Coping-Stress tolerance pattern case study - need help with that

Posted
by monika79 monika79 (New) New

I have to do my first care plan, and I need max point for that. I am first semester nursing student and i don't have anybody who is familiar with nursing. http://images.allnurses.com/smilies/crying2.gif.

My study case is.

Billy Osceola is a 55 -year old diabetic, Native American man recovering from left below knee-amputation performed 10 days ago. During your first home health nursing visit, you see a liquor bottle open on the table. He raises his voice angrily when you try to talk to him about following a diabetic menu plan.

Alcohol is on his breath. When you question him about it, he grunts and angrily asks you to leave, shouting that he doest need any need coming to see him. He refuses to let you near him. You go, telling him you will be back tomorrow.

next day, Mr. Osceola is polite and sober but basically noncommunicable. you are concern when you see him put a stained, damp rag on his stump over the remains of a surgical dressing. When you asking about it, he says his leg hurts and he is trying to fix it with an herbal potion he got from the shaman. he refuses to talk further about his leg and says there is no need to come see him.

Mr. Osceola is stressed. He is receiving difficulty accepting his current situation. His behavior has the potential to interfere with wound healing and prevent him from taking positive action to manage his health.

I have my nursing diagnosis, and some of the outcomes and goals. I want to found out if i am on the right track. Thank you so much for Your help. http://images.allnurses.com/smilies/kiss.gif

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Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience. 4 Articles; 14,603 Posts

I can't give you any opinions if you don't post any of your diagnoses, outcomes/goals and interventions. I need to see your interventions in order to tell if your goals are appropriate.

monika79

monika79

2 Posts

Well.....I came up with some ideas like this.....

As a nursing diagnosis I put, Ineffective Coping related to vulnerability secondary to amputation as evidence by substance abuse, inability to cope with the current situation.

subjective data * pt states his leg hurts * pt uses herbal potions on his leg

objective data * 55 year old male * diabetic * Native American * left below knee amputation performed 10 days ago * pt is stressed * pt has difficulties with accepting his current situation.

Outcome and goals

*Pt will accept his situation by time his wound heal.

*Pt will accept the assistance provided by the nurse at the end of her visit.

Nurse interventions

* will provide informations about the treatment, and prognosis.

* will provide an atmosphere of acceptance

* will appraise adjustment to change in body image,

* will encourage the patient with behavior change,

* will encourage the patient to be more assertive in providing care to his amputated leg.

* will discuss the problem of alcohol abuse,

Rationale for Nursing Interventions

* pt doesn't demonstrate cooperating with the nurse,

* pt doesn't verbalize acceptance of his situation,

* pt doesn't let the nurse to do the dressing on his leg,

Outcomes not met

* pt refuses the assassinate in dressing change on his leg,

* pt states, he doesn't need any help.

How that sound? That is my first care plan, so I expect some mistakes, please help me if I am on the wrong track. Thank you soooooo much!!!

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience. 4 Articles; 14,603 Posts

when care planning the first thing that must be done is an assessment. assessment consists of:

  • a health history (review of systems)
  • performing a physical exam
  • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
  • reviewing the pathophysiology, signs and symptoms and complications of their medical condition
  • reviewing the signs, symptoms and side effects of the medications they are taking

with a scenario the assessment information has been supplied for you and for this particular one some things need to be extracted. this patient is diabetic, had a bk amputation (complication of the diabetes?) and the scenario seems very intent on wanting you to think he was drunk on the first visit. since the scenario also clearly mentions that the patient is a native american, i think that is an important piece of assessment information.

ineffective coping related to vulnerability secondary to amputation as evidence by substance abuse, inability to cope with the current situation.

not being able to cope means the inability to change and use resources that are around you. when we read a diagnostic statement it should tell us a short story of what the problem is, why it is occurring and what the symptoms are that prove it exists. the "related to" part of the diagnostic statement identifies what is causing the problem. where did "vulnerable" come from? what does it mean? you are saying that as a result of this vulnerability he has substance abuse (drinks) and an inability to cope with the current situation.
inability to cope with the current situation
is really a restatement of the nursing diagnosis, isn't it? so, it really isn't evidence that he is coping ineffectively. therefore, the only evidence you are offering that he is coping ineffectively is his substance abuse.

