Ddegenerative Neuromuscular Disease - Case Study Example

Running head: INDIVIDUAL WRITTEN COMPREHENSIVE PLAN Individual Written Comprehensive Plan Insert Insert Insert 10October 2011 Individual Written Comprehensive Plan Student Care Plan NSG1ENC-ESSENTIAL NURSING CARE Student Care Plan Patient Name: John Ryan Patient UR: Ward: Bed No: Assessment Data: Physical examination -John suffers from degenerative neuromuscular disease. -The disease affect 1 million Americans today (Stepanek and University of Maryland, 2008). -In most cases, neuromuscular diseases have been diagnosed to involve neurological, muscular, cardiac, respiratory, endocrine, digestive, and other major body systems (Stepanek and University of Maryland, 2008). -Major symptom of this include some level of progressive muscle weakness or deterioration that later lead to limited or devastated voluntary movement. -Further these conditions results into neurological dysfunction that impact the respiratory status making it impaired (Dikeman and Kazandjian, 2003). -In most cases degenerative neuromuscular diseases affects the motor neurons of the brain and spinal cord thus leading to deterioration of the respiratory and laryngeal muscles. -As the conditions become more established, the patient start to experience dysfunctional cognitive, linguistic, and communication problems (Dikeman and Kazandjian, 2003). -No specified treatment but management of the disease takes place through numerous strategies. Psycho-social examination -Degenerative neuromuscular diseases in most cases affect the psychological functioning of the patient, which later impact on the overall social functioning and well-being of the patient. -Psychological dysfunction may occur through effects of dementia disease and this has led to overall effect on social functioning on the part of John. -John is unable to take care of himself, has limited movement of arms, find it difficult to scratch nose. Due to this, John’s wife has had to resign her job in order to take care of John full-time. -John has to be assisted to eat, toileting, and need lifting assistance machines to mobilize in and out of bed. -He feels he is a burden to family members hence exhibit declined mood, feels helpless, feels great pains. Constipation examination -John was found to be constipated upon admission to the HHC. - Walsh (2007) states that, constipation occurs when there is delayed movement of intestinal content through the bowel (Dougherty and Lister, 2011). -Accordingly, Norton (2006) defines constipation as, “persistent, difficult, infrequent, or incomplete defecation which may or may not be accompanied by hard, dry stools” (cited in Dougherty and Lister, 2011, p.48). - Longstreth et al (2006) observed that constipation affects about 27% of any given population and constitutes critical element of cancer and palliative care (Dougherty and Lister, 2011). -Symptoms include: abdominal pain and cramps, feelings of fatigue, feelings of bloatedness, nausea, headaches, confusion and faecal incontinence (Dougherty and Lister, 2011). -Treatment and management of this condition is attached to the causes of the medical condition. References Dikeman, K. J & Kazandjian, M. S. (2003). Communication and swallowing management of tracheostomized and ventilator-dependent adults. OH: Cengage Learning. Retrieved October 9, 2011, from http://books.google.com/books?id=bx2f2SlzsN0C&pg=PA38&dq=degenerative+neuromuscular+disease+and+physical+impairment&hl=en&ei=Gj6UTujEO8WKhQeXm8GyBg&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFcQ6AEwBg. Dougherty, L & Lister, S. (2011). The Royal Marsden Hospital manual of clinical Nursing procedures, student edition. MA: John Wiley and Sons. Retrieved October 9, 2011, from http://books.google.com/books?id=4AysuLGbMeMC&pg=PT574&dq=Constipation+Care+Plan&hl=en&ei=YdOQTqeUNcS68gOP89UQ&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDQQ6AEwATgU#v=onepage&q=Constipation%20Care%20Plan&f=true. Stepanek, J. S & University of Maryland. (2008). The experiences and needs of parents whose children died due to degenerative disabilities: A qualitative analysis. MI: ProQuest. Retrieved October 9, 2011, from