Nursing Diagnosis for Dysrhythmias | Knowledge Deficit

Nursing diagnosis: deficient Knowledge [Learning Need] regarding cause, treatment, self-care, and discharge needs related to lack of information, misunderstanding of medical condition or therapy needs; unfamiliarity with information resources; lack of recall.

Possibly evidenced by

Questions, statement of misconception

Failure to improve on previous regimen

Development of preventable complications

Desired Outcomes/Evaluation Criteria—Client Will

Knowledge: Disease Process

Verbalize understanding of condition, prognosis, and function of pacemaker (if used).

Relate signs of pacemaker failure.

Knowledge: Treatment Regimen

Verbalize understanding of therapeutic regimen.

List desired action and possible adverse side effects of medications.

Correctly perform necessary procedures and explain reasons for actions.

Nursing intervention with rationale:

1. Assess client and SO level of knowledge and ability and desire to learn.

Rationale: Necessary for creation of individual instruction plan. Reinforces expectation that this will be a “learning experience.” Verbalization identifies misunderstandings and allows for clarification.

2. Be alert to signs of avoidance, such as changing subject away from information being presented or extremes of behavior (withdrawal or euphoria).

Rationale: Natural defense mechanisms, such as anger or denial of significance of situation, can block learning, affecting client’s response and ability to assimilate information. Changing to

a less formal or structured style may be more effective until client and SO are ready to accept and deal with current situation.

3. Present information in varied learning formats, for example, programmed books, audiovisual tapes, question-andanswer sessions, and group activities.

Rationale: Multiple learning methods may enhance retention of material.

4. Provide information in written form for client and SO to take home.

Rationale: Follow-up reminders may enhance client’s understanding and cooperation with the desired regimen. Written instructions are a helpful resource when client is not in direct contact with healthcare team.

5. Reinforce explanations of risk factors, dietary and activity restrictions, medications, and symptoms requiring immediate medical attention.

Rationale: Provides opportunity for client to retain information and to assume control and participate in rehabilitation program.

6. Encourage identification and reduction of individual risk factors, such as smoking and alcohol consumption and obesity.

Rationale: These behaviors and chemicals have direct adverse effect on cardiovascular function and may impede recovery and increase risk for complications.

7. Explain and reinforce specific dysrhythmia problem and therapeutic measures to client and SO.

Rationale: Ongoing and updated information, such as whether the problem is resolving or may require long-term control measures, can decrease anxiety associated with the unknown and prepare client and SO to make necessary lifestyle adaptations. Educating the SO may be especially important if client is elderly, visually or hearing impaired, or unable or even unwilling to learn or follow instructions. Repeated explanations may be needed because anxiety and bulk of new information can block or limit learning.

8. Identify adverse effects and complications of specific dysrhythmias, such as fatigue, dependent edema, progressive changes in mentation, vertigo, and psychological manifestations.

Rationale: Dysrhythmias may decrease cardiac output, manifested by symptoms of developing cardiac failure and altered cerebral perfusion. Tachydysrhythmias may also be accompanied by debilitating anxiety and feelings of impending doom.

9. Instruct and document teaching regarding medications. Include the desired action, how and when to take the drug, what to do if a dose is forgotten (dosage and usage information), and expected side effects or possible adverse reactions or interactions with other prescribed and OTC drugs or substances (alcohol, tobacco, herbal remedies), as well as what and when to report to the healthcare provider.

Rationale: Information necessary for client to make informed choices and to manage medication regimen. Note: Use of herbal remedies in conjunction with drug regimen may result in adverse effects, for example, cardiac stimulation and impaired clotting, necessitating evaluation of product for safe use.

10. Encourage development of regular exercise routine, avoiding overexertion. Identify signs and symptoms requiring immediate cessation of activities, such as dizziness, lightheadedness, dyspnea, and chest pain.

Rationale: When dysrhythmias are properly managed, normal activity should not be affected. Exercise program is useful in improving overall cardiovascular well-being.