endurance will
avoiding patient dependency. ultimately enhance the patient’s
Provide bedside commode as activity tolerance and self-
indicated. esteem.
Encourage physical activity Use of commode requires less
consistent with the patient’s energy expenditure than using a
energy levels. bedpan or ambulating to the
Instruct patient to plan activities bathroom.
for times when they have the Helps promote a sense of
most energy. autonomy while being realistic
Encourage verbalization of about capabilities.
feelings regarding limitations. Activities should be planned
Gradually progress patient ahead to coincide with the
activity with the following: patient’s peak energy level. If
- Range-of-motion (ROM) the goal is too low, negotiate.
exercises in bed, gradually This helps the patient to cope.
increasing duration and Acknowledgment that living
frequency (then intensity) to with activity intolerance is both
sitting and then standing. physically and emotionally
- Deep-breathing exercises three difficult.
or more times daily. Duration and frequency should
- Sitting up in a chair 30 be increased before intensity.
minutes three times daily. Exercise maintains muscle
- Walking in room 1 to 2 strength, joint ROM, and
 minutes TID. exercise tolerance. Physical
- Walking down the hall 20 feet inactive patients need to improve
or walking through the house, functional capacity through
then slowly progressing repetitive exercises over a long
walking outside the house, period of time. Strength training
saving energy is valuable in enhancing
Encourage active ROM endurance of many ADLs.
exercises. Encourage the patient Patient may be fearful of
to participate in planning overexertion and potential
activities that gradually build damage to the heart. Appropriate
endurance. supervision during early efforts
Provide emotional support and can enhance confidence.
positive attitude regarding Appropriate aids will enable the
abilities. patient to achieve optimal
Provide the patient with the independence for self-care and
adaptive equipment needed for reduce energy consumption
completing ADLs. during activity.
Teach the patient and/or SO to Knowledge promotes awareness
recognize signs of physical to prevent the complication of
overactivity or overexertion. overexertion.
Teach energy conservation These techniques reduce oxygen
techniques, such as: consumption, allowing a more
- Sitting to do tasks prolonged activity
- Frequent position changes
- Pushing rather than pulling
- Sliding rather than lifting
- Working at an even pace
- Placing frequently used items
within easy reach
- Resting for at least 1 hour
after meals before starting a
new activity
- Using wheeled carts for
laundry, shopping, and cleaning
needs
- Organizing a work-rest-work
schedule

2. IMBALANCED Ascertain healthy body weight Experts like a dietician can

NUTRITION for age and height. Refer to a determine nitrogen balance as a
dietitian for complete nutrition measure of the nutritional status
assessment and methods for of the patient. A negative
nutritional support. nitrogen balance may mean
Set appropriate short-term and protein malnutrition. The
long-term goals. dietician can also determine the
Provide a pleasant environment. patient’s daily requirements of
Promote proper positioning. specific nutrients to promote
Provide good oral hygiene and sufficient nutritional intake.
dentition Patients may lose concern in
If patient lacks strength, addressing this dilemma without
schedule rest periods before realistic short-term goals.
meals and open packages and A pleasing atmosphere helps in
cut up food for patient. decreasing stress and is more
Provide companionship during favorable to eating.
mealtime Elevating the head of bed 30
Consider the use of seasoning degrees aids in swallowing and
for patients with changes in reduces risk for aspiration with
their sense of taste; if not eating.
contraindicated Oral hygiene has a positive
Consider six small nutrient- effect on appetite and on the
dense meals instead of three taste of food. Dentures need to
larger meals daily to lessen the be clean, fit comfortably, and be
feeling of fullness. in the patient’s mouth to
For patients with physical encourage eating.
impairments, refer to an Nursing assistance with
occupational therapist for activities of daily living (ADLs)
adaptive devices. will conserve the patient’s
For patients with impaired energy for activities the patient
swallowing, coordinate with a values. Patients who take longer
speech therapist for evaluation than one hour to complete a meal
and instruction. may require assistance.
Determine time of day when the Attention to the social
patient’s appetite is at peak. perspectives of eating is
Offer highest calorie meal at important in both hospital and
that time. home settings.
Encourage family members to Seasoning may improve the
bring food from home to the flavor of the foods and attract
hospital. eating.
Offer high protein supplements ating small, frequent meals
based on individual needs and lessens the feeling of fullness
capabilities. and decreases the stimulus to
Offer liquid energy vomit.
supplements. Special devices may be provided
Discourage caffeinated or by an expert that can help
carbonated beverages. patients feed themselves.
Keep a high index of suspicion djustments of the thickness and
of malnutrition as a causative consistency of foods to improve
factor in infections. nutritional intake may be
Encourage exercise. provided by a speech therapist
Consider the possible need for Patients with liver disease often
enteral or parenteral nutritional have their largest appetite at
 support with the patient, family, breakfast time.
and caregiver, as appropriate. Patients with specific ethnic or
Validate the patient’s feelings religious preferences or
regarding the impact of current restrictions may not consider
lifestyle, finances, and foods from the hospital.
transportation on ability to Such supplements can be used to
obtain nutritious food. increase calories and protein
Once discharged, help the without conflict with voluntary
patient and family identify area food intake
to change that will make the Energy supplementation has
greatest contribution to been shown to produce weight
improved nutrition. gain and reduce falls in frail
Adapt modification to their elderly living in the community
current practices These beverages will decrease
hunger and lead to early satiety.
Impaired immunity is a critical
adjunct factor in malnutrition-
associated infections in all age
groups.
Metabolism and utilization of
nutrients are improved by
activity.
Nutritional support may be
recommended for patients who
are unable to maintain nutritional
intake by the oral route. If
gastrointestinal tract is
functioning well, enteral tube
feedings are indicated. For those
who cannot tolerate enteral
feedings, parenteral nutrition is
recommended.
Validation lets the patient know
that the nurse has heard and
understands what was said, and
it promotes the nurse-patient
relationship
Change is difficult. Multiple
changes may be overwhelming.
Accepting the patient’s or
family’s preferences shows
respect for their culture.

