Care Planning

• Create a care plan for the patient:
Mr. J. is a 68-year-old male being discharged home after a 7-day hospital stay for pneumonia.
He will be using 2 L/min oxygen via nasal cannula at home.
He reports feeling weak, becomes short of breath with activity, and is anxious about managing oxygen equipment.
He lives with his wife, who will assist with care.

Goal 2: Activity Tolerance and Functional Capacity Improved

Problem/Need	Expected Outcome	Nursing Interventions	Rationale
Activity Intolerance related to generalized weakness and sedentary lifestyle, evidenced by reports of weakness and DOE with activity.	Mr. J. will ambulate short distances within the home (e.g., room to bathroom) with O$_2$ use and minimal assistance from his wife, reporting reduced DOE within 10 days.	1. Implement energy conservation techniques; encourage pacing activities and planning rest periods between tasks.	Prevents excessive fatigue, which can exacerbate shortness of breath, and allows him to complete essential activities of daily living (ADLs).
		2. Instruct Mr. J. and his wife on a graduated exercise program (e.g., short, frequent walks as tolerated) as prescribed by physical therapy.	Gradually increases strength and endurance without overstressing the respiratory system.
		3. Encourage the use of assistive devices (e.g., rolling walker) during mobility to reduce the energy expenditure required for ambulation.	Maximizes safe mobility and reduces the risk of falls related to weakness.

🧠 Goal 3: Anxiety and Knowledge Deficit Managed

Problem/Need	Expected Outcome	Nursing Interventions	Rationale
Anxiety related to new oxygen dependency and fear of equipment failure.	Mr. J. will verbalize feeling less anxious about managing O$_2$ equipment and report utilizing two coping mechanisms (e.g., deep breathing, distraction) as needed within 48 hours of discharge.	1. Provide hands-on return demonstration and supervised practice for both Mr. J. and his wife on turning the O$_2$ on/off, changing tubing, and checking the water level (if using a humidifier).	Direct practice builds confidence, addresses the "fear of the unknown," and reduces anxiety associated with new technology.
		2. Review the fire safety precautions specific to home oxygen use (e.g., keeping O$_2$ away from heat sources, no smoking).	Clear safety instructions reduce anxiety by empowering the patient to manage environmental risks.
		3. Instruct on slow, controlled breathing techniques (pursed-lip breathing) to use when feeling short of breath or anxious.	Pursed-lip breathing helps control the respiratory rate and reduces air trapping, providing an immediate, non-pharmacological coping mechanism.

🏡 Caregiver Support (Wife)

Role Definition: Clarify the wife's role, emphasizing assistance with monitoring (O$_2$ levels, breathing effort), equipment changes, and light household tasks, not performing all care.

Support System: Provide contact information for the home health agency (respiratory therapist/nurse) and O$_2$ supply company for equipment troubleshooting.

Respite: Encourage the wife to schedule short periods of respite and remind her that her own health is a priority.

Sample Answer

A comprehensive care plan for Mr. J., focusing on his discharge from the hospital following pneumonia and managing new oxygen dependence at home, will prioritize respiratory function, activity tolerance, and anxiety management.

🏥 Discharge Care Plan for Mr. J. (68 y/o, Post-Pneumonia)

🎯 Goal 1: Optimal Respiratory Status Maintained and Managed at Home

Problem/Need	Expected Outcome	Nursing Interventions	Rationale
Impaired Gas Exchange related to acute illness and retained secretions, evidenced by O$_2$ use and DOE (Dyspnea on Exertion).	Mr. J. will maintain O$_2$ saturation $\ge$ 92% (or baseline as defined by physician) on 2 L/min O$_2$ via nasal cannula (NC) at rest and with light activity within 7 days.	1. Educate thoroughly on the proper use, cleaning, and maintenance of the oxygen equipment and nasal cannula.	Ensures safe and effective delivery of prescribed oxygen therapy, reducing risk of infection or mechanical failure.
		2. Instruct and demonstrate proper deep breathing and coughing techniques (e.g., incentive spirometry use, if prescribed) every 4 hours while awake.	Promotes effective airway clearance and lung expansion, preventing atelectasis and recurrence of pneumonia.

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