I've completed a care plan on self-concept and was wondering if someone could check it over. :)

Scenario:

87 yr old woman, was admitted into a LTC facility 2 weeks ago, makes negative comments such as "I wish I were a different person" and "I'm a failure to my family". She focuses on not being able to perform ADLs independently and other things she is no longer able to do. Spend the majority of her day in bed. Negatively self talks. Frequently complains. Dismissive of staff. Has poor hygiene. Prior to admission she had not showered in approx 2 weeks. She has 3 daughters (2 live in the area). She was diagnosed with COPD and osteoarthritis.

List behaviors and specify objective/subject and effective/ineffective:

States "I wish I were a different person" (I,S)

States "I'm a failure to my family" (I,S)

Negative self-talk (I,O)

Focuses on not being able to perform ADLS independently (I,O)

Focuses on things she is no longer able to do (I,O)

Frequently complains (I,O)

Spends the majority of her day in bed (I,O)

Poor hygiene (I,O)

Prior to admission, pt has not showered in an estimated two weeks (I,O)

Dismissive of staff(I,O)

List contextual (things that affect pt):

Negative self-perception

87 years old

Female

Newly admitted into LTC facility

Has poor hygiene

List residual (things you THINK/ MAY affect her, or hunches about pt):

Lacks family support

Grieving

Worried about health problems

Depressed

Anxiety

Pain r/t admitting diagnoses limits ability to perform ADLS

Focal: Negative self-perception

Nursing Diagnosis: Chronic low self-esteem r/t negative self-perception AEB negative self-talk, states she is a "failure to family" and wishing she were a different person

Goals (2 short term and 2 long term)

1. Client will identify 5 personal strengths and 5 values by 11/13/12 (ST)

2. Client will identify and work on small, achievable goals to improve performance of ADLs independently by 11/13/12 (ST)

3. Client will verbalize increased self-acceptance through positive talk about self by 12/8/12 (LT)

4. Client will demonstrate improved ability to interact with others such as spending more time out of bed and cooperating with staff by 12/8/12 (LT)

Nursing Interventions (2 per goal)

1. Nurse will observe for contributing factors of low self-esteem such as poor self-concept, grief, lack of problem solving skills, lack of support, and recent change in life situation
   
2. Nurse will reinforce the personal strengths and positive self-perceptions that a client identifies.
   

[*]

1. Nurse will encourage the client to make choices (as appropriate) and participate in planning care
   
2. Nurse will use reminiscence therapy to identify patterns of strength and accomplishments.
   

1. 1. (Listing principals and evaluations were not required for this assignment)

      
      
   2. Nurse will increase and mobilize support available to older persons by encouraging a variety of mechanisms involving family, friends, peers, and health care providers
      
   3. Nurse will encourage participation in peer group activities
      
   
   
2. Nurse will assist client to challenge negative perceptions of self and performance
   
3. Nurse will encourage the client's family to provide support and feedback regarding client value or worth
   

Don't forget that COPD can make it very difficult to do anything because of shortness of breath. A steamy shower might be frighteningly close for her, so think about alternatives or adaptation for anything requiring physical activity, including eating, activities, or any self-care. How do you think her inability to be her old self is affecting her role in the family or community? There are nursing diagnoses for that --check them out.