Goal Statements COPD CRT
Goal statement for problem # 1: The first problem statement is impaired oxygenation, a life-threatening situation for which true physiological reversal is the only appropriate goal. Thus, the desired outcome is the reversal of all the key symptoms of the acute process (probably pneumonia) that has caused his chronic condition to enter respiratory failure and death. Just as leukocytosis, neutrophilia, fever indicate an acute inflammatory process, their trend toward normal would be evidence that antibiotic therapy ( a collaborative nursing action) is having the desired effect. The goals also recognize that as refractory hypoxemia improves, the patient's %sat on 4 liters of oxygen will stabilize and his exercise tolerance may improve marginally. All goals are in time context, quantifiable, patient related, and reasonable.
Goal statement for problem #2: The second problem statement is about Mr. Culver's increasing likelihood of further damage to his heart if his pulmonary situation is not improved. There is evidence based practice (EBP) showing that long term oxygen therapy (LTOT) at home is associated with decreased mortality for COPD/cor pulmonale patients. Similarly, Mr. Culver will continue to deteriorate if he is not mobilized. To this end he needs physical and emotional rehabilitation which is available following discharge. This process, however, can begin while he is still an in-patient and the nurse will ask for both physical and occupational therapy evaluations. Similarly, the nurse recognizes that mobilization is a current and urgent goal for the patient and outlines reasonable goals to shoot for while Mr. Culver is hospitalized. Evidence is clear that all people should be fully immunized against the flu yearly while elderly or chronically ill patients should be immunized against pneumococcus. This is a protocol and standard of care in this institution and it is reflected in the nurses goals. These goals are stated in quantifiable terms, are in a time context and are reasonable.
Goal statement for problem #3: The goals for a risk for impaired nutrition are to improve nutrition. Thus the goals are stated in a very quantifiable and concrete fashion. The goal about Mr. Culver's dental appointment is speculative on the nurse's part, but based upon the connection between smoking and peridontal disease, plus the fact that the patient has stated he does not leave the house very much. Also, the patient specifically states that masticating the food is a problem for him.
Goal statement for problem #4: As stated previously, problem #4 is a "place-holder" diagnosis awaiting further information as the nurse and patient establish a more trusting relationship. Nevertheless, the goals that are established are aimed at empowering the patient as much as possible and limiting the dependency that frequently accompanies hospitalization.
Goal statement for problem #2: The second problem statement is about Mr. Culver's increasing likelihood of further damage to his heart if his pulmonary situation is not improved. There is evidence based practice (EBP) showing that long term oxygen therapy (LTOT) at home is associated with decreased mortality for COPD/cor pulmonale patients. Similarly, Mr. Culver will continue to deteriorate if he is not mobilized. To this end he needs physical and emotional rehabilitation which is available following discharge. This process, however, can begin while he is still an in-patient and the nurse will ask for both physical and occupational therapy evaluations. Similarly, the nurse recognizes that mobilization is a current and urgent goal for the patient and outlines reasonable goals to shoot for while Mr. Culver is hospitalized. Evidence is clear that all people should be fully immunized against the flu yearly while elderly or chronically ill patients should be immunized against pneumococcus. This is a protocol and standard of care in this institution and it is reflected in the nurses goals. These goals are stated in quantifiable terms, are in a time context and are reasonable.
Goal statement for problem #3: The goals for a risk for impaired nutrition are to improve nutrition. Thus the goals are stated in a very quantifiable and concrete fashion. The goal about Mr. Culver's dental appointment is speculative on the nurse's part, but based upon the connection between smoking and peridontal disease, plus the fact that the patient has stated he does not leave the house very much. Also, the patient specifically states that masticating the food is a problem for him.
Goal statement for problem #4: As stated previously, problem #4 is a "place-holder" diagnosis awaiting further information as the nurse and patient establish a more trusting relationship. Nevertheless, the goals that are established are aimed at empowering the patient as much as possible and limiting the dependency that frequently accompanies hospitalization.
Nursing Actions
Note that nursing actions are specifically related to the stated goals. They are written in an active voice (as a "nursing order") and are as specific as possible. They do not simply state "educate the patient about..." or "ambulate patient..." but wherever possible specific methods and time frequencies are prescribed.