Need Help on Care plan for post CVA

[luckynurse7]

Hi all, I am a student and in need of any assistance I can get with a nursing care plan. Background on the patient: the scenario is the patient is at home and I am their home health nurse. 75 year old female post CVA 5 days ago. She is confused, has impaired memory, difficulty swallowing, and a focus on fear of dying. For my nursing diagnosis I have fear r/t fear of dying as evidenced by patient stating "help me I feel like I'm going to die" and increase in heart rate from 85 bpm to 130 bpm. I am struggling with the client outcomes as she is confused and responses are inappropriate. She will not be able to identify or demonstrate teaching. What are realistic outcomes that you expect with patients who are not alert and oriented? Any help is greatly appreciated.

[caliotter3]

You need to post in the student forum. This is the home health forum.

[Double-Helix, BSN, RN]

It seems to me that your patient may have more pressing issues than her anxiety.

You mentioned difficulty swallowing. What does dysphagia put her at risk for while she is trying to eat and drink? What interventions are required to ensure that she can meet her fluid and nutritional requirements safely? What is a realistic goal for her intake that will meet these requirements?

She is confused and has impaired memory. Is she ambulatory? Continent? If yes, what is an elderly, confused woman at risk for while ambulating around a home? If no, what complications is an elderly, immobile, incontinent woman at risk for? What interventions will you employ to minimize those risks? (Hint: Your goal outcome is that the patient does not experience any of these complications.)

[ruby_jane, BSN, RN]

For my nursing diagnosis I have fear r/t fear of dying as evidenced by patient stating "help me I feel like I'm going to die" and increase in heart rate from 85 bpm to 130 bpm.

Feeling of impending doom. When you auscultate lungs, what might you be listening for?

[Here.I.Stand, BSN, RN]

Feeling of impending doom. When you auscultate lungs, what might you be listening for?

This. I'll share a handful of "help me I'm dying" anecdotes; consider if fear is the issue, or a symptom of something more.

1) One of my kids woke up in the middle of the night coughing and then started crying "mommy help me, I can't breathe. Please help me, I don't want to die." As she was speaking she became stridorous and was barely able to get the words out.

She had developed croup and had a sudden onset of laryngeal edema, and thus not moving air adequately.

2) Subacute rehab pt c/o malaise. VS were normal but a bit sweaty on forehead. Then says, "I feel like I'm dying." With THOSE words, the NP says "we're sending him out. If someone says they're dying, I'm listening."

He was having an MI.

3) C4-5 quad in early 20s, again everything looks normal, but feels something not right, and asks "Am I going to die?"

He had silently aspirated and had pneumonia. Unfortunately he did succumb.

4) Man POD#2 from a heart transplant. He was still intubated so couldn't talk, but started flailing around and banging on the siderails.

Looked down at his chest tube filling with frank blood.

Surgeon called the OR on her cell, telling them to get ready. His anastomosis had come apart, and he was bleeding out inside. Later, stated he had that impending doom feeling.

So yeah... if someone says that, we need to listen. Start with those pulmonary and cardiac assessments. First among your subjective data: sense of impending doom.

[KelRN215, BSN, RN]

If the patient is at home, presumably she has a caregiver who can participate in teaching?