Question

You are a nurse admitting a patient to the hospital from the emergency

department (ED) with shortness of breath and recent weight loss. After receiving

a report from the ED nurse, you ready the patient’s room according to unit

specifications and collect the necessary equipment and forms. When the patient

arrives, she is using oxygen via a nasal cannula and seems to be comfortable.

As you begin your admission activities and paperwork, you note that her

shortness of breath slightly increases as she answers your questions.

Accompanying the patient is her daughter, who comments, “This is the fourth

time she’s been admitted to this hospital in the past year.” The patient and her

daughter demonstrate a close, loving relationship. The daughter not only

encourages her mother, but also sets boundaries regarding her mother’s

anxiety.

a. How would you evaluate the patient’s achievement of cognitive, affective,

and physiologic outcomes?

b. Describe factors that could derail the attainment of expected patient

outcomes.

c. List common plan of care problems encountered during evaluation and

how you might respond.

Answer 1

A.Evaluation of patient's achievement of four types of outcomes.

1.Cognitive Outcome
2.Psychomotor Outcome
3.Affective Outcome
4.Physiologic Outcome

1. Cognitive outcomes involve increases in patient knowledge.

2. Psychomotor outcomes describe the patient's achievement of new skills; they are evaluated by asking the patient to demonstrate the new skill.

3. Affective outcomes pertain to changes in patient values, beliefs, and attitudes and are more complex to evaluate.

4.physical changes in the patient are the targeted outcome.

B.Factors that could derail the attainment of expected patient outcomes.

The expected outcomes are the standards against which the nurse judges if goals have been met and thus if care is successful. Providing health care in a timely, competent, and cost-effective manner is complex and challenging. The evaluation process will determine the effectiveness of care, make necessary modifications, and to continuously ensure favorable client outcomes.

Numerous patient, nurse, and healthcare system variables contribute positively or negatively to patient outcome achieve-meant. positive factors include a patient's strong motivation to learn new health behaviors, a nurse who comes to work well-rested and with a new care

1. Examine the goal statement to identify the exact desired client behavior or response.

2. Assess the client for the presence of that behavior or response.

3. Compare the established outcome criteria with the behavior or response.

4. Judge the degree of agreement between outcome criteria and the behavior or response

.5. If there is no agreement between the outcome criteria and the behavior or response, what is/are the barriers? Why did they not agree?

If the first part of the evaluation process has been carried out effectively, it is relatively simple to determine whether the desired outcome has been met. Both the nurse and client play an active role in comparing the clients' actual responses with the desired outcomes.

C.key challenges encountered during evaluation and associated with the implementation of the nursing process

1.Open up about your awareness of the patient’s fear.

2.Discuss the situation with the patient and help differentiate between real and imagined threats to well-being.

Tell patient that fear is a normal and appropriate response to circumstances in which pain, danger, or loss of control is anticipated or felt.

Be with the patient to promote safety especially during frightening procedures or treatment.

Maintain a relaxed and accepting demeanor while communicating with the patient.

rationale

1.validates the feelings the patient is holding and demonstrates recognition of those feelings.

2. helps the patient deal with fear.

3 reassure places fear within the field of normal human experiences

4.physical connection with a trusted person helps the patient feel secure and safe during this period