http://books.google.com/books?id=AafbHJfnszMC&pg=PA14&dq=degenerative+neuromuscular+disease&hl=en&ei=ymuRTpeYA4PF8QPQl403&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEgQ6AEwBA#v=onepage&q=degenerative%20neuromuscular%20disease&f=false. Problem/Nursing Diagnosis: -Nursing diagnosis is based on assessment data where it becomes the prerogative of the nurse to identify the major medical, social, psychological and physical issues facing the patient. -Diagnosis constitute identifying patient’s problem and in most cases, the diagnosis should be actual basing on readily signs and symptoms that can be identified (Gardner, 2002). -Therapeutic regime for the patient is generally attached to the identified patient’s diagnosis results (Gardner, 2002). -Holistic health perceives and attach great importance to physical, intellectual, socio-cultural, psychological, and spiritual aspects of a client life that should be integrated in health care planning of the individual (Thresyamma, 2005). -As a result, nurses should regard undertake holistic nursing diagnosis that gives rise to comprehensive approach to health care. -Attaining comprehensive holistic health care involves six critical steps that in most cases occur simultaneously: assessment; diagnosis; outcomes, therapeutic care plan, implementation, and evaluation (Dossey, Keegan, and American Holistic Nurses, 2009). - John lacks self-care abilities, which are demonstrated through inability to take care of self, a situation that forces John to receive care from other people. -John cannot carry out basic self-care activities like eating, toileting, buttoning shirt, bathing, holding objects, sitting, and many more. -This has led to the patient to depend upon other people especially his wife and younger daughter who have had to sacrifice their live pleasures and opportunities to take care of John. -John manifests emotional distress due to his condition, subsequently developing low self-esteem moods. -John is just a representative of many physically impaired patients who become depressed, dejected and discouraged by their overall impaired condition. -Identifying patient’s psycho-social position especially low-esteem status is necessary in holistic nursing care. -John is experiencing irregular, hard, lumpy and dry stool that sometimes is accompanied by decreased appetite. -In most cases presence of constipation occur as a result of lack of water in the body, thereby making stool to be dry, lumpy and in most cases irregular. -Lastly, John experiences painful bowel movements and sensation of blockage in rectum. Bowel in most cases function when there is enough water and fibres are responsible for this. -Identification of these patient’s problems makes nursing intervention possible since a clear framework can be established and strategies adopted. References Dossey, B. M., Keegan, L & American Holistic Nurses. (2009). Holistic nursing: a handbook for practice. MA: Jones & Bartlett Publishers. Retrieved October 9, 2011, from http://books.google.com/books?id=E_tneleljwUC&printsec=frontcover&dq=Nursing+Holistic+Care+Plan&hl=en&ei=llaRTrnOLInC8QODm7xB&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDMQ6AEwAA#v=onepage&q=Nursing%20Holistic%20Care%20Plan&f=false. Gardner, P. (2002). Nursing process in action. OH: Cengage Learning. Retrieved October 9, 2011, from http://books.google.com/books?id=o31WCbqQG8UC&pg=PA5&dq=assessment+and+diagnosis+of+constipation&hl=en&ei=TliUTtjsD86whAfUxpnIBg&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFMQ6AEwBg#v=onepage&q=assessment%20and%20diagnosis%20of%20constipation&f=false. Thresyamma, C. P. (2005). Fundamentals of nursing. New Delhi: Jaypee Brothers Medical Publishers. Retrieved October 9, 2011, from http://books.google.com/books?id=lb_Ql1P5O44C&pg=PA147&dq=Potter+and+Perry%E2%80%99s+fundamentals+of+nursing&hl=en&ei=iLWRTtyALoWo8APcm7kJ&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDYQ6AEwAQ#v=onepage&q&f=true. Goals/Expected Outcomes: -Goals constitute what the nursing intervention strategies aims to achieve. The goals originate largely from the identified patient’s problems and the available intervention alternatives. -Four major goals are identified which