NR226 Fundamentals – Patient Care PDF

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Running Head: PATIENT CARE RUA: CONCEPT MAP 1

NR226 Fundamentals – Patient Care RUA: Concept Map Name Institution Instructor Date

PATIENT CARE RUA: CONCEPT MAP

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Individual information Our patient, Bob Nick is a 76-year old white male, windowed after divorce in 2006, and his kinship bestowed to his only daughter. Bob is a retired American army soldier who has been in a nursing facility since admission in 2018. In the nursing care facility, bob has been diagnosed with age-related osteoporosis, smoking, hypertension, vascular implants, and the kidney's cyst. He has also been established to have a history of falls, including hyperkinemia, dehydration, cognitive-communication deficits, and evidence of depressive disorders. Bob has no problem with Cardiopulmonary resuscitation (CPR) procedures. Hypertension and osteoporosis are two of the common ae related diseases that result from environmental interactions as well as genetic factors. Bob, being an aging man, has a high affinity to these conditions. According to Ye and Liu (2017), the number of patients with osteoporosis and high blood pressure increases every year. High blood pressure patients are characterized by excess urinary secretion and increased calcium serum levels induced from secondary parathyroid released from the bone. When the patients' bones lose calcium salts, osteoporosis may be induced. The disease, as indicated by Carpentino (2013), tents to effects the vertebrae bone in men. The disease can also be accelerated by individual behaviors such as smoking, light bine structure, and increased age of the person. Primarily, the risk of osteoporosis is lower for men than women, but it can result in lifetime problems in the wrist, hip, or spine. The two diseases co-exist together and lead to increased risks of mortality and morbidity. Bob is being treated with sustained supplements of vitamin D every day. The patient is also advised to limit alcohol and maintain some increased levels of physical activity. As written in the Gould's Pathophysiology for Health Professions (2014), recurrent stress and increased alcohol intake levels

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cause high blood pressure. High sodium intake age diseases cause such as trends increasing the level of blood pressure above 140/90 mmHg (VanMeter & Hubert, 2014). Other numerous medications such as maintenance of a healthy weight, heathy diet, limiting drugs and alcohol and limiting the amount of salt intake.

Assessment The patient was found in a recumbent position, in an appropriate mood and alert for the situation. GCS 15/15 (4)(5)(6). The patient's sensory and mental functions were intact, presented in the good pose, normal obesity, and proper nutrition. Hair was white and perfect, no nail clubbing or the presence of head infestations to palpation and CN VII was intact. Skin, dry, and warm elastic turgor present while the patient displays smiley and frown facial eyebrow expressions. CN II, III, IV, and VI six cardinal gazes were demonstrated as intact. The patient worn glasses for proper vision and also demonstrated normal conversational abilities. CN IX, X, XII intact. The asymmetrical appearance of nose to face while the patient demonstrated perfect small abilities. The patient would swallow, uvula, and Medline intact, and he wears sets of dentures. Lips are dry and able to clinch the jaw. CN V intact. The patient can vocalize easily, with no goiter or trachea midline lesions. Lung field clears bilaterally to auscultation anteriorly and posteriorly, no adventitious sounds noted. Apical pulse rate and rhythm regular. Normal S1 and S2 present to auscultation in five cardiac areas. Carotid, radial, and pedal pulses palpable and equal bilaterally, 2+. Active bowel sounds present in all quadrants. The abdomen was soft, non-tender. Last BM this afternoon, small, soft,

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semi-formed. There was bilateral strength in the body as the shoulders and elbows shown unlimited ROM. The joints have no deformities or swelling. There is some ulnar deviation in the finders, and a low body demonstrated a little weakness. The patient is assisted when moving to the wheelchair and has denied numbing in extremities. He also uses the sliding board and can ambulate on himself. The patient can flex toes but unable to bend the hip actively. There is limited ROM passively in the knee and hip joints, and very low muscle strength in the lower body. Edema noted in the pink area slightly while the upper leg skin is warm, consistent and has normal pink. There is loose skin, possibly due to aging trends: lower right leg, posterior calf, positive for cellulitis.

