how would you respond to this question

remember that you always have the nursing process to help you of any jam (problem) and you will never go wrong if you follow the steps in sequence because they keep you thinking rationally. i am a med/surg nurse and would approach this as a med/surg nurse.

1. assessment
   (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
   
   
   • a physical assessment of the patient
     
     
   • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
     
     
   • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
     
     
   • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.

• it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
  • your instructors might have given it to you.
    
    
  • you can purchase it directly from nanda.
    nanda-i nursing diagnoses: definitions & classification 2007-2008
    published by nanda international. cost is $24.95
    http://www.nanda.org/html/nursing_diagnosis.html
    
    
  • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
    
    
  • the nanda taxonomy and a medical disease cross reference is in the appendix of both
    taber's cyclopedic medical dictionary
    and
    mosby's medical, nursing, & allied health dictionary
    
    
  • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    • http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
      
      
    • http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm

• goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
  • improve the problem or remedy/cure it
    
    
  • stabilize it
    
    
  • support its deterioration
  [*]interventions are of four types
  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
    
    
  • care/perform/provide/assist (performing actual patient care)
    
    
  • teach/educate/instruct/supervise (educating patient or caregiver)
    
    
  • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

even though you might inherently figure out that this has some psychosocial components to it there is still nursing care involved. step #1 of the nursing process directs you to assess. so, collect data. the patient wants to know about recovery. this involves knowledge of recovery and rehab. step #2 is going to lead you to a conclusion that she is looking for is information and some hope (the problem is most likely deficient knowledge, prognosis and/or a risk of hopelessness). before saying anything, however, find out what she already knows--assess her. ask, "what have you been told?" get her to talk specifically about what the doctor and any of the therapists have told her. get her to repeat to you what goals they have set. look at their documentation. read up on the type of stroke mrs. j has had, it's treatment and rehabilitation and what recovery can be expected. then move on to step #3 planning and intervention, where you might decide to explore mrs. j's feelings about recovery, but do not give her any specific "yes" or "no" answers because it really isn't possible to know. some patients respond well to stories of recovery by others if you know of any. part of giving the patient hope is educating them about their recovery process and what they will be experiencing, how long it will take, etc. the website of the national stroke association (http://www.stroke.org/site/pagenavigator/home) has some terrific information you can utilize to help you answer this scenario. btw, stroke is one of the biggest reasons people are hospitalized and enter acute hospitals for initial treatment, so you are likely to see a lot of mrs. j's in the coming years if you work in an acute hospital. so, there are important issues to learn about here.

• http://www.stroke.org/site/pageserver?pagename=hope - hope: the stroke recovery guide