SUBDOMAIN 726.1 – INTRODUCTION TO NURSING
Competencies:
726.1.2: Therapeutic Communication – The graduate demonstrates therapeutic communication skills necessary to promote patient safety and positive patient outcomes.
726.1.3: Basic Principles of Safety & Quality – The graduate plans a safe care environment to promote safety and quality care for patients, the providers, the immediate environment, and the community.
726.1.4: Cultural Awareness – The graduate creates patient care plans that demonstrate awareness of and sensitivity and respect for cultural differences, beliefs, and values.
726.1.5: Theories of Growth & Development across the Life Span – The graduate uses the nursing process to plan patient care that incorporates the theories of human growth and development into the care process.
726.1.6: Health Perception/Health Management – The graduate determines the impact of the health perceptions of individuals and communities on the promotion of health and health management strategies.
Introduction:
The nursing process is used as a problem-solving framework to plan and provide safe, patient-centered care to patients and their families. The incorporation of growth and development and cultural concepts in the planning and provision of care promotes patient safety and ensures quality care.
Scenario:
Jane Vuong is a Vietnamese 24 year-old single woman who is living in the United States on an academic visa. She has been attending the local university for two years, studying cellular biology as an undergraduate. She comes from an affluent Vietnamese family. Her parents are paying for her education and want her to come back to Vietnam with her doctorate and take over the research lab owned by her uncle. Jane is a straight ‘A’ student and spends much of her time studying. She makes extra money by working part-time in the molecular biology laboratory in the university campus research center. She takes the subway or rides her bicycle to get around.
Jane enjoys working out doing Quan Khi Dao at the local martial arts school. One day while working out, she feels a severe tightness in her chest and says she is having difficulty breathing. Susan, a regular attendee in the class, brings Jane to the emergency department where you work. You note that Jane is having trouble speaking, appears anxious, and her lips are dusky. You are able to hear a wheezing sound when she breathes. She denies a history of asthma but says that she has some allergies which she generally treats with herbs. Susan takes you aside and tells you that she has noticed over the past month that Jane has seemed out of breath after taking the stairs up to the martial arts studio and that she no longer rides her bike to the studio.
Because of the severity of her symptoms, the doctor decides to admit her for evaluation and observation. The physician orders supplemental oxygen, a chest X-ray, blood tests, and a regular diet. Her anticipated stay is two days.
Once on supplemental oxygen, she is better able to communicate, and you begin to do a general assessment and take a history. Here are some of your findings:
Diet: Jane states that she is proud that she only eats a traditional Vietnamese diet of fresh vegetables, chicken, rice and noodles. Much of the food she eats is prepared with Nuoc mam (fish sauce), soy sauce, sour lemons, bean sprouts and scallions. She prefers to eat Banh Khuc (rice ball), Banh Cuon (rolled rice pancake), and Pho-bo (beef and noodle soup). You note that she is very slender, verging on being underweight.
Religion: Jane states she is a Mahayana Buddhist. She goes to the Buddhist temple early each morning for meditation and communion with her dead ancestors. She says her meditation brings blessings from her ancestors, and they watch over her and help her succeed and stay healthy.
Health history: Jane admits she has had a dry cough for several months which she attributes to allergies. She says her allergies have kept her from riding her bike to work. She continues to smoke 1 pack of cigarettes daily and says smoking doesn’t bother her. She laughs and says she could never quit because her roommate smokes too.
Six months earlier she tested positive for Hepatitis B. The diagnosis surprised her since she didn’t have any symptoms. She denies drug use but admits to being sexually active. She reports having 5 sexual partners in the past six months. She states: “I meet guys at the college bar and we have weekend flings. I like it this way, so I don’t have to be involved in any type of long-term relationship, which can make life really complicated.” When asked if she uses protection, she shrugs and says, ‘Sometimes.’ She claims that no one told her that Hepatitis B was sexually transmitted, but she isn’t worried because she says she is over it now.