Reflection Communication and safety Therapeutic communication was maintained in the whole intervention process. Throughout, I tried to use a friendly tone while avoiding a professional jargon arising from unnecessary pieces of advice and trap interviews such as 'what and why' questions. I tried to make use of my nonverbal skills, such as maintaining eye contact when the patient is speaking, maintaining an upright posture, and creating an environment of positivity in the smile. This induced active communication. With a friendly mood, the environment became comforting for the patient as much as possible. I also created a friendliness mood by placing my hand on his shoulder while he is talking. This ensured progress to the desired goal.

PATIENT CARE RUA: CONCEPT MAP

Moreover, safety precautions we maintained to the best levels throughout the process to avoid more problems. Every time the client was at rest in the wheelchair, I ensured the wheels were locked to avoid fall. I also lowered the bad to every time I have shown my back for the same purpose. Hand hygiene is very vital to reduce more infections to the patient, especially during this covid-19 era. All equipment's handled is sanitized, and I will be wearing protective gloves when perfuming other measures such as changing his clothes. Hand hygiene is strictly followed before and after the process in the patient's room.

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Concept map

Mobility problem: osteoarthritis, osteoporosis and decrease in muscle strength shown by use of wheelchair, low ambulation and the

Short Term Goal: increase in dynamic posture and siting for 30 minutes in the bed.

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The patient should know the important of maintain good posture (Kilic, 2017). Use bed rails for upright siting Increase out of bed time and wheelchair Measure vitals to track orthostatic fluid shift (VanMeter & Hubert, 2014).

Outcomes:  During meals, the patient maintained proper posture.  The patient maintained head up while talking.

Long Term Goal: Care burden will be reduced, as the patient will be able to use assistance tools.

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The patient shown how to use proper body mechanics while practicing pose. The patient should how to pivot from bed to wheelchair. Most important is to learn to how to use the sliding board from bed

Outcomes:  Patient learned how use the board.  Caretaker duties reduced.

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Walking difficulty, Loss of muscle strength and high immobility shown by high history of falls.

Short Term Goal: the patient to verbalize to the nurse to use of personal safety tools

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The patient should be educated to keep call light in reach. Instructed on how to use bed rail to avoid falling. Orient him on the whole facility. Highlight him on wearing non-skid shoes and sandals. Door signs, wrist and other fall risk signs should

Outcomes:  Patient expressed understanding of all safety measures.  Patient reminded the nurse of more safety measures.

Long Term Goal: the patient should not demonstrate any fall for more than 21 days.

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Educated on how to use body mechanics properly to avoid fall. The nurse regularly checks the patient to ensure he is properly seated (Kilic, 2017). Footrests on wheelchair, non skid sandals and other measures taken to avoid fall.

Outcomes: Goal outcome not yet met and will be reevaluated in 3 weeks.  The patient is showing progress in safety utilization and use of body mechanics.

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Depressive disorder related disoriented copying: shown by sentiments such as lonely feeling and frequent sadness.

Short Term Goal: patient should be able to communicate few measures to improve mood.

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Close medical administration especially stress related antidepressants. The nurse should discuss past copying strategies alongside their success. Introductive activities such as sewing and writing to divert attention to sad moments (Kilic, 2017). Be approachable by the patient.

Outcomes:  Some useful activities met by the patient.

Long Term Goal: engaging in a team task for at least once every 30 days.

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Patients should be allowed to identify positive hobbies of interest. The patient should be encouraged and allowed to join team clubs of her choice. Spent time a day with the patient. Patients encouraged to help nurses in activities such as folding clothes. Make sure the patient observes medication closely.

Outcomes: Not yet achieved but will be revaluated at the end of 30days. However, the patient has been showing positive progress on the activities.

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References

Ye, Z., Lu, H., & Liu, P. (2017). Association between essential hypertension and bone mineral density: a systematic review and metaanalysis. Oncotarget, 8(40), 68916. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620307 Carpentino, L. J. (2013). Handbook of Nursing Diagnosis (15th ed.). Philadelphia, Pennsylvania: J.B. Lippincott Company. VanMeter, K. C., & Hubert, R. J. (2014). Gould's Pathophysiology for Health Professions (5th ed.). St. Louis, MO: Elsevier Saunders. Kilic, S. (2017). Is Activity Intolerance One of The Nursing Diagnosis for Patients with Depression? Journal of Psychiatric Nursing,8(2), 127-128. Retrieved April 1, 2018....