3. DEFICIENT Render physical comfort for the Based on Maslow’s theory, basic
KNOWLEDGE patient. physiological needs must be
Grant a calm and peaceful addressed before the patient
environment without education. Ensuring physical
interruption. comfort allows the patient to
Provide an atmosphere of concentrate on what is being
respect, openness, trust, and discussed or demonstrated.
collaboration. A calm environment allows the
Include the patient in creating patient to concentrate and focus
the teaching plan, beginning more completely.
with establishing objectives and Conveying respect is especially
goals for learning at the important when providing
beginning of the session. education to patients with
Consider what is important to different values and beliefs about
the patient. health and illness.
Involve patient in writing Goal setting allows the learner to
specific outcomes for the know what will be discussed and
teaching session, such as expected during the session.
identifying what is most Adults tend to focus on here-
important to learn from their and-now, problem-centered
viewpoint and lifestyle. education.
Explore reactions and feelings Allowing the patient to identify
about changes. the most significant content to be
Support self-directed, self- presented first is the most
designed learning. effective.
Help patient in integrating Patient involvement improves
information into daily life. compliance with health regimen
Give adequate time for and makes teaching and learning
integration that is in direct a partnership
conflict with existing values or Assessment assists the nurse in
beliefs. understanding how the learner
Provide clear, thorough, and may respond to the information
understandable explanations and possibly how successful the
and demonstrations. patient may be with the expected
Give information with the use changes.
of media. Use visual aids like Patients know what difficulties
diagrams, pictures, videotapes, will transpire in their own
audiotapes, and interactive environments, and they must be
Internet websites, encouraged to approach learning
Check the availability of activities from their priority
supplies and equipment. needs.
When presenting a material, This technique aids the learner
start with the basics or familiar, make adjustments in daily life
simple, and concrete that will result in the desired
information to less familiar, change in behavior.
complex ones. Informatiom that is in direct
Focus teaching sessions on a conflict with what is already
single concept or idea. held to be true forces a
Pace the instruction and keep reevaluation of the old material
sessions short and is thus integrated more
When teaching, build on slowly
patient’s literacy skills. Patients are better able to ask
Identify patient’s understanding questions when they have basic
of common medical information about what to
terminology, such as “empty expect.
stomach,” “emesis,” and
“palpation.” Different people take in
Use the teach-back technique to information in different ways.
determine the patient’s Adequate preparation is
understanding of what was especially important when
taught: teaching in the home setting.
- The nurse gives information in This method allows the patient
a caring manner, using plain to understand new material in
language. relation to familiar material.
- Ask the patient to explain in Clearly focuses teaching allows
his or her own words. the learner to concentrate more
- Rephrase the information if completely on material being
unable to repeat it accurately. discussed.
- Again ask the patient to teach- Learning requires energy, so
back the information using his shorter, well-paced sessions
or her own words until the reduce fatigue and allow the
nurse is comfortable that is patient to absorb more
understood. completely.
- If the patient still does not In patients with low literacy
understand, consider other skills, materials should be short
strategies. and have culturally sensitive
Provide preadmission self- illustrations.
instruction materials to prepare Patients are expected to read and
patient for postoperative understand labels on medicine
exercises. containers, appointment slips,
Encourage questions and informed consents.
Provide immediate feedback on The teach-back technique
performance. consists of specific steps in a
Allow repetition of the repetitive order to evaluate the
information or skill. recipient’s knowledge of the
Render positive, constructive content discussed. Patients who
reinforcement of learning are not able to do this method
Incorporate rewards into after multiple cycles is
learning process considered cognitively impaired.
Note progress of teaching and Providing patients with
learning. preadmission information about
Help patient identify exercises has been shown to
community resources for increase positive feelings and the
continuing information and ability to perform prescribed
support. exercises.
Approach individuals of color Questions facilitate open
with respect, warmth, and communication between patient
professional courtesy. and health care professionals and
allow verification of
understanding of given
information.
Immediate feedback allows the
learner to make corrections
rather than practicing the skill
wrongly.
Repeated practice allows patient
gain confidence in self-care
ability.
A positive approach by the
patient will help him or her feel
good about learning
accomplishments, gain
confidence, and maintain self-
esteem.
Rewards help to make learning
fun and exciting.
Documentation allows additional
teaching to be based on what the
learner has completed
Learning occurs through
imitation, so persons who are
currently involved in lifestyle
changes can help the learner
anticipate adjustment issues.
Community resources can offer
financial and educational
support.
Instances of disrespect and lack
of caring have special
significance for individuals of
color.
 References:

Week No. __ – Complete Date (Month/Day/Year) (Day of the Week)