Exam: During her examination, red circular burns are found on Jane’s chest. On Jane’s back, there are reddened abrasions. When asked about these strange marks, Jane explains that she was having difficulty breathing earlier in the week, and went to a Vietnamese medicine man who treated her with ‘coining’ on her back and ‘cupping’ on her chest to remove the bad air. He also gave her an herbal mixture and told her to boil it and breathe the steam from the mixture three times daily. She says it really helped her.
Jane’s primary nursing diagnosis is ‘impaired gas exchange.’
Task:
B. Given Jane’s history, select two additional nursing diagnoses from the below list. All of these diagnoses are reasonable diagnoses for Jane; you are not evaluated on which one you select.
� Knowledge Deficit
� Ineffective Denial
� Activity Intolerance
� Alterations in Health Maintenance
1. Using the attached Nurse Care Plan Templates, complete a nursing diagnoses chart for each of the two diagnoses you have chosen with the following information:
a. Subjective data that support the diagnosis
b. Objective data that support the diagnosis
c. Problem (nursing diagnosis)
d. Etiology
e. Signs and symptoms
f. Two short-term patient outcomes to be achieved before discharge
g. One long-term patient outcome to be achieved two weeks to six months after discharge
h. Nursing interventions that describe what the nurse will do to help the client meet each short-term and long-term outcome
Note: Interventions must be culturally and developmentally appropriate when applicable.
i. Rationale for each nursing intervention, including why this nursing intervention is relevant to helping the patient achieve the corresponding goal
WGU Prelicensure Nursing Program
Nursing Care Plan Template
| Nursing Diagnosis # 1 | ||||
| Insert à relevant, subjective and objective data from scenario to support nursing diagnosis. | Subjective data: Use of self medication herbs; Lack of medical treatment and diagnosis. Dusky lips and anxiousness can be clearly seen in the patient. | Objective data: •the trouble speaking and dryness of lips can indicate the shortness of breath which could even be forcing the patient to breathe through the mouth. | ||
| P=Problem | E=Etiology | S=Signs & Symptoms | ||
| Nursing diagnosis: Alterations in Health Maintenance | Related to: self prescription of drugs in form of herbs; use of medication from witch doctors. | As manifested by: difficulty breathing, changes in the skin, and weakness which is experienced by the patient (Mayers, 1972). | ||
| Measurable Outcomes/Goals “The patient will…” | Nursing Interventions that support corresponding goal. | Rationale for each intervention | ||
| Short term: stabilizing breathing and oxygen supply in the patient so that the patient can breathe properly and without much difficulty. Encourage adequate rest and regulated exercise periods (Mayers, 1972). | To reduce the consistencies of breathing difficulties and prevent cardiac workload. To ensure that the patient is able to have adequate oxygen supply that is not medically supported. | Treatment should combine both medical diagnosis and therapy to maintain the treatment process (Mayers, 1972).Encourage the patient to exercise so as strengthen their breathing system as well as get adequate rest (Mayers, 1972). | ||
| Short term: the client should be able to make choices of exercises that are not strenuous to them (Mayers, 1972). | C. The care taker can help in providing the necessary information in the kind of exercises that can improve breathing and ones that are not strenuous to the patient. D. The care taker can also do some f the exercises with the patient so as to motivate them (Mayers, 1972). | Helps prioritize activities and arrange them around fatigue pattern.Motivate the patient to be consistent with the exercises and the medication at the same time so as to speed the stabilization process (Mayers, 1972). | ||
| Long term: establish an effective pattern of medical checkup in the long run (Mayers, 1972). | Design a medical checkup schedule that is fit for the patient both at the time when they are in pain and for regular checkups (Mayers, 1972).The consistency of medical checkup of a patient should be their long term goal even without monitoring by the nurse or doctor. | E. Maximize the time for medical checkup to explore the health status in depth (Mayers, 1972). F. The nurse should ensure that the patient follows the designed schedule consistently. | ||
| G. Regular breathing checkups every time the patient visits the doctor. This will reflect how well the patient is following the medical plan (Mayers, 1972). | G. Use the available exercise time and energy for self-care tasks that promote the health condition of the patient (Mayers, 1972). | |||
References
Mayers, M. G. (1972). A systematic approach to the nursing care plan. New York: Appleton-Century-Crofts.