If the patient refuses the assigned number of repetitions for Incentive spirometry (say he was assigned 10 reps, but is able to do only 3), do we declare CDM and then revise the Intervention for that ND ( and say Patient will perform Incentive Spirometry times 3)? Or do we not revise- since patient already did perform the intervention.
In that case, should'ent the intervention be worded like this in the planning phase,
" Instruct patient to perform incentive spirometry times 10, or as tolerated" ?
Hi Mona, It was great talking to you on the live web conference. Although I did answer the question in the conference, I will still post the answer here for other students who are browsing and have a similar question and can gain the insight.
I will first say that let your Kardex (Assignment) guide you. Your Kardex will have 2 stars next to Respiratory Management and Incentive Spirometer will be checked off and right next it, it will say either X3 or X10 or AS TOLERATED.
First off, during the Implementation Phase, after you the patient uses it 4 times and becomes really activity intolerant or fatigued, you will explain to the patient how important the use of incentive spirometer is for expansion of the lungs post surgery for example, and then verify that the patient still can't go on. Don't push too much but encourage only... watch your tone. If the patient still is unable to use the spirometer, AT THAT POINT IN TIME, turn to the CE and state that you are invoking CDM on the basis of physical and emotional jeopardy, as the patient is only able to use the IS x 4.
When I say that let your Kardex guide you for the Careplans, it will be up to you how to word your intervention for Ineffective Airway Clearance. You can keep it simple and nonspecific and say Encourage patient to use incentive spirometer. But I want you to make it specific according to what is assigned to you on the Kardex as some CEs can be picky.
So, lets say your intervention is Encourage patient to use incentive spirometer x 10 as it stated on the Kardex. You will turn to the Revised Planning Phase and write down at the same location as the previous Planning Phase: Encourage patient to use Incentive Spirometer X 4. Don't forget, DO NOT initial the top of the original Planning Phase Page.. that initial indicates that nothing form the original Planning Phase changed.