PRIORITIZED NURSING PROBLEM FOR ANEMIA
Nursing Diagnosis Nursing Intervention
1. ACTIVITY Independent
INTOLERANCE Establish guidelines and goals
of activity with the patient
and/or SO.
Evaluate the need for additional
help at home.
Have the patient perform the
activity more slowly, in a
longer time with more rest or
pauses, or with assistance if
necessary.
Gradually increase activity with
active range-of-motion
exercises in bed, increasing to
sitting and then standing.
Dangle the legs from the bed
side for 10 to 15 minutes.
Refrain from performing
nonessential activities or
procedures.
Assist with ADLs while
avoiding patient dependency.
Provide bedside commode as
indicated.
Encourage physical activity
consistent with the patient’s
energy levels.
Instruct patient to plan activities
for times when they have the
most energy.
Encourage verbalization of
feelings regarding limitations.
Gradually progress patient
activity with the following:
- Range-of-motion (ROM)
exercises in bed, gradually
increasing duration and
frequency (then intensity) to
sitting and then standing.
- Deep-breathing exercises three
or more times daily.
- Sitting up in a chair 30
minutes three times daily.
- Walking in room 1 to 2
Rationale
Motivation and cooperation are
enhanced if the patient
participates in goal setting.
Coordinated efforts are more
meaningful and effective in
assisting the patient in
conserving energy.
Helps in increasing the tolerance
for the activity.
Gradual progression of the
activity prevents overexertion.
Prevents orthostatic hypotension.
Patient with limited activity
tolerance need to prioritize
important taks first.
Assisting the patient with ADLs
allows conservation of energy.
Carefully balance provision of
assistance; facilitating
progressive endurance will
ultimately enhance the patient’s
activity tolerance and self-
esteem.
Use of commode requires less
energy expenditure than using a
bedpan or ambulating to the
bathroom.
Helps promote a sense of
autonomy while being realistic
about capabilities.
Activities should be planned
ahead to coincide with the
patient’s peak energy level. If
the goal is too low, negotiate.
This helps the patient to cope.
Acknowledgment that living
with activity intolerance is both
physically and emotionally
difficult.
Duration and frequency should
be increased before intensity.
Exercise maintains muscle
strength, joint ROM, and
 minutes TID.
- Walking down the hall 20 feet
or walking through the house,
then slowly progressing
walking outside the house,
saving energy
Encourage active ROM
exercises. Encourage the patient
to participate in planning
activities that gradually build
endurance.
Provide emotional support and
positive attitude regarding
abilities.
Provide the patient with the
adaptive equipment needed for
completing ADLs.
Teach the patient and/or SO to
recognize signs of physical
overactivity or overexertion.
Teach energy conservation
techniques, such as:
- Sitting to do tasks
- Frequent position changes
- Pushing rather than pulling
- Sliding rather than lifting
- Working at an even pace
- Placing frequently used items
within easy reach
- Resting for at least 1 hour
after meals before starting a
new activity
- Using wheeled carts for
laundry, shopping, and cleaning
needs
- Organizing a work-rest-work
schedule
2. IMBALANCED Ascertain healthy body weight
NUTRITION for age and height. Refer to a
dietitian for complete nutrition
assessment and methods for
nutritional support.
Set appropriate short-term and
long-term goals.
exercise tolerance. Physical
inactive patients need to improve
functional capacity through
repetitive exercises over a long
period of time. Strength training
is valuable in enhancing
endurance of many ADLs.
Patient may be fearful of
overexertion and potential
damage to the heart. Appropriate
supervision during early efforts
can enhance confidence.
Appropriate aids will enable the
patient to achieve optimal
independence for self-care and
reduce energy consumption
during activity.
Knowledge promotes awareness
to prevent the complication of
overexertion.
These techniques reduce oxygen
consumption, allowing a more
prolonged activity
Experts like a dietician can
determine nitrogen balance as a
measure of the nutritional status
of the patient. A negative
nitrogen balance may mean
protein malnutrition. The
dietician can also determine the
Provide a pleasant environment.
Promote proper positioning.
