scenario for nursing care plan - need help

  1. Hi,

    I am extremely stuck with an assignment. It is in two parts. In the first part of the assignment, I have to identify four nursing diagnoses with rationale and prioritisation and one patient centred goal for each diagnoses with rationale for the goal. I am stuck with which diagnoses to use and the prioritisation.
    This is my scenario:
    You are a registered nurse employed by a residential aged care facility to undertake comprehensive nursing assessments, develop plans of care and monitor the implementation and evaluation of this care in the facility.
    Mr Bonnici is 68 years of age and was admitted to the aged care facility two days ago. Mr Bonnici speaks little English. He refuses to take his medications and is spending a lot of time lying on his bed. When approached by a staff member he speaks rapidly and loudly. Mr Bonnici has a reddened area at the base of his spine and his right elbow. He is overweight, has mild right sided weakness from a stroke (Cerebral Vascular Accident - CVA) mobilises independently with a frame and has a history of severe right sided shoulder pain. He has had no bowel actions since entering the facility.
    I have had so many thoughts about this and they keep changing, that I feel unable to write the assignment.
    I was thinking:
    Impaired skin integrity (reddened areas - pressure ulcer) priority one
    Constipation (no bowel action) priority two
    Chronic pain (history of severe right sided shoulder pain) priority three
    Noncompliance (refusing to take medications) priority four

    Any ideas, tips, suggestions?
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    About sostuck

    Joined: Aug '10; Posts: 1


  3. by   nyashan
    man is spending a lot of time in bed...may want to find out why. psychiatric symptoms????

    little or no english, that needs addressing. otherwise one cant assess him holistically.
  4. by   itsmejuli
    Check this out

    Also check out the stickies at the top of the General Nursing Student discussion forum.

    Love, love, love all the assistance available on All Nurses!!!
  5. by   nbocock
    Hey, i am looking at the same Essay, just googled the same scenerio!
    ummmm...looking at
    1 Non-compliance ummm this can include pain management - it refers the pain as history (maybe previous pain)
    2 Skin Integrity (the area is already red 1st stage ulcer and the complications that can come of this)
    3 Depression (treating Depression will see the patient improve on all levels of health care)
    4 Constipation ( the health measures with the above health conditions will assist in bowel movement anyway
    I hope this helps!
    You will have to find references to back up all this and read read read!
    By any chance r u from Whyalla???
  6. by   getyournursingon
    risk for injury (stroke)
  7. by   FazzDazzle
    impaired coping r/t new environment, language barrier

    This is up there since his inability to cope is affecting his willingness to accept care. There are many therapuetic interventions available to help this pt. Some of your goals could be that he will get out of bed to explore the new facility (willingness to walk down the hallway in the next two days..also helps with his constipation and pressure ulcer), willingness to accept medication, effective communication between staff.... a definate intervention would be to get an interprutor and an english<-->his language dictionary for staff to use when communicating with him.

    I usually put pain (chronic or acute) before constipation. If your pt is experiencing pain this will impair his/her ability to take part in activities that will imporve bowel movement. Always remember that pain is assessed with vital signs, so it takes high priority when it comes to NDs.

    Good luck!