Scenario for nursing care plan - need help.

[sostuck]

Hi,

I am highly stuck with an assignment. It is in two parts. In the first part of the assignment, I have to identify four nursing diagnoses with rationale and prioritization and one patient-centered goal for each diagnosis with an explanation for the goal. I am stuck with which diagnoses to use and the prioritization.

This is my scenario:

You are a registered nurse employed by a residential aged care facility to undertake comprehensive nursing assessments, develop care plans, and monitor the implementation and evaluation of this care.

Mr. Bonnici is 68 and was admitted to the aged care facility two days ago. Mr. Bonnici speaks little English, refuses to take his medications, and spends much time lying on his bed. When approached by a staff member, he speaks rapidly and loudly. Mr. Bonnici has a reddened area at the base of his spine and right elbow. He is overweight, has mild right-sided weakness from a stroke (Cerebral Vascular Accident - CVA), mobilizes independently with a frame, and has a history of severe right-sided shoulder pain. He has had no bowel actions since entering the facility.

I have had so many thoughts about this, and they keep changing that I cannot write the assignment.

I was thinking:

Impaired skin integrity (reddened areas - pressure ulcer) is priority one

Constipation (no bowel action) is priority two

Chronic pain (history of severe right-sided shoulder pain) priority three

Noncompliance (refusing to take medications) is priority four

Any ideas, tips, or suggestions?

Thanks.

[nyashan]

Man is spending much time in bed and may want to know why. Psychiatric symptoms?

Little or no English that needs addressing. Otherwise, one cant assess him holistically.

[itsmejuli]

Check this out https://allnurses.com/nursing-student-assistance/check-here-first-272271.html

Also, check out the stickies at the top of the General Nursing Student discussion forum.

Love, love, love all the assistance available on All Nurses!

[nbocock]

I am looking at the same Essay; I just googled the same scenario!

Umm, looking at;

1 Non-compliance ummm this can include pain management - it refers to the pain as history (maybe previous pain)

2 Skin Integrity (the area is already red 1st stage ulcer and the complications that can come of this)

3 Depression (treating Depression will see the patient improve on all levels of health care)

4 Constipation ( the health measures with the above health conditions will assist in bowel movement anyway

I hope this helps!

You must find references to back up all this and read, read, read!

Good luck.

By any chance, are you from Whyalla?

[getyournursingon]

risk for injury (stroke)

[FazzDazzle]

Impaired coping r/t new environment, the language barrier.

This is up since his inability to cope affects his willingness to accept care. There are many therapeutic interventions available to help this pt. Some of your goals could be that he will get out of bed to explore the new facility (willingness to walk down the hallway in the next two days..also helps with his constipation and pressure ulcer), willingness to accept medication and effective communication between staff. A definite intervention would be to get an interpreter and an English language dictionary for the team to use when communicating with him.

I usually put pain (chronic or acute) before constipation. If your point is experiencing pain, this will impair their ability to participate in activities that improve bowel movement. Always remember that pain is assessed with vital signs, so it takes high priority for NDs.

Good luck! ?