Comprehensive Care Plan of the Patient - Lab Report Example

Comprehensive Care Plan Assessment Data ive assessment: John Ryan said he was constipated Objective assessment: Pain expressed located in the general abdominal region (based in the visual analogue scale of 1-10, 10 being the most intense, patient rates it at 6). Palpation of abdominal area indicating faecal masses Digital rectal examination revealing hard impacted faeces lodged at the rectal area (RN Central, 2007). Decreased bowel sounds (RN Central, 2007) Nursing Diagnosis: Alteration in bowel elimination: constipation related to immobility (RN Central, 2007), secondary to degenerative muscular disorder as evidenced by: Pain (rated 6 out of 10) in the general abdominal region (based on the visual analogue scale of 1-10; 10 being the most severe). Palpation of abdominal area indicating faecal masses Digital rectal examination revealing hard impacted faeces lodged at the rectal area (Hunter, et.al., 2000). Decreased bowel sounds (RN Central, 2007) Fewer than 3 times a week of stool evacuation (RN Central, 2007) Goals/Outcomes: Mr. Ryan will have soft formed stool within 24 hours after admission and at 12-hour or 24-hour intervals of bowel evacuation. Nursing Interventions 1. Increased physical activity Rationale: Halter, et.al., (2009) emphasizes that “greater physical activity (including regular walking) is associated with less self-reported and symptom-specific constipation in older people living both at home and in long-term care”. Such physical activities however should be consulted first with physical therapists and the patient’s attending physician in order to ensure that they are within parameters appropriate to his condition. 2. Administration of laxatives or stool softeners as ordered and prescribed by attending physician Rationale: Laxatives or stool softeners act either to soften the stool or to increase gut contraction or movement in order to enable peristaltic activity in the intestines and consequently propel the faeces along the GIT (Doyle, et.al., 2005). 3. Administration of enema Rationale: According to Funnell (2005), an enema is often ordered in order to “promote the evacuation of faeces and alleviate constipation, to administer a drug rectally, to prepare a bowel for diagnostic procedures or surgery, or to begin a bowel training program”. In Mr. Ryan’s case, the enema will be administered in order to evacuate faeces lodged in his intestines and rectum, and consequently to provide more comfort to him. Subjective Assessment: Mr. Ryan verbalized that he feels sad about being a burden to his family Objective Assessment: Wanting to sleep all the time Decreased appetite Expressing thoughts about wanting and hoping to die Crying Identified Problems/Nursing diagnosis: Ineffective coping related to depression (Wold, 2005) secondary to degenerative neuromuscular disorder Goals/outcomes: To improve coping skills by 50% within a week from admission and after implementation of nursing interventions Nursing Interventions 1. Teaching the patient how to independently and safely conduct his activities of daily living Rationale: The Institute of Medicine in the United States (1991) were able to succinctly emphasize that with “increasing inability to perform ADLs and IADLs, one’s dependency on others for care increases”. The opposite is therefore also true. 2. Provide emotional support Rationale: As student nurses and as future nurses, it is important for us to realize that providing emotional support to our clients is one of the most important and most independent nursing functions we can perform in behalf of the patient. This emotional support would call on us to interact with Mr. Ryan; to listen to him, to focus on his needs, to counsel him, and to help him solve his problems (Miller, 2009). 3. Social Skills Training Rationale: Social skills training will help Mr. Ryan cope with the possible changes that he is going to encounter. Wisocki (1991) discusses that “social skills training appears to be a promising form of intervention that can assist the elderly in acquiring or improving the kinds of competencies that facilitate coping and adaptation in later life”. Potential risk: Falls Objective Assessment: Walking with assistance Fear of walking, standing and sitting up without assistance Limited mobility Use of cane or walker wherever he goes Halter, et.al., (2009) discusses symptoms similar to those exhibited by Mr. Ryan which makes him at great risk for falls. Nursing Diagnosis: Potential risk for falls related to decreased muscle and bone strength secondary to degenerative neuromuscular disorder. Goals/ Outcomes: Mr. Ryan will be able to minimize his risks of falling to the least possible degree Nursing Interventions 1. Exercise Rationale: This will help build up his muscles and strengthen his bones (Halter, 2009). The exercises which may be applied to Mr. Ryan’s case however, must be those which are recommended by his physical therapist and his attending physician. In other words, the exercises must not cause him further injury. 