but then, i see this. . .subjective data * pt states his leg hurts * pt uses herbal potions on his leg

objective data * 55 year old male * diabetic * native american * left below knee amputation performed 10 days ago * pt is stressed * pt has difficulties with accepting his current situation.

if this is your data supporting this diagnosis then it should also be used as your aeb items. but, you didn't do that. instead you used the following as your aeb items:

  • substance abuse

  • inability to cope with the current situation - restatement of the nursing diagnosis and not evidence

pt states his leg hurts. . . pt uses herbal potions on his leg. . .
55 year old male. . .diabetic. . .native american. . .left below knee amputation performed 10 days ago. . .
are
not
evidence of ineffective coping.
pt has difficulties with accepting his current situation
is a judgment you made.
diabetic
is a medical diagnosis and can't be used in a nursing diagnostic statement anyway.

outcome and goals

*pt will accept his situation by time his wound heal.

*pt will accept the assistance provided by the nurse at the end of her visit.

outcomes are what you expect will happen if the etiology (cause) of the problem (ineffective coping) is altered in some way. your etiology is "
vulnerability
". how do you expect to do anything about his "
vulnerability
"?

goals are what you predict will happen when your nursing interventions are followed. your interventions are aimed at the data that support the existence of the problem (substance abuse, inability to cope with the current situation)

accepting his situation by the time his wound heals and accepting assistance provided by the nurse at the end of her visit makes no sense to me with respect to this specific diagnosis. it just doesn't tie into any of it.

nurse interventions

* will provide informations about the treatment, and prognosis.

this should be with a diagnosis of
impaired tissue integrity.

* will provide an atmosphere of acceptance

* will appraise adjustment to change in body image

if there is body image problem use a diagnosis of
disturbed body image
. however, i saw no evidence indicating there was a change in body image.

* will encourage the patient with behavior change,

how?

* will encourage the patient to be more assertive in providing care to his amputated leg.

again, this is not coping and doesn't belong with this psychosocial diagnosis. this is has to do with
impaired tissue integrity.

* will discuss the problem of alcohol abuse,

substance abuse was one of your symptoms for this patient's ineffective coping. this is really the only intervention you have for it. did you do any research on alcohol abuse? what can we do that is going to be helpful for someone who is an alcoholic and probably using the alcohol to cope with their problems? you really need to expand on this and develop more interventions relating to this since it was one of your patient's symptoms of this problem. even if
he
doesn't want to talk about alcohol there are other interventions that can be done because he is at risk for falls and injuries.

rationale for nursing interventions - none of these are appropriate rationales (reasons) for why you are performing the specific nursing interventions.

* pt doesn't demonstrate cooperating with the nurse,

* pt doesn't verbalize acceptance of his situation,

* pt doesn't let the nurse to do the dressing on his leg

outcomes not met

* pt refuses the assassinate in dressing change on his leg - no relevance to this diagnosis

* pt states, he doesn't need any help.

--------------------------------------------

i would construct this diagnosis differently and use different evidence to prove it's existence: ineffective coping r/t disturbance in pattern of tension release and inadequate level of control aeb became angry when talked to about following a diabetic menu plan and began shouting that he doesn't need anyone coming to see him.

outcome: client will answer visiting nurses questions without becoming angry and asking her to leave.

goal: client will talk calmly about how he has been dealing with his current dietary situation.

interventions:

  • ask the patient what he does to relieve his tension when he feels stressed
    • rationale: having the patient describe what works effectively helps him to use previous experience in adapting to present situations.

    [*]assess current ability to deal with stressors and persons available to help in his life

    • rationale: data collection is necessary to formulation of a plan of action.

    [*]note what specific subjects triggers patient to angry outbursts and avoid these topics.

    • rationale: identifying triggers help to target areas where skills are weakest.

    [*]use active listening and therapeutic communication skills to talk with patient about his diabetes, diet and amputation wound.

    • rationale: a safe environment provides the client with opportunities to open up and reveal information.

    [*]refer the patient to social services, if appropriate.

    • rationale: nurses are managers of patient care and provide a link between the client and other services that are needed.

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