Health Issues and Nursing Intervention - Term Paper Example

Health Issues and Nursing Intervention Abstract This is a care plan specifically designed for The West Family who resides in a good living environment earning a competent income, a family composed of 2 kids, a 19month old daughter and another one on the way. Both parents are working, following a simultaneous schedule designed to accomplish both parental roles and obligations to their growing child. The nature if this family structure is extended in such a way that recently the grandfather moved in. The central paradigm of this paper is the application of the theories involved in the method of Assessment and Identification of potential or currently existing health issues that not only affect each member in the family, but also the society a whole. The results of such assessment and diagnosis will establish a scientific basis necessary for health management. A nursing care plan shall be created to meet the health issues of this family whereby planning for intervention along with the actual implementation of care be documented for the eventual purpose of evaluating whether such intervention proved effective. Nursing Diagnosis: West Family’s Health Issues According to the initial assessment, John West 38 year old male, Caucasian and the head of the family has a lifestyle posing himself at high risk for hypertension. Taking into consideration the nature of his work, a habit of smoking a pack of cigarette a day, a body mass index of 32.41 indicates obesity all the more predisposes John West according to the Department of Health and Human Service-National Institute of Health2. This, along with the work related stress that is a constant demand in the corporate world plus the lack of exercise and the kind of food he eats on a daily basis strengthens the likelihood for not only hypertension but also cardiovascular disease (Fletcher. 2002). Hypertension is a condition whereby the consistency and pressure of the blood flowing through the vein is beyond the normal capacity owing to a systolic and diastolic pressure of over 140 and 90 respectively. When this happens the pumping capacity of the heart is exhausted resulting to a likewise increase in tension, when left unmanaged will produce consequential malfunction of other major organs. Symptoms are not likely to occur during an early stage, whilst the more common yet already severe sign is drowsiness, nausea, pain in the nape area, shortness of breath and even chest pains. Factors affecting the prevalence of this condition includes among others, a sedentary lifestyle, nicotine intake, and high sodium content diet (Medical Encyclopaedia. 2006). Preventive care includes, regular monitoring of blood pressure, improving lifestyle in a way that encourages regular exercise for weight loss and proper balanced high fibre diet. At this point, explaining to John how this condition might debilitate him once it transcends to a worse level, might help in his determination to follow the requisites. The patient’s awareness of pros and consequences fosters cooperation. The primary aim here is to manage the patient’s health into removing him from the predisposing factors if not preventing the conditions to increase, that will necessitate a pharmacological treatment3. Although, medical management may be necessary for prevention in cases where blood pressure continues to rise and does not respond despite religious adherence to nutritional and lifestyle changes (Dwight, 2004). May, a wife and expectant mother of a second child, is on her 8th weeks of gestation, but her pregnancy weight gain proves to be not increasing ideally. Her being underweight with a bmi of 18.8, night shift work, occasional wine consumption along with the pregnancy related nausea and fatigue poses her at high risk pregnancy4. Considering that her first child is barely 19 months old, indicates that her current condition is less likely ideal. The Centre for Disease Control or CDC classified those women with short inter-pregnancy interval as candidates for nutritional risk and more likely to experience abnormal birth outcomes5. The overall condition of May, along with her need to attend to the household chores and parental obligations exhausting her energy, contributes not only to her inability to sleep and the constant fatigue. Should this kind of lifestyle continue, adverse reaction is a probability not only to the neonate but most importantly to maternal health (Kotch. p. 129). While it is expected for pregnant women to experience fatigue and nausea, psychological factors like family stress will amplify this. It is very important that May lessens her activity and spends more time for rest, so that her body can recuperate from the stress demanded by her responsibilities both from work and at home, rest may also normalize her pattern of sleep and promote the ideal weight gain required (Mengel and Schweibert. 