NURSING CARE PLAN

Nursing Diagnosis: Noncompliance R/T patients value system AEB clients perception of the importance of complying with treatment regimen Goal: Client will have improved attitude and demonstrate compliant behavior by discharge from hospital on, 4-29-10.

Assessment Data Vitals upon admit 4-11-10 B/P 154/80 P 112 R 22 T 96.5 F Health history Diabetes Mellinitis, Type I since age 11 yrs, w/BG levels < 500mg/dL upon entering the hospital on 4/11/10 End Stage Renal Disease, on dialysis every other day Hypertension: taking several medications to manage Chronic Acities, on medication to manage excess fluid Legally Blind in both eyes Loss of hearing, Rt ear Missing two toes (one on each foot) Chronic anemia on vitamin supplements to manage this also

Expected Outcomes Client will: Reduce sugar intake from 5 sugars in an 8oz cup of coffee, to 2 sugar substitutes Use an alternative diabetic sweetener on cereal and pancakes or any other food that additional sweetener is desired Drink more water , at least six 8oz glasses per day Verbalize the mechanisms of diabetes and how diabetes affects the other systems in the body Will select healthier food snack choices like fresh fruits and vegetables

Nursing Interventions 1. Approach in nonjudgmental manner. q shift P

Scientific Rationale

1.

This demonstrates unconditional regard toward client. Client is less likely to become defensive (Miaskowski,2007)

2. Identify specific areas of noncompliance. q shift S

2. In order to help the client overcome noncompliance behavior, the areas of noncompliance need to be defined. (Miaskowski,2007)

3. Practice therapeutic nursing, with active listening. q-shift P

3.

4. Emphasize the positive aspects of compliance. q-shift S

By practicing active listening, it may reveal concerns not necessarily identified in words and will assist in developing a plan of teaching specific to the client (Miaskowski,2007)

4.

Will contact a community

Diabetes Support group to receive more information on diabetes

5. Use support systems to enforce and reinforce agreed upon measures. T q shift 6. Attempt to identify influencing factors associated with noncompliant behavior, such as lack of understanding, unrealistic expectations, lack of financial ability or cultural differences. q shift S 7. Acknowledge right to choose whether to follow regimen. q shift P

Understanding that compliance can reduce risk factors, prevent complications, and assist with management of chronic diseases may encourage client compliance (Miaskowski,2007) Support systems have daily contact and therefore can foster compliance (Miaskowski,2007) Reasons for noncompliance can vary widely, besides lack of knowledge, forgetfulness, feeling good or feeling bad, it could be due to contradicting advice between family members, friends, and healthcare workers (Bernstein, 1989) Someone with many medical diagnoses may feel overwhelmed and out of control to make decisions. They may feel hopeless or helpless in determining their future. By reinforcing their right to choose it will give them a sense of

Esophageal varices, dropping deoxygenated blood and excess fluid directly into the superior vena cava At mealtime, use of and request for multiple sugar packets to be poured over food and drinks. Request of high sugar foods for inbetween snacks Many missing teeth and remained teeth with dark spots on them

Have a BG level of <200mg/dL Have a lower blood pressure and pulse by management of healthier eating Will become involved in the community

5.

6.

Evaluation Use of 2 sugar substitutes in 8 oz. of coffee Diabetic pancake syrup is used on pancakes

7.

Drinks 2 oz cups of water day

8. Help clarify values(ie: family, religion, activities) q shift P