Page 643 - Cardiac Nursing

LWBK340-c25_p595-622.qxd 06/30/2009 17:45 Page 619 Aptara

C HAPTER 2 5 / Cardiac Surgery 619

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Nursing Care Plan 25-1 (c (continued) ) )
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Nursing Diagnosis 4 ➧ Potential disturbance in self-concept related to changes in facial appearance secondary to im-
munosuppressive drug therapy, manifested by subjective complaints.
Nursing Goal 1 ➧ To assist patient with identifying strategies to enhance appearance and self-esteem
Outcome Criteria ➧ 1. Patient will identify methods to minimize hirsutism and increased body hair.
2. Patient will identify methods to de-emphasize cushingoid facial features.
3. Patient will remain socially involved.
4. Patient will take initiative to seek resources for enhancing appearance if desired.
NURSING INTERVENTIONS RATIONALE
1. Introduce patient to a transplantation support group or to 1. Transplant recipients achieve a better understanding of
other patients who have had a cardiac transplantation. positive adaptive measures used by other patients who
have experienced transplantation.
2. Offer female patients possible solutions to increased body 2. Cyclosporine stimulates hair follicles, causing a diffuse in-
hair growth and hirsutism if perceived as disturbing. Shav- crease in hair growth (hypertrichosis). Corticosteroid steroid
ing, bleaching, and cream hair removers may be suggested. therapy contributes to the development of hirsutism. Male
Caution patient not to apply to inflamed, broken, or patients may not view this as problematic, but female
chapped skin. patients may find this side effect to be troublesome.
Nursing Diagnosis 5 ➧ Potential knowledge deficit about medications related to lack of familiarity, manifested by in-
ability to self-administer medications correctly.
Nursing Goal 1 ➧ To provide patient with knowledge and skills that will allow patient to self-administer medica-
tions correctly by discharge.
Outcome Criteria ➧ 1. Patient will identify each medication by name, proper dose, dose schedule, and potential
side effects by discharge.
2. Patients will self-administer medications at correct time on a consistent basis by discharge.
NURSING INTERVENTIONS RATIONALE

1. Set realistic goals for self-administration. Consider pa- 1. It is unrealistic to expect patients to learn multiple
tient’s previous experience with self-medication, present medications in a short time. They also may not be feel-
state of recovery, ability to concentrate and read ing well and may not be able to concentrate on instruc-
printed material. Include patient in planning realistic tion while still experiencing discomforts from surgery.
time frames. Rushing learning may only increase anxiety about their
capabilities.
2. Medication lists are available with color pictures of exact 2–3. An actual picture allows the patient visual and written
medication, use, side effects and precautions. information about medications. Its format allows for
3. Provide patient with a variety of materials to assist independent review at the patient’s directed pace.
with learning, such as flashcards, posters, and written Learning is more successful when a variety of materials
material. are used.
4. Allow patient to assume gradually total responsibility for
self-administration of medication. Patient’s significant
other will be a active participant in all education. Acknowl-
edge accomplishments.
5. Monitor patient’s progress in ability to self-administer
medications and document.

Note: There are many other areas of potential knowledge deficit. These include the following:
Prevention of infection
Signs and symptoms of infection
Monitoring activity progression at home
Diet
Treatment of rejection
Seeking medical attention for illness or unusual symptoms
Follow-up care
Management of health care insurance and other financial issues
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