Nursing Diagnosis: Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs
May be related to
- Lack of exposure/recall
- Information misinterpretation; unfamiliarity with resources
Possibly evidenced by
- Questions/request for information, statement of misconception
- Inaccurate follow-through of instructions, development of preventable complications
- Verbalize understanding of condition, prognosis, and potential complications.
- Verbalize understanding of therapeutic needs.
- Correctly perform necessary procedures and explain reasons for actions.
- Initiate necessary lifestyle changes and participate in treatment regimen.
Knowledge Deficit — Burn Injury Nursing Care Plan (NCP)
|Review condition, prognosis, and future expectations.||Provides knowledge base from which patient can make informed choices.|
|Discuss patient’s expectations of returning home, to work, and to normal activities.||Patient frequently has a difficult and prolonged adjustment after discharge. Problems often occur (e.g., sleep disturbances, nightmares, reliving the accident, difficulty with resumption of social interactions, intimacy/sexual activity, emotional lability) that interfere with successful adjustment to resuming normal life.|
|Review and have patient/SO demonstrate proper burn, skin-graft, and wound care techniques. Identify appropriate sources for outpatient care and supplies.||Promotes competent self-care after discharge, enhancing independence.|
|Discuss skin care, e.g., use of moisturizers, sunscreens, and anti-itching medications.||Itching, blistering, and sensitivity of healing wounds/graft sites can be expected for an extended time, and injury can occur because of the fragility of the new tissue.|
|Explain scarring process and necessity for/proper use of pressure garments when used.||Promotes optimal regrowth of skin, minimizing development of hypertrophic scarring and contractures and facilitating healing process. Note: Consistent use of the pressure garment over a long period can reduce the need for reconstructive surgery to release contractures and remove scars.|
|Encourage continuation of prescribed exercise program and scheduled rest periods.||Maintains mobility, reduces complications, and prevents fatigue, facilitating recovery process.|
|Identify specific limitations of activity as individually appropriate.||Imposed restrictions depend on severity/location of injury and stage of healing.|
|Emphasize importance of sustained intake of high-protein/ high-calorie meals and snacks.||Optimal nutrition enhances tissue regeneration and general feeling of well-being. Note: Patient often needs to increase caloric intake to meet calorie and protein needs for healing.|
|Review medications, including purpose, dosage, route, and expected/reportable side effects.||Reiteration allows opportunity for patient to ask questions and be sure understanding is accurate.|
|Advise patient/SO of potential for exhaustion, boredom, emotional lability, adjustment problems. Provide information about possibility of discussion/interaction with appropriate professional counselors.||Provides perspective to some of the problems patient/SO may encounter, and aids awareness that assistance is available when necessary.|
|Identify signs/symptoms requiring medical evaluation, e.g., inflammation, increase or changes in wound drainage, fever/chills; changes in pain characteristics or loss of mobility/function.||Early detection of developing complications (e.g., infection, delayed healing) may prevent progression to more serious/life-threatening situations.|
|Stress necessity/importance of follow-up care/|
|Long-term support with continual reevaluation and changes in therapy is required to achieve optimal recovery.|
|Provide phone number for contact person.||Provides easy access to treatment team to reinforce teaching, clarify misconceptions, and reduce potential for complications.|
|Identify community resources, e.g., skin/wound care professionals, crisis centers, recovery groups, mental health, Red Cross, visiting nurse, Ambli-Cab, homemaker service.||Facilitates transition to home, provides assistance with meeting individual needs, and supports independence.|