Case Study of ADPIE: Planning Interventions (Nursing)

00:00 So, now that we've created our nursing diagnosis, we can move on to the planning piece of the pie.

00:06 This part is really important here, because we're going to create desired outcomes, goals, and interventions for our patient.

00:14 So if you remember, when we're talking about goals, don't forget about that SMART acronym.

00:19 Specific, Measurable, Attainable, Realistic, and Timely.

00:23 So again, this may seem silly, but this is really useful in regarding making a good, tangible, and a realistic goal for your patient.

00:33 So don't forget the SMART acronym when you're talking about goals.

00:36 So here's some great goals that we can talk about and apply that SMART acronym for Mrs. Meyer.

00:42 So, if you look at the top here, we see her impaired oxygen exchange diagnosis, or a nursing diagnosis related to our chronic condition, as evidenced by the use of two liters of oxygen.

00:54 So we're going to make a goal for Mrs. Meyer.

00:57 We see here, that patient will not use any oxygen at the time of discharge.

01:02 So I want you to take a minute and look at this.

01:04 Is this a SMART goal? Well, so is it pretty specific? Yeah. We can measure also that the patient is not or the client is not using any oxygen, that's a measurable piece that we can look at.

01:17 Is this attainable or realistic for Mrs. Meyers? You know, this is where clinical judgment comes in.

01:23 This is pretty attainable for her because she's on a very low level of oxygen.

01:28 And if you recall, she didn't use oxygen at home.

01:31 And also, this gives us a time to evaluate by meaning by discharge.

01:35 So I would say, this one is a SMART goal.

01:38 Now, let's look at her pain problem here.

01:41 If you recall, here's our NANDA statement of acute pain related to her surgery on her hip, as evidenced by pain score of 7 out of 10.

01:50 Now, let's look at this one and apply the SMART acronym as well.

01:54 Patient report a pain score of 5 out of 10, or less by the end of the shift.

02:01 Okay, so let's apply the SMART here.

02:03 Now, is this specific and measurable? Yeah, definitely, right? We have a specific number we can measure here.

02:10 And it's attainable for our patient, because remember, what was their pain score? Well, seven.

02:16 Well, moving from a seven to five is pretty attainable and realistic for her.

02:21 Also, do we have a time to evaluate by? Yes, by the end of the shift.

02:25 So I would also say this is a SMART goal, as well.

02:29 So we're talking about outcomes and interventions, once we've made our plan.

02:33 Remember, we've got nursing interventions, and we've got outcomes as well to keep in mind.

02:39 So those interventions are tasks that will be done to help meet those desired outcomes.

02:44 Examples of this are providing education to the patient, working with their physical therapy, taking medications as prescribed.

02:52 And remember, we're also going to make a desired outcome for the patient to see if we're going to measure this and evaluate this later.

03:00 Did our patient meet it or not? So example, the desired outcome may have to do with vital signs.

03:05 In Mrs. Meyer's case, oxygen saturation, for example.

03:09 Mobility, pain, or intake and output.

03:13 So let's take a look at Mrs. Meyer's nursing issues, her main problems here, specifically.

03:19 Talking about outcomes and interventions.

03:22 So, if we look at the top here, if you remember to recall that named the statement, she's got impaired oxygen related to her chronic condition, and using that two liters of oxygen.

03:32 Now, a great goal here, our SMART goal, if you recall, patient will not use any oxygen at the time of discharge.

03:40 So now let's look at the interventions and the outcomes piece.

03:44 Now, on the intervention piece here, what we can do is provide interventions to help us meet an outcome.

03:50 Such as, we're going to obtain an oxygen saturation every four hours.

03:55 This is an easy intervention to see, are we going to meet an outcome or not? We can also intervene to help with our oxygenation to increase that head of bed at least 30 degrees or maintain that head of bed greater than 30 degrees for her.

04:11 So now let's look at the pain piece.

04:13 Now, if we have acute pain related to surgery on that right hip, and that score was pretty high, the 7 out of 10.

04:20 What's a great goal for a patient? And as you recall, we've talked about our SMART goal.

04:25 If she'll report a pain, of a pain score of less than 5 out of 10, 5 out of 10 or less.

04:32 So that's pretty attainable.

04:34 Now, how can we get there, right? How can we meet this goal? Well, we can provide intervention such as, providing patient on patient education on that numeric pain scale, administering PRN, or as needed medications to address her pain.

04:51 So now that we've talked about those interventions that's going towards those goals.

04:54 Let's look at the outcomes.

04:57 So if we look back here at the top, and we're talking about that oxygenate issues.

05:01 Let's look at the outcomes piece.

05:04 Our desired outcome for Mrs. Meyer was maintained oxygen saturation greater than 90%.

05:10 And she has an unlabored breathing pattern.

05:14 So just to recap here. You see your NANDA statement.

05:18 We have a goal set for her oxygen that she won't use at needed the time of discharge.

05:23 We've got some interventions that we're going to help support that goal and our outcome, or our desired outcome, or those that she keeps her O2 sats up, and her breathing pattern is unlabored.

05:34 So now, let's look at the pain piece and apply that us again.

05:37 So back to her name, the statement was her acute pain.

05:41 She have 7 out of 10 pain.

05:43 Now a goal for her, as you remember was a SMART goal.

05:46 And it's pretty attainable that we try to lessen that as at a 5 out of 10, or less.

05:51 Now, what are those interventions to help her get to that goal? Provider on education on that numeric scale, and give her PRN pain medications is indicated or ordered.

06:00 Now, let's look at her outcome.

06:03 So patient will verbalize better pain control.

06:05 And she's more aware of when she needs to request pain medication.

06:09 That's a desired outcome for our patient here in regard to her pain.