Nursing Diagnosis for Cardiac Surgery | Knowledge Deficit

Nursing diagnosis: deficient Knowledge [Learning Need] regarding condition, postoperative care, self-care, and discharge needs related to lack of exposure or recall; information misinterpretation

Possibly evidenced by

Questions and requests for information

Verbalization of problem, statement of misconception

Inaccurate follow-through of instructions

Desired Outcomes/Evaluation Criteria—Client Will

Cardiac Disease Self-Management

Participate in learning process.

Assume responsibility for own learning.

Begin to ask questions and look for information.

Knowledge: Treatment Regimen

Verbalize understanding of condition, prognosis, and potential complications.

Describe reasons for therapeutic actions.

Nursing intervention with rationale:

1. Reinforce surgeon’s explanation of particular surgical procedure, providing diagram as appropriate.

Rationale: Provides individually specific information, creating knowledge base for subsequent learning regarding home management. Length of rehabilitation and prognosis are dependent on type of surgical procedure, preoperative physical condition, and duration and severity of any complications.

2. Discuss importance of reporting changes in memory or mentation.

Rationale: Cerebral dysfunction ranging from focal ischemic injury to encephalopathy has been associated with CPB and may present from 1 to several days after the procedure, thus affecting length of stay and mortality rates (McKhann et al, 2002, 2006).

3. Reinforce continuation of breathing exercises, incentive spirometry, and coughing with splinting incision.

Rationale: Promotes alveolar ventilation, reducing risk of lung congestion.

4. Discuss routine and prophylactic medications and OTC drug use. Stress importance of checking with physician before taking any drugs. Reinforce need for routine laboratory tests, outpatient education, and community resources when client with valve replacement will be taking warfarin (Coumadin).

Rationale: Depending on type of valve replacement (i.e., synthetic), lifelong anticoagulant therapy may be indicated. Potential for drug interactions must be considered before adding therapeutic agents to regimen. Note: Using herbal products, such as ginkgo, garlic, and vitamins, can alter coagulation and have an adverse effect when taken with anticoagulants.

5. Review prescribed cardiac rehabilitation or exercise program and progress to date. Assist client and significant other (SO) to set realistic goals.

Rationale: Individual capabilities and expectations depend on type of surgery, underlying cardiac function, and prior physical conditioning. Note: Obesity is a predictor of hospital readmission and may require additional interventions.

6. Encourage participation in home routines, such as self-care and cooking. Suggest alternating rest periods with activity, and light tasks with heavy tasks. Avoid heavy lifting and isometric and strenuous upper-body exercise.

Rationale: Prevents excessive fatigue and exhaustion. Scheduling rest periods and short naps several times a day enhances coping abilities, reduces nervousness (common in this phase),

and promotes healing. Note: Strenuous use of arms can place undue stress on sternotomy.

7. Problem-solve with client and SO ways to continue progressive activity program during temperature extremes and high wind or pollution days, such as walking predetermined distance within own house, in local indoor shopping mall, or on exercise track.

Rationale: Having a plan forestalls giving up exercise because of interferences such as weather.

8. Reinforce physician’s time limitations about lifting, driving, returning to work, resuming sexual activity, and exercising that involves upper extremities.

Rationale: These restrictions are present until after the first postoperative office visit for assessment of sternum healing.

9. Assist client and SO to develop strategies for dealing with changes during recovery period, such as shifting responsibilities to other family members, friends, or neighbors; acquiring temporary assistance for housekeeping; and investigating avenues for financial assistance.

Rationale: Planning for changes that may occur or be required promotes sense of control and accomplishment without loss of self-esteem.

10. Identify services and resources available after discharge. Provide telephone contact number or schedule follow-up calls as appropriate. Include referral names for home care

services, as indicated.

Rationale: Facilitates transition to home and provides for ongoing monitoring, continuation of prescribed therapies, and opportunity to discuss concerns and alleviate anxiety.