Possibly evidenced by
Statements of concern; request for information
Inadequate follow-through of instruction
Inappropriate or exaggerated behaviors—hysterical, hostile, agitated, apathetic
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Disease Process
Verbalize understanding of ramifications of diagnosis, prognosis, and possible complications.
Participate in learning process.
Knowledge: Treatment Regimen
Verbalize understanding of therapeutic regimen.
Correctly perform necessary procedures and explain reasons for the actions.
Initiate necessary lifestyle changes.
Nursing intervention with rationale:
1. Discuss diagnosis, current and planned therapies, and expected outcomes.
Rationale: Provides individually specific information, creating knowledge base for subsequent learning regarding home management. Radiation or chemotherapy may follow surgical intervention, and information is essential to enable the client and SO to make informed decisions.
2. Reinforce surgeon’s explanation of particular surgical procedure, providing diagram as appropriate. Incorporate this information into discussion about short- and long-term
recovery expectations.
Rationale: Length of rehabilitation and prognosis depend on type of surgical procedure, preoperative physical condition, and duration and degree of complications.
3. Discuss necessity of planning for follow-up care before discharge.
Rationale: Follow-up assessment of respiratory status and general health is imperative to assure optimal recovery. Also provides opportunity to readdress concerns or questions at a less
stressful time.
4. Identify signs and symptoms requiring medical evaluations, such as changes in appearance of incision, development of respiratory difficulty, fever, increased chest pain, and changes in appearance of sputum.
Rationale: Early detection and timely intervention may prevent or minimize complications.
5. Stress importance of avoiding exposure to smoke, air pollution, and contact with individuals with upper respiratory infections (URIs).
Rationale: Protects lung(s) from irritation and reduces risk of infection.
6. Review nutritional and fluid needs. Suggest increasing protein and use of high-calorie snacks as appropriate.
Rationale: Meeting cellular energy requirements and maintaining good circulating volume for tissue perfusion facilitate tissue regeneration and healing process.
7. Identify individually appropriate community resources, such as American Cancer Society, visiting nurse, social services, and home care.
Rationale: Agencies such as these offer a broad range of services that can be tailored to provide support and meet individual needs.
8. Help client determine activity tolerance and set goals.
Rationale: Weakness and fatigue should decrease as lung heals and respiratory function improves during recovery period, especially if cancer was completely removed. If cancer is advanced, it is emotionally helpful for client to be able to set realistic activity goals to achieve optimal independence.
9. Evaluate availability and adequacy of support system(s) and necessity for assistance in self-care and home management.
Rationale: General weakness and activity limitations may reduce individual’s ability to meet own needs.
10. Encourage alternating rest periods with activity and light tasks with heavy tasks. Stress avoidance of heavy lifting and isometric or strenuous upper body exercise. Reinforce physician’s
time limitations about lifting.
Rationale: Generalized weakness and fatigue are usual in the early recovery period but should diminish as respiratory function improves and healing progresses. Rest and sleep enhance
coping abilities, reduce nervousness (common in this phase), and promote healing. Note: Strenuous use of arms can place undue stress on incision because chest muscles
may be weaker than normal for 3 to 6 months following surgery.
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