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Implementing Evaluating A Plan Nursing Care

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Question:

Discuss About The Implementing Evaluating A Plan Nursing Care?

 

Answer:

Introduction

The actual problem in Mr. Pope’s situation is that she is highly malnourished to an extent that she may potentially encounter muscle weakness, dizziness, and may also be at high risk of contracting diseases (Verlaan et al, 2017). However, the most prominent potential problem to be encountered by Mrs. Pope is an unintentional loss of weight which may be at the rate of 5% to 10% within 3 to 6 months (Bowers, 1999).

The assessment will begin by measuring Mrs. Pope’s (the client’s) weight, body mass index (BMI) and triceps skinfold thickness (compared to a normal of >13mm). Next, there will be an assessment of her skin colour (may be pale in case of malnutrition). The patient may also appear thin and have less serum albumin and serum cholesterol than required. According to Bowers (1999), this will sum up to a protein-calorie malnutrition diagnosis with proper recommendations for calorie intake made.

Goals and Expected Outcomes

Depending on the assessment, it may be recommended that the patient should gain at least one pound per week. Similarly, as part of the plan, the nurse will be expected to verbally explain the nutritional requirements and the strategies required to ensure that the nutritional requirements are incorporated into the client’s diet upon discharge (Verlaan et al, 2017). Ultimately, it is an expected outcome that the patient will remain free of infection.

As part of the actions, the nurse will ensure that the client is weighed weekly at a specific time of the day to keep a record of the progress. Secondly, as recommended by Verlaan et al (2017), the nurse is expected to teach the patient’s caregiver on basic nutritional requirements besides designing a program that would guide the patient on how to eat the recommended food nutrients ( e.g. high calorie or high protein). However, the program should also incorporate the patient’s preferences (Bowers 1999). Finally, the client must be guided on how to reduce the risk of infections.

To ensure that the client’s situation is closely monitored even after discharge, she will be asked whether she feels more energetic. Likewise, as Bowers (1999) recommends, the Miss Goodey will be asked to assist in purchasing food that will ensure she maintains the required calorie and protein levels.

 

Psychosocial consequences faced by Mr Pope during her association with Miss Goodey

Bowers (1999) defined psychosocial problems as those associated with work, relationships or schools. While older people may experience stressors that are common to other people, they are also highly susceptible to other problems which are common to people in later stages in life. For instance, due to the age difference between Mrs. Pope and Miss Goodey, Mrs. Pope might have faced isolation, or loneliness because of lack of peers to interact with (Verlaan et al, 2017).

As mentioned earlier, a major potential problem to be encountered by Mrs. Pope due to her status of malnutrition include is high susceptibility to diseases. To prevent this, strategies such as maintaining hand hygiene, environmental hygiene, vaccination and care coordination between the Mrs. Goodey and the nurse can be of great help in reducing the risk of disease infection (Verlaan et al, 2017).

To discharge the patient, I would enrol the patient to a nutritional support program close to her home for 4 to 6 months, where she would be exposed to a prescribed diet for the first two months and varied nutritional diets in the subsequent months until she gets stable (Bowers 1999). If there is no nutritional support program near her home, I would refer them to the nearest health center for a continued monitoring and evaluation.

I would assess my client’s cognition levels through a clinical neuropsychological assessment which involves a detailed interview with the client together with a close family member. Argued by Rao & Sarkar (2017) as the gold standard for cognition assessment, neuropsychological assessment entails a study of the client’s history together with the family member’s representation of the nature and cause of their cognitive impairment. Hence, to conduct a successful neuropsychological assessment, I would be required to have previous psychological and medical reports of the patient to help develop a hypothesis of what could be the cause of a patient’s cognitive impairment.

Nursing Interventions to Promote Cognitive Wellness

A major intervention for promoting cognitive wellness among aged patients is cognitive intervention. Based on the neuroplasticity theory, cognitive interventions such as processing efficiency training can improve mental processing while teaching cognitive strategies such as mnemonics have been proven to compensate for lost cognitive abilities (Rao & Sarkar, 2017). Equally, as Shu-Ying & Ting-Yueh (2017) mention, psychotherapy has been a major intervention towards cognitive wellness because it helps eliminate symptoms of cognitive decline such as anxiety, irritability, and depression.

Xie (2017) supports nutrition and physical activity as good interventions. On the other hand, Kalyuga (2008) and Shu-Ying & TingYueh (2017) agree that cognitive training is among the best strategies. However, other studies (Hwang & Hwang, 2008) suggest that a successful introduction of these interventions to aged patients requires a deeper understanding of their personality and preferences, as some techniques may not achieve a high success rate with some kinds of personalities.

Firstly, observe what is inside to prepare for the weight and check the condition of the box to prevent of dropping the box if it has rips (Van der et al, 2015). Secondly, ensure that the route towards the storage is clear to avoid stumbling and tripping off with the box. Thirdly, keep the back straight before firmly gripping the sides of the box for a slow lifting. Fourthly, while carrying the box, the carrier should keep their back straight and never to twist at any given point because twisting may cause injury. Finally, while placing the box down, the carrier’s back should be straight before shifting the box to their legs and squatting to place the box gently on the floor.

