Nursing Care Plan
Patient Assessment and Implementation of Nursing Model in Addressing Patient Care Goals
The patient being assessed is a 72-year-old female brought to the gynae ward for diarrhea and vomiting and generally unwell and weakness in addition to a non-productive cough. Medical history of this patient includes Alzheimer's, Left Nephrectomy, aortic repair, asthma, and mobility problems.
Problem Solving Approach: Patient/Client Problem
The two problems identified during the assessment are those of:
(1) Asthma; and (2) Alzheimer's.
Goal Statement
The goal of care is to instruct patient on coping with asthma and Alzheimer's through use of the Roper, Logan and Tierney model. This was the first model for nursing which had as its basis a model of living. The research arose from study of Nancy Roper in 1970 in which she "sought to identify the core of nursing activities across any field of nursing practice, which could then be supported by knowledge, skills and attitudes required to working the individual specialist's fields." (Holland, Jenkins, and Solomon, 2003) Roper, Logan and Tierney published the 'Elements of Nursing' in 1980, which identified the "individual aspects of the model as a whole and how nursing could use it as a framework for the care of patients in a wide variety of situations." (Holland, Jenkins, and Solomon, 2003) The model has two parts including: (1) the model of living; and (2) the model for nursing. (Holland, Jenkins, and Solomon, 2003) This model makes identification of "five factors associated with the condition of living" including:
(1) The need to perform activities of living;
(2) The nature of a person's lifespan;
(3) The presence of a dependence/independence continuum;
(4) Factors that can influence a person's ability to perform activities of living; and (5) A person's individuality. (Timmins and McCabe, 2009)
Activities of living are inclusive of:
(1) Maintenance of a safe environment;
(2) Communicating;
(3) Breathing;
(4) Eating and drinking;
(5) Eliminating;
(6) Personal cleansing and dressing;
(7) Controlling body temperature;
(8) Working and playing;
(9) Mobilizing;
(10) Sleeping;
(11) Expressing sexuality; and (12) Dying. (Timmins and McCabe, 2009)
The largest contribution made by the RLT model is "individuality in living…assisting nurses to move away from what Fawcett (1999) terms 'romance' with the medical profession, manifested by preoccupation with the medical approach, which isn't always appropriate for nurses or patients." (Timmins and McCabe, 2009)
Considering the individuality of the patient is reported to make provision for "a more meaningful and personalized approach to patient care." (Timmins and McCabe, 2009) The RLT framework makes provision of a chance for the nurse to interview not only the patient but their family as well and to document the problems and needs of the patient in regards to each particular activity.
Nursing Care Plan One - Asthma
The nursing care plan for the patient with Asthma addresses the following daily living activities:
(1) Communicating;
(2) Breathing;
The nursing care plan for this patient with asthma includes the following:
1. Maintaining the patient's respiratory function and relieving bronchoconstriction while allowing mucus plug expulsion.
2. Controlling exercise-induced asthma by having the patient sit down, rest, and use diaphragmatic and pulse-lip breathing until shortness of breath subsides.
3. Supervising the patient's drug regimen.
4. Demonstrating the proper use of metered doe inhaler properly.
5. Reassuring the patient during an asthma attack and stay with him.
6. Placing the patient in semi-fowler position and encourage diaphragmatic breathing.
7. Assisting the patient to relax as much as possible.
8. As ordered, administering oxygen by nasal cannula to ease breathing and to increase arterial oxygen saturation during an acute asthma attack.
9. Adjusting oxygen according to the patient's vital functions and ABG measurements.
10. Administering drugs and I.V. fluids as ordered.
11. Combating dehydration with I.V. fluids until the patient can tolerate oral fluids, which will help loosen secretions.
12. Encouraging the patient to express his fears and concerns about his illness.
13. Encouraging the patient to identify and comply with care measures and activities that promote relaxation. (Nursing File, 2011)
Nursing Care Plan Goals - Asthma
The goals in the nursing care...
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