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IMPAIRED ADJUSTMENTS Nursing Care Plan

Impaired adjustments is a nursing diagnosis used when there's inability in the patient to modify lifestyle or his or her behavior in a manner of consistent with a change in health status.

Related Factors
Disability or health status requiring change in lifestyle.
Multiple stressors; intense emotional state.
Low state of optimism; negative attitudes toward health behavior; lack of motivation to change behaviors.
Failure to intend to change behavior.
Absence of social support for changed beliefs and practices.
[Physical and/or learning disability]

Defining Characteristics
SUBJECTIVE:
Denial of health status change
Failure to achieve optimal sense of control

OBJECTIVE:
Failure to take actions that would prevent further health problems
Demonstration of nonacceptance of health status change



PLANNING
After 2 hours of nursing intervention, the patient will demonstrate increasing interest and participation in self-care, the patient will also develop ability to assume responsibility for personal needs when possible. The patient will also initiate lifestyle changes that will permit adaptation to current life situations. In addition, the patient will identify stress situations leading to impaired adjustment and specific actions for dealing with them and identify and use appropriate support systems.

INTERVENTIONS
- Assess the degree of impaired function. Perform a physical and psychosocial assessment to determine the extent of the limitation(s) of the current condition. Listen to the client’s perception of inability or reluctance to adapt to situations that are occurring currently. Survey (with the client) past and present significant support systems like family, church, groups, and organizations to identify helpful resources.

- Explore the expressions of emotions signifying impaired adjustment by client such as overwhelming anxiety, fear, anger, worry, passive and/or active denial.

- Identify the causative and contributing
factors relating to the impaired adjustment by listening to client’s perception of the factors leading to the present impairment, noting onset, duration, presence/absence of physical complaints, social withdrawal. Review previous life situations and role changes with client to determine coping skills used. Determine lack of inability to use available resources. You must also review available documentation and resources to determine actual life experiences, resources like medical records, statements by parents, relatives, friends and co-workers because in situations of a great stress, physical or emotional, the client may not accurately assess occurrences leading to present situation.

- Assist the client in coping/dealing with
impairment by organizing a team conference that also includes the client and ancillary services to focus on contributing factors of impaired adjustment and plan for management of the situation. Acknowledge client’s efforts to adjust by telling him or her, "You have done your best.” It lessens feelings of blame, guilt and defensive response. Share information with adolescent’s peers when illness/injury affects
body image because peers are primary support for this age group.

- Explain disease process/causative factors and prognosis as appropriate and promote questioning to enhance understanding. Provide an open environment encouraging communication so that expression of feelings concerning impaired function can be dealt with realistically. Use therapeutic communication skills such as active-listening, acknowledgment, silence, and I-statements.

- Discuss and evaluate resources that have been useful to the client in adapting to changes in other life situations like vocational rehabilitation, employment experiences, psychosocial support and services.

- Develop a plan of action with client to meet immediate needs such as physical safety and hygiene, emotional support of professionals and significant others and assist in implementation of the plan. It will provide a starting point to deal with current situation for moving ahead with plan and for evaluation of progress.

- Explore previously used coping skills and application to current situation. Refine and develop new strategies as appropriate. Identify and problem-solve with the client frustration in daily care. Focusing on the smaller factors of concern gives the individual the ability to perceive the impaired function from
a less-threatening perspective, one-step-at-a-time concept. Involve SO(s) in long-range planning for emotional, psychological, physical, and social needs.

Promote wellness, teaching and discharge considerations. Identify strengths the client perceives in current life situation. Keep focus on the present, as unknowns of the future may be
too overwhelming. Refer to other resources in the long-range plan of care (e.g., occupational therapy, vocational rehabilitation) as indicated.

- Assist client/SO(s) to see appropriate alternatives and potential changes in locus of control. Assist SO(s) to learn methods for managing present needs. Pace and time learning sessions to meet client’s needs. Provide feedback during and after learning experiences (e.g.,
self-catheterization, range-of-motion exercises, wound care, therapeutic communication) to enhance retention, skill, and confidence.

EVALUATION
After 2 hours of nursing intervention, the patient demonstrated increasing interest and participation in self-care, the patient also developed ability to assume responsibility for personal needs when possible. The patient also initiated lifestyle changes that will permit adaptation to current life situations. In addition, the patient identified the stress situations leading to impaired adjustment and specific actions for dealing with them and identify and use appropriate support systems.

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