Assisting a Client to Stand and Move to a Chair/Bed

The client should be asked to put his/her hands on the chair’s armrest, before leaning forward and moving to the front of the chair. The next step is to ask the client to put their feet on the floor while keeping it under their knees and within the hip width. The client should then be asked to lean forward while still in a sitting position so that her nose is over the toes and upper body over and above their knees. The nurse can then confirm if the client is ready and steady; telling them to rock gently before asking them to push to a standing position while supporting themselves on the armrest (Bernadette et al 2009). To sit on next chair/bed, the client is asked to use back of their legs to feel the bed/chair and gently lower themselves to the bed/chair upon reaching for the armrest (Van der et al 2015).

For a safe sit-up, the nurse should first be as close as possible to the patient – by seeking support on the patient’s bed (Bernadette et al, 2009). Next, the nurse should talk to the patient explaining to him/her how to keep the correct posture by keeping the spine in its S-curve natural shape, keeping the eyes and head facing straight ahead. Likewise, it is important to get a firm grip on the patient as they gently sit up (Van der et al, 2015).

According to Darabi et al (2016), performing a nutritional assessment is to develop a good intervention and improving the client’s health by identifying changes in their lifestyles. The first step is to collect clinical data of the patient including their weight and BMI. Similarly, I would take the nutrition history of the patient including their eating disorders, food preparation and the micronutrient levels in the food intake to be considered while designing a diet plan for the patient (Argyri et al, 2011). It is also important to monitor the client’s weight history and history of physical activity before assessing the food preparer’s knowledge of the patient’s targeted blood glucose levels (Darabi et al, 2016).

 

Strategies to Reduce Negative Outcomes and Effects of the Home Cooked Meals on Diabetes

The patient should take foods with a low glycemic index to have a modest rise in blood sugar (Argyri et al, 2011). Similarly, there is a need to establish proper meal timing, and the meals must match with the insulin doses to ensure that the body has time to respond to insulin doses. Likewise, it is important for the patient not to skip meals as this may lead to hypoglycaemia (Darabi et al, 2016).

Educational Direction on Long-Term Effects of Raised Blood Glucose Levels

I would first inform the patient about the possible macro vascular complications which include damages on the legs, brain and heart vessels. Similarly, I would inform the patient about possible micro vascular complications which entails the damage of feet, kidney, and eye blood vessels (Argyri et al, 2011). I would then educate the patient on how to minimize the possibilities of these effects.

Instructions for Procedures

An eye bath is usually undertaken when a toxic substance accidentally enters the eye. In case of this emergency, the victim should:

  1. a) Move immediately to the eye washing station
  2. b) Activate the flushing unit according to the operating instructions
  3. c) Position the eyes directly on the flushing stream
  4. d) Keep the eyes wide open by holding eyelids apart
  5. e) Roll the eyes gently in an anti-clockwise direction so that the fluid reaches all areas of the eyes
  6. f) Continue flushing the eyes for 15-20 minutes so that the chemical/toxic substance is fully diluted
  7. g) Upon flushing, victim should visit a doctor for further directions.

Changing a Dressing

According to Verlaan et al, (2017), this procedure is normally undertaken to ensure that the wound dries as first as possible. The author further suggests the following steps to be followed:

  1. a) Wear non-sterile new pair of gloves
  2. b) Place the preferred packing tape or gauze pads on a bowl with saline
  3. c) Squeeze the packing tape until saline no longer drips
  4. d) Carefully cover the wound with the wet packing tape, leaving no spaces under the skin
  5. e) Cover the wet packing pad with a dry dressing pad larger in size before holding the dressing in place with a tape
  6. f) The used supplies should then be put in a securely closed plastic bag before putting it in a second closed plastic bag and trashing it
  7. g) Wash hands upon finishing

I would greet the patient with their first name. In this manner, the patient will feel more secure and confident with me. This also builds an incredible relationship between the carer and the patient, creating more room for proper engagement during the procedure (Tateaki et al, 2017).

Techniques Used To Assist an Elderly Patient Shower, Shave and General Personal Grooming

First, bathing should be done only as often as necessary if the patient finds a difficulty in bathing. While it may be possible to avoid a daily bath, carers must ensure that the patient’s genital area, hands, and face are washed daily. Before conducting the bath, the carer must ensure that all the bathing supplies are ready and that the room is kept comfortably warm. An electric shave is recommended due to its safety and ease of use. However, the patient must be in a sitting position and they must have dentures in their mouths too before shaving (Dahl et al, 2015).

 

Oral hygiene

I would ensure the patient’s mouth is cleaned on a daily basis, and that the dentures are regularly checked for cracks. I would also remove the dentures for regular cleaning and store them in clean water while not in use (Tuncbilek & Senol, 2016).

