Care Plan Help! Ineffective Denial/Defensive Coping?

[bae1979]

I need to do a psychosocial care plan on a patient with ESLD. He a wound on both hips (from a biopsy) and is attached to a wound vac. He also has had a colostomy bag for 2 years.

SO, my problem is the gentleman is very pleasant and seems to have a solid grasp on his medical care. he knows the dosage of all his meds, has his own way of wrapping his legs, meticulously changes his colostomy bag, and taught me how to change his wound vac. he borders on being condecending in his tone, but was excited to have a student and said he gets excellent care at the hospital.

The only things I can come up with his that he is borderline OCD in his behaviors and is trying to control his environment because his health is spinning out of control. He is 64 years old and despite his other conditions is hopeful of getting a new liver. I am trying to make Ineffective Denial or Defensive Coping work for him.

Any suggestions?

[bloodlikefire]

i need to do a psychosocial care plan on a patient with esld.

the only things i can come up with his that he is borderline ocd in his behaviors and is trying to control his environment because his health is spinning out of control. any suggestions?

first remember that it is not our job to diagnosis him with a psychiatric condition, so i would not call him "borderline ocd". i would say he is trying to control his environment because that is all that he can control right now. i would use social interaction, impaired or social isolation. you did not mention any family visits. where is his family? you could also try family processes, interrupted r/t hospitalization.

[tex42cares]

I am not a RN .... but my father had a major MVA and became immobile.. He was mad!!! Mad that he was always strong and doing the things he loved,including work.

After they told him that he would never recover and would require 24/7 help ..his world and life was never the same. He said he did not feel complete nor did he feel like a man anymore he only felt like a burden and not in control.

[bae1979]

thanks for the replies... The patient does have a wife that comes visit everyday and the rest of his family was planning to visit for Father's day. He did miss out on a wedding on Saturday so I will look into the two diagnosis you recommended.

I also agree that he could have some anger deep down, he was very calm and said there is nothing he can do to change things, so he doesn't bother complaining. He never complained of pain or discomfort. I can see how he might view himself of a burden though, and I think he has definitely lost the control in his life.

[tex42cares]

try some redirecting or diversion activities...

my mom had surprised my dad with a new desktop computer with a big monitor .. he loved going over in his power-chair and playing cards ..he really got into cooking .. at least to feel like he was doing something to help... one time he was so upset and frustrated that he could not take himself to get a haircut(a simple task that men enjoy-my Dad was in his mid 60's as well ) he opened the garage and took off in the power-chair with his oxygen tank and went the 4 blocks by himself!!! My mom did not ever dream he would have done that. Of course we still laugh about that .Toward the end he was the happiest and felt free when he was on his boat fishing and talking about his Naval Search and Rescue days.

Sorry Iam rambling ..but I write this to put a real perspective on your patients situation.

Thru the years my Dad had some awesome care in all the various surgeries and lots of ICU stays .. he loved it when his Nurses would laugh and joke with him and make him feel special ..he loved that TLC. From the time of the MVA he lived 6.5 yrs.