Jump to content

Care plan help: how to deal with nonverbal patients' stressors?

Posted

hello everyone, I am in my med-surge rotation. I am currently doing a care plan on a patient that is nonverbal and lethargic. She has a diagnosis of chronic uti and pneumonia. Prior to hospitalization the patient was able to walk and talk, but ever since she was hospitalized, her mental status changed and she couldnt walk nor talk anymore. She makes no action whatsoever and is aaox0. I am in the middle of doing my care plan until I got to the point of the neuman system, where I need to identify the patient's stressors and variables. How do I identify stressors and variables in a patient that is nonverbal?? I have tried asking friends and family, but this does not help much in the intrapersonal department..

Regardless, looking forward to some of your guys' suggestions, thank you!

la_chica_suerte85, BSN, RN

Specializes in Pediatric Hematology/Oncology.

I don't know if this helps but there are some things that might still affect the pt in terms of stressors just by being in the hospital environment. If you were in this pt's situation but recovered miraculously with completely intact memory of what happened to you, what would you be bothered by or what would you feel helped? For example, even with pts like this we still talk to them about everything we are doing for/to them. What kind of stressor is that supposed to be easing? Would it maybe be social isolation? Just being in the hospital is a stressful environment -- overstimulation and understimulation are legitimate concerns regardless of the pt's status. Is there any chance this pt would be in pain?

I'm not very familiar with the Neuman Systems Model but apparently there are some basic things that any pt, regardless of A+O status, would be confronted with on a med-surg unit (i.e. keeping the pt warm, clean, comfortably positioned). The pt may or may not be emotionally stressed by not having these needs met but the physical stress is there and the body will respond in kind. Just like when I get a tattoo worked on, I may not necessarily be in emotional distress because I know it's supposed to hurt but my body definitely responds to the stress of the pain (i.e. inflammation, fatigue, increased pulse/BP, etc).

I hope that helps. :cautious:

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

How old is this patient? Is this a real patient? Has any other work up been done to explore the reasons she has suffered such an extreme change in mental status? If she is non verbal how do you know she is alert and oriented....but then you state she is lethargic?

Hello, she is 98 years old, real patient. all other work ups include a chest x ray showing infiltration of the RUL and RML, she lived in a board and care and was sent in because of decreasing LOC and sob. Sorry about the aaox0 i didnt mean to say she alert and oriented, I would have no idea since she is lethargic. She is awake though.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Ok...it is not uncommon for the elderly to become confused, lethargic, and withdrawn with illness/infection. Their body systems are fragile. Her age is a huge factor. I do not know much about about this Betty person

Content

  • the variables of the person in interaction with the internal and external environment comprise the whole client system

Betty Neuman's System Model

By looking at this quick look version I would think that the unfamiliar environment (changes in surroundings/routine from home), fever, and the stressors of the illness itself have affected her mentation and recovery. She may be depressed or she may have just decided it's time.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Is she febrile? What is her O2 sat?

Hypoxia can be another issue with her mentation. Which would be impaired gas exchange....

she also had dysphagia and clenched her mouth shut so no oral temp was taken. Axillary temp was 98.8, O2 stat on 5L via NC was 99%, upon observation however, she was using her accessory muscles with no nasal flaring involved. I can understand she may feel very overwhelmed with everything, I just dont know how that will play out just because she doesn't talk or give any response back. To make matters worse, she has alzheimers, so any wanted response is out of the question.

I initially thought it was due to the uti, but in her chart it stated it was a chronic uti.Im definitely leaning towards the pneumonia being the causative factor though

Several issues that come to my mind, but my disclaimer is that I'm vaguely familiar with the theory. Also, I'm including what she's at risk for given the info.:

Physical stressors: impaired gas exchange, mobility, comfort, urinary elimination, & swallowing; self-care deficit, infection, & pain

Psychological: Social isolation, impaired social interaction & coping, confusion, fear/anxiety

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

she also had dysphagia and clenched her mouth shut so no oral temp was taken. Axillary temp was 98.8, O2 stat on 5L via NC was 99%, upon observation however, she was using her accessory muscles with no nasal flaring involved. I can understand she may feel very overwhelmed with everything, I just dont know how that will play out just because she doesn't talk or give any response back. To make matters worse, she has alzheimers, so any wanted response is out of the question.
Ok now it is making sense...she has alzheimers. Dysphagia is NOT the purposeful clenching of teeth. But otherwise did she have trouble swallowing or was she just refusing?

She has alzheimers and failure the thrive.

mariebailey Several issues that come to my mind, but my disclaimer is that I'm vaguely familiar with the theory. Also, I'm including what she's at risk for given the info.:

Physical stressors: impaired gas exchange, mobility, comfort, urinary elimination, & swallowing; self-care deficit, infection, & pain

Psychological: Social isolation, impaired social interaction & coping, confusion, fear/anxiety

She is also nutritionally at risk. impaired nutrition less that requirements. Does she track your movements in the room?

la_chica_suerte85, BSN, RN

Specializes in Pediatric Hematology/Oncology.

she also had dysphagia and clenched her mouth shut so no oral temp was taken. Axillary temp was 98.8, O2 stat on 5L via NC was 99%, upon observation however, she was using her accessory muscles with no nasal flaring involved. I can understand she may feel very overwhelmed with everything, I just dont know how that will play out just because she doesn't talk or give any response back. To make matters worse, she has alzheimers, so any wanted response is out of the question.

Ohhhhh.....see, now everything I said doesn't really make too much sense anymore.

Alzheimer's would require a very nuanced sort of assessment especially for what is required by the theory you stated (i.e. how advanced is the condition?).

She has alzheimers however prior to hospitalization she was able to talk and walk according to family. After, she doesn't do any of that. She has dysphagia, trouble swallowing. AND she clenches her mouth very tight so she makes now noise whatsoever. She has a fixed gaze and doesn't pay attention to anyone or anything.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

again it can be a failure to thrive and the stress of the illness has advances the alzheimers to this present state.

ah I see, so would stress of the illness be considered something intrapersonally then, considering it is within the patient?

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

ah I see, so would stress of the illness be considered something intrapersonally then, considering it is within the patient?

I don't know what you are talking about....what do you mean?