Documentation to Be Completed During the Day

I would maintain a grooming and dressing checklist and accident reports to ensure that all the grooming activities are executed and that any accident that occurs during the day is recorded.  

6.5 Items to be noted in the Progress Notes for an Adult Daily Care

  1. a) Client’s emotional changes
  2. b) Client’s physical changes and
  3. c) Client’s behavioural changes
  4. Case studies
 

How to Prevent Valdi’s Frustration and anger

Valdi could be assisted by making the instructions more easy and simple to understand, besides avoiding too many questions or statements at once.

Fulfilling Religious Needs of the Care Patients

To assist Farzan to meet his religious needs, it is important to let him know that the hospital respects his religious status and gives him the liberty to exercise the rights associated with the religion. However, the patient can be made to understand that having two caregivers five times a day may be impossible for the hospital. Thereafter, the hospital can negotiate with the client to reduce the number of prayer sessions to accommodate the hospital’s routines (Verlaan et al, 2017).

 

References

Argyri, K, Sotiropoulos, A, Psarou, E, Papazafiropoulou, A, Taouxis, M, Zampelas, A, & Kapsokefalou, M 2011, 'Desserts of modified composition have a positive effect to postprandial glucose and insulin response in diabetics', Hellenic Journal Of Nutrition & Dietetics, 2, 1, pp. 37-45.

Bowers, S 1999, 'Nutrition Support For Malnourished, Acutely Ill Adults', MEDSURG Nursing, 8, 3, p. 145.

Bernadette, P, Leonie, D, Yvonne F., H, Johan, M, P. N. Richard, D, & Jan H., V 2009, 'Development of a Battery of Instruments for Detailed Measurement of Health Status in Patients with COPD in Routine Care: The Nijmegen Clinical Screening Instrument', Quality Of Life Research, 7, p. 901.

Darabi, A, Pourafshar, S, Suryavanshi, R, & Arrington, T 2016, 'Comparison of three instructional strategies in food and nutrition education: developing a diet plan for a diabetic case', International Journal Of Science Education, 38, 7, pp. 1197-1211.

Dahl, U, Johnsen, R, Saetre, R, & Steinsbekk, A 2015, 'The influence of an intermediate care hospital on health care utilization among elderly patients - a retrospective comparative cohort', BMC Health Services Research, 15, 1, pp. 940-966.

Hwang, G, Tseng, J, & Hwang, G 2008, 'Diagnosing Student Learning Problems Based on Historical Assessment Records', Innovations In Education And Teaching International, 45, 1, pp. 77-89.

Kalyuga, S 2008, 'When Less Is More in Cognitive Diagnosis: A Rapid Online Method for Diagnosing Learner Task-Specific Expertise', Journal Of Educational Psychology, 100, 3, pp. 603-612.

Rao, S, & Sarkar, A 2017, 'Beneficial Effects of Exercise on Cognitive Decline in Old Age', Indian Journal Of Gerontology, 31, 4, pp. 423-429.

Shu-Ying, T, & Ting-Yueh, C 2017, 'Research on Outdoor Environments and Activity Behavior of Senior Citizens with Dementia - A Study in Taipei City', Applied Mechanics & Materials, 865, p. 605.

Tateaki, N, Taro, O, Takashi, A, Takuya, O, Yoshiyuki, M, Madoka, K, Hitomi, S, Haruyasu, M, Hirotsugu, K, Tetsuhiko, T, Akira, O, Kazushige, W, Hisao, I, Takuya, O, Takeshi, I, Shota, O, Kazuhisa, N, Masahiro, E, Katsuhiro, O, & Keita, M 2017, 'Unfavorable impact of cancer cachexia on activity of daily living and need for inpatient care in elderly patients with advanced non-small-cell lung cancer in Japan: a prospective longitudinal observational study', BMC Cancer, 17, pp. 1-10.

Tuncbilek, Z, & Senol Celik, S 2016, 'Nursing diagnoses and interventions in the care of elderly patients undergoing surgery', Expert Review Of Pharmacoeconomics & Outcomes Research, 16, 1, p. 17.

Van der, S, R. A., G, R., B, F. Galindo, G, J., E, T. J., H, & N. L. U. van, M 2015, 'What Augmented Physical Activity and Empowerment Can Bring to Patients Receiving Total Knee Replacement: Content, Implementation, and Comparative Effectiveness of a New Function-Tailored Care Pathway in a Routine Care Setting', Biomed Research International, Vol 2015 (2015), Directory of Open Access Journals, EBSCOhost, viewed 8 March 20.

Verlaan, S, Ligthart-Melis, G, Wijers, S, Cederholm, T, Maier, A, & de van der Schueren, M 2017, 'High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults--A Systematic Review and Meta-Analysis', Journal Of The American Medical Directors Association, 5.

Xie, Q 2017, 'Diagnosing university students’ academic writing in English: Is cognitive diagnostic modelling the way forward?', Educational Psychology, 37, 1, pp. 26-47.

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