Provide good oral hygiene and
dentition
If patient lacks strength,
schedule rest periods before
meals and open packages and
cut up food for patient.
Provide companionship during
mealtime
Consider the use of seasoning
for patients with changes in
their sense of taste; if not
contraindicated
Consider six small nutrient-
dense meals instead of three
larger meals daily to lessen the
feeling of fullness.
For patients with physical
impairments, refer to an
occupational therapist for
adaptive devices.
For patients with impaired
swallowing, coordinate with a
speech therapist for evaluation
and instruction.
Determine time of day when the
patient’s appetite is at peak.
Offer highest calorie meal at
that time.
Encourage family members to
bring food from home to the
hospital.
Offer high protein supplements
based on individual needs and
capabilities.
Offer liquid energy
supplements.
Discourage caffeinated or
carbonated beverages.
Keep a high index of suspicion
of malnutrition as a causative
factor in infections.
Encourage exercise.
Consider the possible need for
enteral or parenteral nutritional
patient’s daily requirements of
specific nutrients to promote
sufficient nutritional intake.
Patients may lose concern in
addressing this dilemma without
realistic short-term goals.
A pleasing atmosphere helps in
decreasing stress and is more
favorable to eating.
Elevating the head of bed 30
degrees aids in swallowing and
reduces risk for aspiration with
eating.
Oral hygiene has a positive
effect on appetite and on the
taste of food. Dentures need to
be clean, fit comfortably, and be
in the patient’s mouth to
encourage eating.
Nursing assistance with
activities of daily living (ADLs)
will conserve the patient’s
energy for activities the patient
values. Patients who take longer
than one hour to complete a meal
may require assistance.
Attention to the social
perspectives of eating is
important in both hospital and
home settings.
Seasoning may improve the
flavor of the foods and attract
eating.
ating small, frequent meals
lessens the feeling of fullness
and decreases the stimulus to
vomit.
Special devices may be provided
by an expert that can help
patients feed themselves.
djustments of the thickness and
consistency of foods to improve
nutritional intake may be
provided by a speech therapist
Patients with liver disease often
have their largest appetite at
 support with the patient, family,
and caregiver, as appropriate.
Validate the patient’s feelings
regarding the impact of current
lifestyle, finances, and
transportation on ability to
obtain nutritious food.
Once discharged, help the
patient and family identify area
to change that will make the
greatest contribution to
improved nutrition.
Adapt modification to their
current practices
3. DEFICIENT Render physical comfort for the Based on Maslow’s theory, basic
KNOWLEDGE patient. physiological needs must be
breakfast time.
Patients with specific ethnic or
religious preferences or
restrictions may not consider
foods from the hospital.
Such supplements can be used to
increase calories and protein
without conflict with voluntary
food intake
Energy supplementation has
been shown to produce weight
gain and reduce falls in frail
elderly living in the community
These beverages will decrease
hunger and lead to early satiety.
Impaired immunity is a critical
adjunct factor in malnutrition-
associated infections in all age
groups.
Metabolism and utilization of
nutrients are improved by
activity.
Nutritional support may be
recommended for patients who
are unable to maintain nutritional
intake by the oral route. If
gastrointestinal tract is
functioning well, enteral tube
feedings are indicated. For those
who cannot tolerate enteral
feedings, parenteral nutrition is
recommended.
Validation lets the patient know
that the nurse has heard and
understands what was said, and
it promotes the nurse-patient
relationship
Change is difficult. Multiple
changes may be overwhelming.
Accepting the patient’s or
family’s preferences shows
respect for their culture.
Grant a calm and peaceful
environment without
interruption.
Provide an atmosphere of
respect, openness, trust, and
collaboration.
Include the patient in creating
the teaching plan, beginning
with establishing objectives and
goals for learning at the
beginning of the session.
Consider what is important to
the patient.
Involve patient in writing
specific outcomes for the
teaching session, such as
identifying what is most
important to learn from their
viewpoint and lifestyle.
Explore reactions and feelings
about changes.
Support self-directed, self-
designed learning.
