As more patients survive acute SCI, they face the changes associated with aging with a
disability. Therefore, teaching in the home and community focuses on health promotion
and addresses the need to minimize risk factors (eg, smoking, alcohol and drug abuse,
obesity) (Mastrogiovanni, Phillips & Fine, 2003). Home care nurses and others who
have contact with patients with SCI are in a position to teach patients about healthy
lifestyles, remind them of the need for health screenings, and make referrals as
appropriate. Assisting patients to identify accessible health care providers, clinical
facilities, and imaging centers may increase the likelihood that they will participate in
health screening.
Evaluation
Expected Patient Outcomes
Expected patient outcomes may include the following:
Demonstrates improvement in gas exchange and clearance of secretions, as
evidenced by normal breath sounds on auscultation
o Breathes easily without shortness of breath
o Performs hourly deep-breathing exercises, coughs effectively, and clears
pulmonary secretions
o Is free of respiratory infection (ie, has normal temperature, respiratory
rate, and pulse, normal breath sounds, absence of purulent sputum)
Moves within limits of the dysfunction and demonstrates completion of
exercises within functional limitations
Demonstrates adaptation to sensory and perceptual alterations
o Uses assistive devices (eg, prism glasses, hearing aids, computers) as
indicated
o Describes sensory and perceptual alterations as a consequence of injury
Demonstrates optimal skin integrity
o Exhibits normal skin turgor; skin is free of reddened areas or breaks
o Participates in skin care and monitoring procedures within functional
limitations
Regains urinary bladder function
o Exhibits no signs of UTI (ie, has normal temperature; voids clear, dilute
urine)
o Has adequate fluid intake
o Participates in bladder training program within functional limitations
Regains bowel function
o Reports regular pattern of bowel movement
o Consumes adequate dietary fiber and oral fluids
o Participates in bowel training program within functional limitations
Reports absence of pain and discomfort
Is free of complications
o Demonstrates no signs of thrombophlebitis or DVT
o Exhibits no manifestations of pulmonary embolism (eg, no chest pain or
shortness of breath; arterial blood gas values are normal)
o Maintains blood pressure within normal limits
o Reports no lightheadedness with position changes
o Exhibits no manifestations of autonomic dysreflexia (ie, absence of
headache, diaphoresis, nasal congestion, bradycardia, or diaphoresis)