2005). Management includes structuring and plotting her working schedule and rest, nutritional and exercise6 planning and education both husband and wife of the risk factors that needs to be avoided during pregnancy. With the primary goal of health promotion, regular medical and prenatal check up is also necessary in order to monitor both maternal and neonatal well being along with the required vitamin supplements that May needs to take. She also needs to be aware of the adverse effects of alcohol consumption whereby according Mengel and Schwiebert in Family Medicine will create behavioural problems as well as learning disabilities in children (p. 676). Additional medical management includes among others, immunization and folic acid intake as indicate in Family Medicine preconception and prenatal care (p. 674-675), The above identified issues are potentials issues that may affect the health condition of the entire family, however a more severe issue that requires immediate nursing management is the health status of Stanley West which we are going to present in the succeeding paragraph. Plan of Care Proforma Patient: Mr. Stanley West Nursing Issue: Impaired physical mobility related to musculoskeletal impairment, stiffness, diminishing eyesight and pain (acute) located in the right hip. At high risk for muscular atrophy due to restrictive movement as evidenced by the patient’s reluctance to move about. Nursing Issue Rationale: When aging begins, the body shows signs of degeneration especially in the area that receives a higher impact of weight predominantly in the joint that is typically affected by factors like thinning of cartilages that allows the range of movement. When this happens, flexibility of the tendons and ligaments is decreased, and since there is no more vascular support movement often results to pain. In the case of Mr. Stanley West, “Hip Osteoarthritis often occurs in the elderly population and tends to be common in men, where pain is characteristically present in the groin” (Simon et all. 2001). The Refusal of the patient to move about is not only subsequent to pain but also to the fear that he might injure himself and aggravate his condition due to impaired vision. This issue, if left unmanaged will eventually cause the muscle to atrophy (Simon & Koenigsknecht. p. 44). Goals for intervention: Our primary aim in identifying the health issue is to attain the most effective means to manage the immediate concern(s) that produces the greatest amount of discomfort to the patient in the soonest possible time thereby alleviating discomfort either permanently through prescribed pharmacologic treatment or minimizing it to a level by tolerable non-medical means. In a span of one week with medical or non medical pain, gradually encourage patient to ambulate. Once this is achieve, the nurse can then proceed with promoting physical fitness by creating, demonstrating and introducing an exercise plan designed specifically according to the range of movement capabilities, come up with a daily nutritional plan to restore and improve musculature to its optimum. At the end of two weeks, the patient will manifest improvement in mobility, willingness and ability to move with in the house and ultimately be transferred to a room in the ground floor to minimize risk for accidents or injury. Nursing Intervention: Goals with rationale Pain Management – Pain is the primary cause of discomfort that requires immediate intervention by alleviating it. While the most common medical management for degenerative joint disorder is Non-steroidal anti-inflammatory drugs, it is best to work with a physician who can better decide and prescribe this, at best the nurse may manage the pain thru simple analgesic such as Tylenol7 if the pain non responsive to warm compress or hydrotherapy (Simon & Koenigsknecht. p. 46). Exercise and Nutritional Plan Intervention – exercise therapy particularly the incorporation of isometric setting and ROM or range of movement exercises in his daily routine at least three to fur times, along with the daily high protein high calorie diet will help improve energy and muscle quality. It is also important to implement this nutritional plan with other vitamin supplement prescribe by the physician, in small frequent feeding in order to maximize metabolic function thereby increasing energy. The provision of walking aids and some visual aid (eye glasses) can also boost the confidence in moving about (Taylor. 2005) Health Promotion Plan for the West Family Taking into consideration the potential risk identified in the West Family the most relevant plan effective for the promotion of well being of every member in the family is the improvement of their daily nutritional routine. Earlier, it has been pointed out as part of the nursing care plan for all three subjects (i.e., John, May and Stanley) the implementation of good nutrition to address the predisposition of both John and May to health risk, while that of Stanley to improve musculature and energy for physical mobility, it is necessary to be highlighted as part of the over all care plan for the West Family that they should have, a proper and balanced Nutrition that can be plotted out for them to follow. Making them aware of the essentials of nutrition in relation to the potentials of their present condition will foster self discipline, adherence and determination to overcome old habit and replace it with new and improved ones. The relocation of grand father Stanley from the upstairs room into the ground floor that will not necessitate him to climb up and down the stairs during meal time or even the employment of a health practitioner (again if the finances allow) to supervise him while he is in the process of improving the impairment in mobility. Although premature at this point to emphasize on the need for that practitioner to