subsequently enable establishment of objectives. Just like in any other intervention outside nursing field, the objectives need to be simple, measurable, achievable, realistic, and within specified period of time (SMART). -The first goal is to enable John develop basic self-care abilities such as eating, handling, and arms movement (Brunner and Suddarth, 1996). This goal will be introduced during John’s two weeks in the HHC and homecare program will be developed to be implemented when the time expires at the HHC. -The two weeks will basically be to introduce the basics of ADLs and integrate the family members into the program. -Second goal is to enable John develop positive perception (self-esteem) about self. Positive self-esteem is important in the holistic development, healing, and management of John’s condition (Bynum-Grant and Travis-Dinkins, 2010). Within the two weeks, a comprehensive self-esteem therapy plan will be introduced that various aspects on how to improve John’s self-esteem nature will be introduced. Again integration of family members will be important to ensure homecare management is appropriate. -Third goal is to integrate John’s family into the overall care program through education and training. John’s family is important and critical to his overall care especially with home management. Therefore a comprehensive education and training program will be developed within the two weeks to ensure they acquire necessary skills, attitudes and competences to take care of John. -Next goal aims to treat and manage John’s constipation condition. This particular goal will be achieved within the two weeks whereby laxative medication will be introduced -Last goal will be to improve John’s bowel movement. Within the two weeks, dietary and related lifestyles will be introduced and subsequent monitoring will be undertaken to ensure within the two weeks John realize changes. Outcomes -John will possess relative ability for self-care such as eating, handling spoon and moving arms. -John self-esteem level will improve hence self-appreciation. -John’s family will acquire knowledge and basic training on how to care for John after the expiry period in HHC. -John will experience reduced effects of constipation and bowel movement will improve. References Brunner, L. S & Suddarth, D. S. (1986). The Lippincott manual of nursing practice. PA: Taylor & Francis. Retrieved October 9, 2011, from http://books.google.com/books?id=OlYVAAAAIAAJ&pg=PA63&dq=nursing+interventions+to+encourage+patient+self-care+abilities+%28ADLs%29&hl=en&ei=xpaRTsGPJIWx8gPhzNAz&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFYQ6AEwBw#v=onepage&q&f=false. Bynum-Grant, D & Travis-Dinkins, M. (2010). Schaums outline of psychiatric nursing. NY: McGraw-Hill Professional. Retrieved October 9, 2011, from http://books.google.com/books?id=ru57ujcVO6sC&pg=PA176&dq=nursing+interventions+to+encourage+patient+self-care+abilities+%28ADLs%29&hl=en&ei=xpaRTsGPJIWx8gPhzNAz&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEcQ6AEwBA#v=onepage&q&f=false. Interventions/Nursing Actions Diagnosis one: -Develop, train and encourage basic aspects of ADLs (Brunner and Suddarth, 1996). -Encourage and promote effective and interpersonal communication skills (Baldwin and Woodhouse, 2010). Diagnosis two: -The aim is to develop and carry out self-esteem therapy. -The aim of the therapy is to encourage John to develop positive self-esteem aspects which will increase his mood positivity. -The entire process should be framed on aspects of trust, respect, cultural-sensitivity and accommodative communication environment (Stein-Parbury, 2009). -Psycho-education should be initiated between John and family members while open communication should be encouraged (Tollefson, 2004). This is important to ensure transition from HHC to homecare is smooth and beneficial to John. Diagnosis three: -Introduce pharmacological support intervention, and this involves introduction of laxatives which are perceived to be the best strategies of treating constipation (Dougherty and Lister, 2011). -Different kinds of laxatives exist. -Laxatives participate in retaining water and promoting microbial growth in the