Joanne Nursing Care
Part A
Introduction
A nursing care plan is useful in preventing potential health problems from occurring and maintain an excellent functional ability of the body. A nursing care plan utilizes all the assessment data that are described by a patient, and this data allows a nurse or medical practitioner to come up with the correct intervention and prevention strategies that are suitable to achieve the long term care, usually a healthy body status (Desai, Bishnoi, Devi and Rukadikar, 2019). When constructing a care plan, it is essential to identify the best nursing model that will lead the nurses towards understanding the patient’s condition and come up with a suitable plan that will ensure that the unique patient needs are met (Elo, 2017). The assignment uses a case study on a 55-year-old woman called Joanne, and the information provided guides us towards choosing a nursing model. The assignment looks at the Roper Logan Tierney model and why this model is suitable as well as giving the assessment data and the planning stages for the correct treatment and prevention of the health care conditions that Joanne is facing.
The Roper-Logan-Tierney Model
A nursing model gives nurses directions and knowledge on how to conduct or deliver medical care to patients. The type of nursing mode to be used depends highly on the health condition of the patient and the data provided to the nurse (de Moura et al., 2015). In the case of Joanne, it is appropriate to use the Roper, Logan, and Tierney model. This nursing model follows a logical and systematic approach to providing care for the patient. It is vital to put into consideration facts and assumptions before the delivery of medical care. The kind of model chosen should be able to provide the nurse with all the necessary details before administering medication to a patient. The use of the Roper Logan model offers a good understanding of the logic behind actions undertaken (Williams, 2015). The Roper-Logan-Tierney nursing model is suitable for Joanne because it is based on realism and accessibility; it is based on the activities of daily living. The model is ideal because it conceptualizes Joanne as a biological being with an inseparable mind, health, and body as the ability to function independently concerning 12 components of living (Holland and Jenkins, 2019). With the use of this model as a nurse, I can focus on the activities of life, which are observable, describable, and objectively measured.
Care plan
The nursing process approach for Joanne follows client-centred care that has five steps assessment, diagnosis, planning, implementation, and evaluation. It is essential to check the background information of the patient so that we can ascertain the effective care plan for her, and the nursing model directs us to look at the details provided and come up with the proper nursing care.
Assessment
In the living community, the Roper Logan Tierney model was used. This model provides a suitable reflection of the 12 activities of living, which are useful in the assessment of the patient’s condition. The 12 events include; mobility, working, sexuality, playing, breathing, eating, communication, dying, maintaining a healthy environment, drinking, and controlling body temperature. As a nurse, therefore, it is essential to observe, interview, and physically assess the patient to obtain data to diagnose Joanne.
Joanne has difficulty in communication and therefore uses PRCs to communicate her needs; this means that she utilizes pictures, images, and graphics to communicate with nurses and her family members. She is also 55 years old, saying her sexual life is not active because she is past menopause. She takes part in community activities by attending a cookery class and also assists in shopping. She is living in a community house with four other women.
Joanne has breathing issues; she has an audible wheeze on expiration and shows signs of distress. She is unwell because she is experiencing an exacerbation of her asthma, something she had since her childhood. Her respiratory rate is 26 breaths per minute.
Her previous medical history shows that she has been using salbutamol through a nebulizer when she experiences difficulty in breathing, and again she has used corticosteroids whenever she did not respond to salbutamol. Joanne also has a type 2 diabetes, and that she has no previous medication for the condition, she is 5.4 and has a weight of 12,3lbs with a waist circumference of 35 inches.
Further assessment data necessary
The patient should also provide more information that will assist a nurse in coming up with a suitable treatment plan for the patient. This includes religion so that nurses can provide the patient with spiritual needs and not risk disputing medical procedures due to religious beliefs (Gillenwater Jr, 2012). It is also essential to request for demographic information as well as the next of kin information, and this includes home address and telephone numbers to be used for any inquiries and requests as well as updates on patient progress.
The patient is also required to provide more information on the lifestyle factors that can help explain the current physical and psychological condition of the patient. It is also important to provide drinking information, and this is necessary to be able to link the drinking patterns with the current medical state.
The details needed to make the nursing model functional are based on the 12 living activities; they should all be able to describe the living pattern of Joanne, and this way, it becomes easier to design the correct interventions against the medical conditions inhibiting the normal life of Joanne. When the lifestyle of the patient is linked with medical history, it becomes easy to identify the causes of the progress of a disorder or a result of another.
