Student28

i need help! i am pulling my hair. i tried several care plans but my instructor still not happy with some part of it. i have two exams tomorrow and my paper is due tomorrow. i am about to give up doing it again but i cannot because it is graded satisfactory/unsatisfactory. this is gonna be third time. please help. here is the medical diagnosis, my assessment on my patient and nursing diagnoses i came up with. hypertension, gerd, obesity, hypothyroidism, anemia, type ii diabetes mellitus, syncope episodes,hyperglyceridemia she is 89 yrs old, 180.8 lbs and 64 inches. neurological: alert, oriented to time, place and self. cranial nerves intact by showing responds to the stimulus such as touching, hearing, eye movements. cardiovascular: radial pulse is present, strong, irregular, and 78. dorsalis pedis pulse is present but weak. gastrointestinal: abdomen soft, bowel sounds are present on four quadrant. appetite is ok. eating 50%, 50%, less than 50% of her breakfast, lunch, and dinner, respectively. drinks 1680ml fluids. musculoskeletal:rom is limited bilaterally on lower and upper extremities. no loss of range in the neck. needs assistant 2 or more for transfer to a chair. genitourinary/reproductive: incontinent bladder and bowel elimination. one bowel movement/day and 3 bladder elimination/day. skin/integumentary:dry skin, no pressure ulcers. some scratch marks on the hip due to itching. edema +1 on ankles, bilaterally. healing bruise on right first metaphalangeal joint, presents no pain. feet feel cool. incisions and drains: big vertical incision on stomach. belly button is removed during surgery. pain: pain on right knee. on a scale 1-10, pain is 3 during ambulation. pain lasts 5-10 seconds and ends when no ambulation. and here is my nursing diagnoses nursing diagnosis #1: risk for fall r/t: impaired physical mobility, impaired balance, difficulty with gait, anemia, decreased lower extremity strength, elderly, aeb: bruise in her right great toe. goal: the client will remain free of falls. interventions: rationale for intervention: expected outcome: (measurable) keep the call light, bed side table, water, glasses, and such within the client's easy reach. these are to prevent fall. the client will not experience fall. have the client wear supportive low-heeled shoes with good traction when ambulating. supportive shoes provide the client with better balance and protect the client from instability on uneven surfaces. the client will express that wearing supportive shoes are important to keep the body balanced. ensure that the chair or wheelchair fits the build and needs of the client to ensure with minimizing problems with shearing. wheelchair should fit the client so that the client will not slide out of wheelchair, flip out of wheelchair or attempt to rise unsafely from uncomfortable chair. the client will demonstrate that she can move the wheels comfortably, stand up from the chair with facing no issues or will not complain about comfort. prevent the client from staying in bed for extended periods of time. ambulation during the day increases muscle tone, balance and decreases the fall risk. the client will participate in spending more time out of bed during the day. encourage the client to eat a balanced diet, with particular inclusion of vitamin d and calcium. lack of vitamin d and hypocalcemia are common in older adults, contributing to falls, musculoskeletal weaknesses, leading to functional and mobility deficits the client will state the importance of taking vitamin d and calcium supplements to support bone system. teaching/discharge planning: rationale: expected outcome: teach fall prevention techniques, such as sitting up for a moment before rising from the bed. especially, in frail elderly, orthostatic hypotension is important. moving from laying position to standing up position should be in stages. the client will perform the fall prevention technique before rising off bed. instruct the client and family or caregivers on how to correct identified hazards such as extension cords, scatter rugs unsafe stairs. home visits by health professional to assess and modify the home environment prove to be effective to reduce the number of falls. the family and client will state to correct hazards at home. teach the client how to safely ambulate at home, using safety measures such as grab bars in bathroom, and need to avoid performing other tasks while ambulating. in the frail elderly, multitasking results in being things rushed to get done and may lead to falling. the client will state that she will not multitask and get things done one at a time. teach the client the importance of maintaining a regular exercise program. lack of a consistent exercise program was one of the variables associated with a higher incidence of falls. the client verbalizes that maintaining continuous exercise program is important. nursing diagnosis #2: risk for injury r/t: body mass index greater than 30, pain musculoskeletal impairment, intolerance to activity/decreased strength and endurance, discomfort, sedentary lifestyle, disuse, decreased muscle strength, loss of integrity of bone structures, joint stiffness or contractures, lack of physical or social environmental supports. aeb: no ambulation by herself even in the wheelchair. during rom exercises, needs assistance to complete the action and during transfers to a wheelchair, hoyer-lift use is required. goal: the patient will report an increase in strength and endurance of extremities interventions: rationale for intervention: expected outcome: (measurable) put a bed-side cushion such as strong mat placed on the floor next to the bed. this is to prevent likelihood of serious injury by falling onto hard surfaces. the client will not have serious injuries in case of falling off the bed. consult with physical therapist for further evaluation, strength training, gait training, and development of a mobility plan. techniques such as gait training, strength training, and exercise to improve balance and coordination can be very helpful for rehabilitating clients. the client will demonstrate the improvement by walking with help/no help. increase independence in adls, encouraging self-efficacy and discouraging helplessness as the client gets stronger. providing unnecessary assistance with transfers and bathing activities may promote dependence and a loss of mobility. the client will express that she is able to do some adls independently or with some dependency. if the client does not feed self, put your hand over the client's hand, support the client's elbow with your other hand, and help the client feed self. this feeding technique increases client mobility, range of motion, and independence, and clients often eat more food. the client will demonstrate to eat with some help or no help depending on the seriousness of her condition. if the client is immobile, perform passive rom exercises at least once a day repeating each move three times. inactivity rapidly contributes to muscle shortening and changes in joint structure. the client will start doing exercises by herself showing that muscle strength is achieved. teaching/discharge planning: rationale: expected outcome: assessing home environment for factors that create barriers to physical mobility. it is to continue to improve the client's mobility exercises in the home without any interruptions. client demonstrates that she understands the instructions to continue exercises. providing support to the client and family/caregivers during long-term impaired mobility. long-term impaired mobility may necessitate role changes within the family and precipitate caregiver stress. family members understand that they will participate in improving the client's mobility. referring to physical therapy for strength training and balance training. physical therapists can provide direct interventions as well as assess need for assistive devices. client will increase the mobility with the help of physical therapist. teaching family members and caregivers to work with clients during self-care activities such as eating, grooming, dressing rather than having the client be a passive care recipient. maintaining as much independence as possible helps maintain mobility skills. family members/caregivers demonstrate understanding that they should help the client only when her own ability is not sufficient to complete the task.