2. Ensure the presence of handrails and other safety assistance devices for the patient (Rice, 2006). Rationale: These handrails would help ensure that Mr. Ryan can maintain his independence, at the same time, be able to brace himself during periods when he may lose his balance or when his bones or muscles may not be in their best condition. 3. Modify the environment Rationale: Elderly individuals are at great risk for falls. For Mr. Ryan, the risk is almost doubled because he has a degenerative condition. The nurse must note that stairwells and hallways are well-lit; that edges of tables, chairs, or other furniture are marked with dark or contrasting colours; that beds have side rails; and the bed not be too high (Wold, 2004). Subjective assessment: Mr. Ryan is complaining that he is starting to develop bed sores Objective assessment: Reddish and tender spots or areas at Mr. Ryan’s back, especially areas with bony protrusions Sensitive sensations very like pain on areas with reddish spots Nursing diagnosis: Impaired skin integrity related to decubitus ulcers (stage II) secondary to immobility (Basavanthappa, 2004) Goals/Outcomes: Mr. Ryan’s bed sores or reddish/tender spots would be healed by 80% after a week of nursing interventions Nursing Interventions: 1. Increased mobility through log-rolling every 2 hours, changing position every two hours, and general movement every 2 hours. Rationale: Increased mobility decreases pressure on the skin and on the bony protrusions of the skin (Gilchrest, 2000). Bed sores are caused by increased pressure for prolonged periods on one part of the body. Consequently, this will help prevent the progress of the bed sores into the more advanced stages. 2. Keeping the skin dry and clean Rationale: By keeping Mr. Ryan’s skin dry and clean, this will help prevent infection and prevent the progress of the ulcers into the more advanced stages (Ferrell & Coyle, 2006). Moist skin increases tenderness and infection in the areas affected by bed sores. Therefore, it is important to keep Mr. Ryan dry at all times. 3. Pillow bridging Rationale: This technique will help prevent the progress of the pressure ulcer into the more advanced stages. Pillow bridging acts to vary areas of the body under pressure. “Bridging is useful in protecting specific areas and is also very suitable for use in the prone position” (Torrance, 1983). It will also help prevent areas of Mr. Ryan’s body which are always being pressured or being subjected to friction from incurring pressure sores. Works Cited Alteration in Bowel Elimination: Constipation (10 March 2007) RN Central. Retrieved 04 October 2009 from http://www.rncentral.com/nursing-library/careplans/bec Basavanthappa, B. (2004) Fundamentals of Nursing 2004 Ed.2004 Edition. India: JP Medical Publishers Doyle, D., Hanks, G., Cherny, N. and Calman, K. (2005) Oxford textbook of palliative medicine. New York: Oxford University Press Ferrell, B. & Coyle, N. (2006) Textbook of palliative nursing. New York: Oxford University Press Funnell, R. (2005) Tabbners Nursing Care: Theory and Practice. New South Wales: Elsevier Australia Gilchrest, B. (2000) Skin and aging processes. Florida: CRC Press Halter, J., Ouslander, J., Tinetti, M., Hazzard, W., Studenski, S., High, K., and Asthana, S. (2009) Hazzards Geriatric Medicine and Gerontology. USA: McGraw-Hill Hunter, C., Johnson, K., and Muss, H. (2000) Cancer in the Elderly. New York: Marcel Dekker Institute of Medicine Committee on a National Research Agenda on Aging (1991) Extending life, enhancing life: a national research agenda on aging. Washington, D.C.: National Academies Press Miller, C. (2009) Nursing for wellness in older adults. Pennsylvania: Lippincott Williams and Wilkinson Rice, R. (2006) Home care nursing practice: concepts and application. Missouri: Elsevier Mosby Torrance, C. (1983) Pressure sores: aetiology, treatment, and prevention. Australia: Taylor and Francis Wisocki, P. (1991) Handbook of clinical behavior therapy with the elderly client. New York: Springer Wold, G. (2004) Basic geriatric nursing. Missouri: Elsevier Mosby Read More