The patient should also provide information on whether the patient is able to mobilize freely or if they require assistance.
Problems Identified
Joanne has been diagnosed with type 2 diabetes, and this is a chronic condition that interferes with how the body processes glucose. This is a condition that makes the body resist insulin or fail to produce insulin (Casqueiro, Casqueiro and Alves, 2012). The condition forces the body to rely on energy present in body organs and can lead to a list of symptoms which include lack of energy, blurred vision, weight loss and fatigue.
Asthma is a condition that is caused by inflammation of the respiratory tract that leads to the production of excess mucus, making it difficult to breathe. Joanne shows signs of asthma through her medical history and the inaudible wheeze, and her respiratory rate is 26, while the normal respiratory rate should be 12 to 20.
Joanne is also overweight, her weight is considered unhealthy, and the bodyweight is measured using the BMI. This is a condition evident from her waist size, and her waist size is larger than expected. ; She should keep her waist size below 32 inches (GBD 2015 Obesity Collaborators, 2017).
The patient has a severe intellectual disability, which explains poor language, therefore, uses PECs to communicate. Joanne also spends most of her time watching television, which is an unhealthy lifestyle causing her overweight.
Planning
It is important for the nurse to prepare long and short term goals for the patient after assessing the patient’s condition (Ballantyne, 2016). The goals that are implemented must directly impact the patient in that they are patient-specific, and when these goals are achieved, then it ensures positive results. The reason for constructing a care plan is to make sure that the patient received individualized care due to their unique needs. When constructing a care plan, overall conditions are important. The long and short term goals should be very specific, meaningful, action-oriented, realistic, and timely.
Long Term Goals
The patient blood sugar level reading should be less than 180mg/dl; Hemoglobin A1C level less than 7%. Effective treatment of type 2 diabetes ensures normalization of the blood glucose level to eliminate complication. There is a need for insulin replacement, balanced diet, and increased body activity through exercises. It is, therefore, vital to monitor the blood sugar level of the patient for long term health.
Secondly, the patient requires compensatory communication techniques and strategies that include using the AAC and any other assistive technology to enhance spoken and written language for better and effective communication.
Thirdly, the patient should receive a quick asthma inhaler so that it can help during asthma attacks, remember the condition does not have a medication that can cure the condition. The goals are to ensure normal breathing and reduced inflammation of the respiratory tract, Joanne should be able to breathe normally.
The patient has been diagnosed with type 2 diabetes; therefore, management of hyperglycemia and other risk factors that are associated with this health condition such as hypoglycemia, hypotension, and drug interaction are among the goals of the nursing plan.
Short Term Goals
The patient should receive a healthy diet and exercise daily to maintain a healthy weight. There should be effective communication between the patient, their family, and the medical care team so that there will be important updates through the recovery period. The patient should also maintain a pulmonary or breathing function to normal to prevent asthma exacerbations. The patient should have a close friend or family member so that communication can be assisted through translations and avoid miscommunication in case of effective images and graphics when using the PECs.
Interventions
These are the treatment options and actions that are done to take care of the patient and help him/her reach individualized goals. A nurse uses his knowledge and information collected from the patient to identify which interventions will be helpful in achieving the goals of the nursing process. From the data provided the patient did not have information that she had type 2 diabetes, which means that she has had the disease for a short time and that she does not have heart disease; therefore, it can be treated with lifestyle and metformin only (Adel et al., 2019)
The first thing to do is to educate the patient to understand the benefits of having a healthy diet and exercising by participating in physical activities. This includes offering or developing a time schedule through the help of coaching personnel who will help the patient through exercising activities. This way, the patient will get a healthy diet with enough exercise that will be useful in managing diabetes and other health risk factors.
Health intervention for overweight and obesity includes choosing a healthy lifestyle that includes designing a nutritional diet chart for the patient. The chart includes routine physical activities that will ensure weight loss (Bleich et al., 2018). Joanne has to be advised to take part in yoga to help her in breathing exercises, which will help her with asthma. The quality of diet that is by increasing fruits, wholegrain, and vegetables and reducing the amount of saturated fat will lead to the improvement in airway inflammation and control exacerbation and asthma (Stoodley, Williams, Thompson, Scott, and Wood, 2019).