be present in the west family, I see this is as imperative in addressing the problems of May west and her need for ample rest while pregnant, John’s time for a much needed exercise and weight reduction program over the weekend instead of spending all his time taking care of his daughter while the Wife is at work, the medical management of pain and the constant regular monitoring and implementation an exercise plan for of Stanley not to mention his bowel incontinence, A person who can monitor the proper nutrition for the Madeline while allowing the mother to rest, the preparation of a healthy home cooked meal when the family gathered during work free days, these are all the things that the West Family needs to learn to handle until eventually they can do this effectively on their own. As expensive as this may sound, but considering the kind of hectic schedule both husband and wife leads, not to mention the debilitated family member that needs to be attended to, the only way they can ease up the stresses brought about by family, economic and societal pressures is the employment of somebody professional enough to ensure health promotion as well as the prevention of illness. However temporary the employment of this professional be, will create a long way in avoiding future medical issues that may pose a much costly price. More specifically, while the need to take care of the ill grandfather is inherent among extended family, the time and anguish brought about by the psychological impact John and May see being suffered by Stanley will unconsciously despair them considering that this is an added responsibility that they have to attend to. While Stanley may also see this aspect as a blow to his self esteem making him feel as though he has become a burden to the family especially with the present condition of May, he may regress and not want to improve his condition at all, all the more making the situation worse. It is therefore important that a proper psychological management be implemented as well in order to maintain the good interpersonal relationship of this three adult, which is consequential to a healthy if not ideal example for Madeline, the 19year old growing up child, to see especially in this stage of curiosity and observation. A good interpersonal skill begins at home, therefore when the home environment is healthy and stress free, it is much easier for John to transcend that healthy and stress free behaviour in his dealings with others. When stress is managed to a tolerable degree, life will become easy and health conditions that are precipitated by such can be avoided. As for John, he needs to realize that the early detection and management of the possible risk brought about by smoking and being overweight is necessary, not only for his well being but for the future of his family. Being the Head of the family and the income generating, it is important to invest on good health for the sustainability of permanence of income. While John may already have a medical plan that is regular and a common practice in the corporate world, he may also want to prepare for untoward incident related to future care and hospitalization needs for his father Stanley West. He must have the option to either place his father in an aged facility that will ensure proper medical attention of present complains and eventual prognosis, or the option to retain his father inside the house and have someone take care of him and the help attend to the baby occasionally while his wife is pregnant. It is important that he realizes the need to restructure the family finances to accommodate another person in the house, notwithstanding that size is a 4 bedroom two storey house, and must realize that this is a good opportunity and learning experience for every member in the house. As for May, being in her second pregnancy, not discounting the fact that she conceived under a limited inter-pregnancy interval posing her uterus less time for recuperation from her first pregnancy, should begin and plan the next schedule of pregnancy, hopefully taking into consideration proper gap and spacing as well as the means to prevent conception, should the option be otherwise. Since her pregnancy limits her the opportunity to interact with her first baby who is normally active during this stage, she needs to be assured that the rate of growth varies accordingly and sometimes her fears that something is wrong with her baby may just be an apprehension brought about by the mental fatigue and stress that she is experiencing amidst all that has happened in her family. Rest and relaxation is therefore required for May, and if the family finances permits, she should take a much needed vacation until such time that her Obstetrician assures the well being of both or until matters in the houses eases up a bit. Like all the other family stresses, no dilemma can’t be solve with cooperation. References Blumenfel, JD. & Laragh, JH. (November 2001). American Journal of Hypertension. Vol. 14 Issue 11. p. 11154-1167. Retrieved April 30, 2006 from Curtis, R. and Timiras, P. (2003). The Physiological Basis for Aging and Elderly 3rd ed. CA:CRC Press. Department of Health and Human Service-National Heart, Lung and Blood Institute. (2005). Aim for Healthy Weight. Retrieved April 29, 2006 from Dr. Dwight, M. Hypertension ( December 7, 2004). Retrieved from Medicinenet.com database Read More