Published May 19, 2014
kenee23
106 Posts
I have to write a case study on a pt in my clinical site. I have the basic info but I need help putting it into a format and what info should go where, also it is about geriatric and I have to include Erikson. Can anyone give me some ideas or websites on how to set it up?
Esme12, ASN, BSN, RN
20,908 Posts
Thread moved for best response.
Your school gave you no format to follow?
Tell me about your patient
My School did give me a format but it is very basic and I thought that it should contain more but I could be wrong.
Demographic
Psychosocial Hx: role in fam, support system, length in facility, future plan and goals.
Physical asses: head to toe asses, 3 problems or potential problem, at leat 2 interventions for each problem
Functional asses:
Spiritual asses:
Nutritional asses:
Erikson developmental stage:
My pt is a 64 y/o female with a Hx of DM, Cirrhosis of the live(non alcohol), Ascites, CKD, Obesity depression, esophageal varices along with some other disorders. She is divorced, 3 children who all passed away. She is also retired. She is in a long term care facility for a little over a year but her goal is to get better and move into an assisted living facility. She is a Protestant who feels that God can heal her. She was also on a transplant list for a liver but was taken off 2 months ago for noncompliance.
nurseprnRN, BSN, RN
1 Article; 5,116 Posts
"Asses" is the plural of "ass."
"Assessment" is probably what they mean :)
We don't use the word "noncompliance" in nursing anymore, haven't for, well, ass's years. Complying is what you do when someone gives you an order and you must obey; patients always have the choice to adhere or not to adhere to any component of a medical or nursing plan of care.
Otherwise that's a perfectly reasonable outline of what to include in a case study. What else did you have in mind?
My School did give me a format but it is very basic and I thought that it should contain more but I could be wrong. DemographicPsychosocial Hx: role in fam, support system, length in facility, future plan and goals.Physical asses: head to toe asses, 3 problems or potential problem, at leat 2 interventions for each problemFunctional asses:Spiritual asses:Nutritional asses:Erikson developmental stage:My pt is a 64 y/o female with a Hx of DM, Cirrhosis of the live(non alcohol), Ascites, CKD, Obesity depression, esophageal varices along with some other disorders. She is divorced, 3 children who all passed away. She is also retired. She is in a long term care facility for a little over a year but her goal is to get better and move into an assisted living facility. She is a Protestant who feels that God can heal her. She was also on a transplant list for a liver but was taken off 2 months ago for noncompliance.
You are in your last semester of a LPN program. You need to use your assessment data
Demographic Psychosocial Hx: role in fam, support system, length in facility, future plan and goals. Physical asses: head to toe asses, 3 problems or potential problem, at least 2 interventions for each problem Functional asses: Spiritual asses: Nutritional asses:Erikson developmental stage: My pt is a 64 y/o female with a Hx of DM, Cirrhosis of the liver(non alcohol), Ascites, CKD, Obesity depression, esophageal varices along with some other disorders. She is divorced, 3 children who all passed away. She is also retired. She is in a long term care facility for a little over a year but her goal is to get better and move into an assisted living facility. She is a Protestant who feels that God can heal her. She was also on a transplant list for a liver but was taken off 2 months ago for noncompliance.
Physical asses: head to toe asses, 3 problems or potential problem, at least 2 interventions for each problem
My pt is a 64 y/o female with a Hx of DM, Cirrhosis of the liver(non alcohol), Ascites, CKD, Obesity depression, esophageal varices along with some other disorders. She is divorced, 3 children who all passed away. She is also retired. She is in a long term care facility for a little over a year but her goal is to get better and move into an assisted living facility. She is a Protestant who feels that God can heal her. She was also on a transplant list for a liver but was taken off 2 months ago for noncompliance.
Demographic: 64 y/o female with a Hx of DM, Cirrhosis of the liver(non alcohol), Ascites, CKD, Obesity depression, esophageal varices along with some other disorders. (what disorders?)
Functional asses: you have given us no data to help you
Spiritual asses: She is a Protestant who feels that God can heal her.
Nutritional asses: you have given us no data to help you
Erikson developmental stage: http://psychology.about.com/library/bl_psychosocial_summary.htm
[TABLE]
[TR]
[TD]Stage[/TD]
[TD]Basic Conflict[/TD]
[TD]Important Events[/TD]
[TD]Outcome[/TD]
[/TR]
[TD]Infancy (birth to 18 months)[/TD]
[TD]Trust vs. Mistrust[/TD]
[TD]Feeding[/TD]
[TD]Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust.[/TD]
[TD]Early Childhood (2 to 3 years)[/TD]
[TD]Autonomy vs. Shame and Doubt[/TD]
[TD]Toilet Training[/TD]
[TD]Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.[/TD]
[TD]Preschool (3 to 5 years)[/TD]
[TD]Initiative vs. Guilt[/TD]
[TD]Exploration[/TD]
[TD]Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt.[/TD]
[TD]School Age (6 to 11 years)[/TD]
[TD]Industry vs. Inferiority[/TD]
[TD]School[/TD]
[TD]Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.[/TD]
[TD]Adolescence (12 to 18 years)[/TD]
[TD]Identity vs. Role Confusion[/TD]
[TD]Social Relationships[/TD]
[TD]Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self.[/TD]
[TD]Young Adulthood (19 to 40 years)[/TD]
[TD]Intimacy vs. Isolation[/TD]
[TD]Relationships[/TD]
[TD]Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation.[/TD]
[TD]Middle Adulthood (40 to 65 years)[/TD]
[TD]Generativity vs. Stagnation[/TD]
[TD]Work and Parenthood[/TD]
[TD]Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.[/TD]
[TD]Maturity(65 to death)[/TD]
[TD]Ego Integrity vs. Despair[/TD]
[TD]Reflection on Life[/TD]
[TD]Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.[/TD]
[/TABLE]
Fyi 98% on my case study. Thanks for all the tips
YEAH!!!!!!!!!!!!
Anytime!