Review all the factors on the patient’s routine and meal plans that contribute to blood glucose instability. It is also vital to educate the patient how medications work, stating the different side effects and ways on how each work to control blood glucose. Educating the patient on glucose monitoring will also ensure that the patient identifies blood variations and manage them (Kautzky-Willer, Harreiter and Pacini, 2016).
The patient will receive training on the use of assistive technology to aid in improving communication and avoid misrepresentation because of limited assistance from the use of the PECs. Making sure that the patient communicates effectively facilitates monitoring of his condition and, therefore, easy to identify concerns that may arise during medication.
Assessing the signs of hyperglycemia, a condition that results when there is a low amount of insulin to glucose. When there is excess glucose in the blood, there is increased thirst, hunger, and increased urination because of the osmotic effect because of the inadequate insulin present to glucose (Zheng, Ley, and Hu, 2018). The patient may report cases of fatigue and blurred vision. We should also assess the feet’ temperature, colour, sensation, and pulses to monitor peripheral perfusion and neuropathy. This way, we shall be trying to treat the possible risk factors that can result when treating diabetes mellitus (Cardenas-Valladolid et al., 2012).
Evaluation
During this stage, the patient’s status has to be continuously evaluated and modified if there is any need so that the methods and treatment options are effective and convenient (Jones, 2016).
To evaluate the interventions used by the nurses to normalize Joanne’s health status first, we take the patient through a series of exercises and ask questions if she understands the proper diet and lifestyle that needs to be followed so that she can achieve the essential health status. The nurse also can check and interpret the health conditions because they know what to look for and can easily detect improvements, especially of the blood sugar levels. Another thing is listening to the breathing rhythm to check if exercises and yoga are helping the patient in eliminating respiratory problems (Marek, 1997). The clinical patient outcomes play an important role in determining the effectiveness of medical care, and the patient will show signs of improvements in breathing, exacerbation, and a normal blood sugar level (Blackwood and Bindra, 2009).
Part B
Type 2 diabetes is a health condition that affects the metabolism of glucose, the body either does not allow effects of insulin to occur, or it does not produce enough insulin for normal glucose level maintenance (Chaudhury,2017). The condition does not have a cure, but it can be contained and controlled through exercises and eating a healthy diet, and when these are not enough, then it is essential that a patient receives insulin therapy and medications.
It is essential that Joanne manages her blood sugar at normal; the first step is to ensure that the patient knows and understands the recommended range of blood sugar level. When she has this information, she can be able to check her blood sugar levels. This way, she will be able to know when her blood sugar is not at the normal level and therefore, can seek medication. When she has knowledge of her condition, it is not difficult to follow the steps below in managing her sugar levels. Joanne can follow the following steps in managing her sugar levels.
- Joanne should keep her supplies with her all the time, and this includes anything else that she might need to monitor her blood sugar levels.
- She should keep track of her testing strips, and they should not be out of date to avoid receiving inaccurate results. This will provide misleading information and indicate a problem when there is none (Lodwig, Kulzer, Schnell and Heinemann, 2014).
- Joanne should develop a routine for how often to conduct the self-test on blood sugar levels.
- Joanne should never assume that her meter is correct; there is a control solution on the accuracy of the meter and strips. She has to make comparisons with those of the doctor to avoid discrepancies (Kirk and Stegner, 2010).
- She should have a journal to log in to her blood every time she tests it.
- She should follow steps to avoid infections- these steps include keeping her testing kits and not sharing them, disposing of the strips after each use, etc.
Medical devices and services must always be effective and safe and not risk attracting other infections and safety issues. When monitoring blood sugar levels there are safety and infection issues likely to occur if correct measures are not undertaken, these issues include;
- Transmission of blood-borne pathogens – hepatitis B is transmitted due to unsafe blood sugar monitoring, and when testing kits and equipment are reused, then infections can be transmitted from one patient to the other (Klonoff, 2011). Diabetes mellitus makes the patient susceptible to infections, and the nurse should be able to screen for other infections before letting the patient individually manage her blood sugar (Casqueiro, Casqueiro, and Alves, 2012).
- Finger trauma- finger lancing when obtaining blood samples for blood sugar monitoring. There is no safe lancing, and therefore this is a safety issue that can only be prevented by using samples from different parts of the body, e.g., thighs, palms, and forearms, which causes less pain.
- Clinical accuracy- the equipment used can lead to clinical accuracies that might result in wrong decisions based on the condition of the patient. The results might also be correct, but the interpretation can be made incorrectly, thereby misleading the caregivers.
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