colon, stimulating peristalsis, increasing faecal mass, and softening of faecal mass. -Monitoring should thoroughly be carried out to ensure that side effects are minimized. Diagnosis four: -Intervene through introducing nutritional/dietary supplements (Dougherty and Lister, 2011). -Diet is specifically important in improving bowel movement of the patient. -Patients to take more fibre which improve bowel movement. -Alongside diet, other lifestyle changes should be initiated like increasing intake of fluids such as water and juice that help bowel movement function smoothly (Dougherty and Lister, 2011). Rationale -Research shows that improving and encouraging ADLs activities enable the patient to develop self-care abilities, improve confidence, and gives the patient chance to undertake self-care management (Brunner and Suddarth, 1986). -Research by Bynum-Grant and Travis-Dinkins (2010) shows that low self-esteem derail patient’s recovery and improvement initiatives thus leading to deterioration of patient’s condition and making it difficult to treat or manage. -Constipating patients experience pain and discomfort and professionals have established that the condition can be treated through administration of laxatives (Dougherty and Lister, 2011). -Nazarko (1996) established that bowel habits are dictated by diet, lifestyle and environment (Dougherty and Lister, 2011). -Hence introducing and encouraging right foods enable the patient to increase bowel movement and passing at least three stools per week (McSherry, Simmons and Abbott, 2002). References Baldwin, M. A & Woodhouse, J. (2010). Key concepts in palliative care. NY: SAGE Publications. Retrieved October 9, 2011, from http://books.google.com/books?id=KWTSXIodD_sC&pg=PT30&dq=Key+concepts+in+nursing&hl=en&ei=AbyRTr3rG4nB8QPFteUz&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEgQ6AEwBA#v=onepage&q=Key%20concepts%20in%20nursing&f=false. Brunner, L. S & Suddarth, D. S. (1986). The Lippincott manual of nursing practice. PA: Taylor & Francis. Retrieved October 9, 2011, from http://books.google.com/books?id=OlYVAAAAIAAJ&pg=PA63&dq=nursing+interventions+to+encourage+patient+self-care+abilities+%28ADLs%29&hl=en&ei=xpaRTsGPJIWx8gPhzNAz&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFYQ6AEwBw#v=onepage&q&f=false. Bynum-Grant, D & Travis-Dinkins, M. (2010). Schaums outline of psychiatric nursing. NY: McGraw-Hill Professional. Retrieved October 9, 2011, from http://books.google.com/books?id=ru57ujcVO6sC&pg=PA176&dq=nursing+interventions+to+encourage+patient+self-care+abilities+%28ADLs%29&hl=en&ei=xpaRTsGPJIWx8gPhzNAz&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEcQ6AEwBA#v=onepage&q&f=false. Dougherty, L & Lister, S. (2011). The Royal Marsden Hospital manual of clinical Nursing procedures, student edition. MA: John Wiley and Sons. Retrieved October 9, 2011, from http://books.google.com/books?id=4AysuLGbMeMC&pg=PT574&dq=Constipation+Care+Plan&hl=en&ei=YdOQTqeUNcS68gOP89UQ&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDQQ6AEwATgU#v=onepage&q=Constipation%20Care%20Plan&f=true. McSherry, R., Simmons, M & Abbott. (2002). Evidence-informed nursing: a guide for clinical nurses. NY: Routledge. Retrieved October 9, 2011, from http://books.google.com/books?id=zcjjALs13ocC&pg=PA71&dq=Constipation+Care+Plan&hl=en&ei=ecuQTq7lLdCq8QOv4t0H&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDIQ6AEwATgK#v=onepage&q=Constipation%20Care%20Plan&f=false. Stein-Parbury, J. (2009). Patient & Person: interpersonal skills in nursing. London: Elsevier Health Sciences. Retrieved October 9, 2011, from http://books.google.com/books?id=9Eo8vcllBmAC&printsec=frontcover&dq=Patient+and+person:+interpersonal+skills+in+nursing&hl=en&ei=o7qRTqGbCM-y8QO268gu&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q=Patient%20and%20person%3A%20interpersonal%20skills%20in%20nursing&f=false. Tollefson, J. (2004). Clinical psychomotor skills. Sydney: Cengage Learning Australia. Retrieved October 9, 2011, from http://books.google.com/books?id=jmKnfvbdvacC&printsec=frontcover&dq=Clinical+Psychomotor+Skills&hl=en&ei=Mr6RTuKxKs6z8QP_4Mkx&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q&f=false. Read More