Help patient in integrating
information into daily life.
Give adequate time for
integration that is in direct
conflict with existing values or
beliefs.
Provide clear, thorough, and
understandable explanations
and demonstrations.
Give information with the use
of media. Use visual aids like
diagrams, pictures, videotapes,
audiotapes, and interactive
Internet websites,
Check the availability of
supplies and equipment.
When presenting a material,
start with the basics or familiar,
simple, and concrete
information to less familiar,
complex ones.
Focus teaching sessions on a
single concept or idea.
addressed before the patient
education. Ensuring physical
comfort allows the patient to
concentrate on what is being
discussed or demonstrated.
A calm environment allows the
patient to concentrate and focus
more completely.
Conveying respect is especially
important when providing
education to patients with
different values and beliefs about
health and illness.
Goal setting allows the learner to
know what will be discussed and
expected during the session.
Adults tend to focus on here-
and-now, problem-centered
education.
Allowing the patient to identify
the most significant content to be
presented first is the most
effective.
Patient involvement improves
compliance with health regimen
and makes teaching and learning
a partnership
Assessment assists the nurse in
understanding how the learner
may respond to the information
and possibly how successful the
patient may be with the expected
changes.
Patients know what difficulties
will transpire in their own
environments, and they must be
encouraged to approach learning
activities from their priority
needs.
This technique aids the learner
make adjustments in daily life
that will result in the desired
change in behavior.
Informatiom that is in direct
conflict with what is already
held to be true forces a
Pace the instruction and keep reevaluation of the old material
sessions short and is thus integrated more
When teaching, build on slowly
patient’s literacy skills. Patients are better able to ask
Identify patient’s understanding questions when they have basic
of common medical information about what to
terminology, such as “empty expect.
stomach,” “emesis,” and
“palpation.” Different people take in
Use the teach-back technique to information in different ways.
determine the patient’s Adequate preparation is
understanding of what was especially important when
taught: teaching in the home setting.
- The nurse gives information in This method allows the patient
a caring manner, using plain to understand new material in
language. relation to familiar material.
- Ask the patient to explain in Clearly focuses teaching allows
his or her own words. the learner to concentrate more
- Rephrase the information if completely on material being
unable to repeat it accurately. discussed.
- Again ask the patient to teach- Learning requires energy, so
back the information using his shorter, well-paced sessions
or her own words until the reduce fatigue and allow the
nurse is comfortable that is patient to absorb more
understood. completely.
- If the patient still does not In patients with low literacy
understand, consider other skills, materials should be short
strategies. and have culturally sensitive
Provide preadmission self- illustrations.
instruction materials to prepare Patients are expected to read and
patient for postoperative understand labels on medicine
exercises. containers, appointment slips,
Encourage questions and informed consents.
Provide immediate feedback on The teach-back technique
performance. consists of specific steps in a
Allow repetition of the repetitive order to evaluate the
information or skill. recipient’s knowledge of the
Render positive, constructive content discussed. Patients who
reinforcement of learning are not able to do this method
Incorporate rewards into after multiple cycles is
learning process considered cognitively impaired.
Note progress of teaching and Providing patients with
learning. preadmission information about
Help patient identify exercises has been shown to
community resources for increase positive feelings and the
continuing information and ability to perform prescribed
support.
Approach individuals of color Questions facilitate open
with respect, warmth, and communication between patient
professional courtesy.
exercises.
and health care professionals and
allow verification of
understanding of given
information.
Immediate feedback allows the
learner to make corrections
rather than practicing the skill
wrongly.
Repeated practice allows patient
gain confidence in self-care
ability.
A positive approach by the
patient will help him or her feel
good about learning
accomplishments, gain
confidence, and maintain self-
esteem.
Rewards help to make learning
fun and exciting.
Documentation allows additional
teaching to be based on what the
learner has completed
Learning occurs through
imitation, so persons who are
currently involved in lifestyle
changes can help the learner
anticipate adjustment issues.
Community resources can offer
financial and educational
support.
Instances of disrespect and lack
of caring have special
significance for individuals of
color.
 References:

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