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Assessment, planning and implementing nursing interventions based on my patient

Assessment, Planning and Implementing nursing Interventions based on my patient

Shokunbi Oluwadamilola

University of Ontario Institute of Technology

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Older Adults Nursing Theory & Practicum

NURS 1700U

Doctor Winnie Sun

March 6, 2019

Assessment, Planning and Implementing nursing Interventions based on my patient

The term “Nursing” can be described as a profession which is based on the health and care given to an individual, so they may attain the maximum quality of life but Watson defines nursing as the science of caring (“watson caritas”,” 2007). As described by Douglas 2010, caring is important for the well-being of staff working with patients. Working with hospitalized patients but older adults in specific can be really challenging because their needs are not generalized and can.

The purpose of this paper is to utilize the completed assessment of my assigned patient, planning and implementing nursing interventions or strategies to meet the needs of an older adult patient in a hospitalized environment. I am also going to incorporate some of the Caritas Processes from Watsons theory like Creating a healing environment at all levels; subtle environment for energetic authentic caring presence which I believe was one of the main contributing factors to the stabilization of the patient and the healing phase.

Patient Description

My patient is a 100-year-old female who is still independent and functional in her activities of daily living. The patient has a medical history of high blood pressure, Coronary Artery Disease, congestive heart failure, cataracts, hearing impairment and knee osteoarthritis and is currently taking four (4) medications which are Lisinopril, furosemide, ASA, and metoprolol. The patient has recently developed abdominal pains which have been increasing steadily across five (5) days; and had obstipation for one (1) day. She is currently acutely ill and has appeared uncomfortable and volume depleted. After further exams were conducted, it was discovered that she has abdominal distention, hypoactive bowel sounds and no mass was found. Abdominal distention is defined as according to my research the symptoms associated with bloating is usually associated with abdominal girth (Houghton, 2011, p. 1). It is often described by patients as very intrusive, significantly impacting their quality of life which in my patients’ case was impacting her maximum comfort. Her heart was enlarged and there was no presence of S3. An abdominal CT scan discovered that her cecum was dilated to 13cm and shows a possible mass in the descending colon.

Laboratory tests were ordered and the results that came back had some questions which needed immediate attention: her white blood cell count was relatively high at 13290 while the normal range is from 4000 to 11″,000. This is a sign that there are problems such as infection or trauma, Sodium levels were low at 128 mEQ/L while the normal ranges from 135 to 145 mEQ/L; a low sodium level may occur due to certain medication or if the patient is taking in too much water causing cells to swell. Potassium level was low as well at 2.6 while the normal potassium level ranges from 3.5 to 5. Low potassium levels can be caused by many things but is usually as a result of vomiting, diarrhea or the use of diuretics; low potassium levels in the body can make muscles feel weak and abnormal heart rhythms may develop

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strategies to meet the patients need

When I was given this patient, I did not know what to expect because her health was depleting day by day. After being briefed about the patient, the thing that struck me the most was the volume deletion because volume depletion can lead to serious vomiting, excessive sweating, diarrhea, burns, diuretic use, and kidney failure and can leave some serious damage especially in the place of an older adult

Nursing interventions are the actions taken by the caretakers that help patients achieve the goals that have been set for them, or they have set themselves. The nurse uses his or her knowledge, experience and critical-thinking skills to decide which intervention will help the patient the most. It also serves as a medium to help improve the nurse client therapeutic relationship.

In my scenario, for GI bleed, the use of PPI was implemented. PPI stands for Proton Pumps Inhibitors which are drugs that inhibit the activity of the protein pumps and are used to inhibit gastric acid secretions in the treatment of gastroesophageal reflux disease.

For pneumonia, the use of a spirometer was involved and was made to ambulate around to enable proper blood flow and respiratory function as soon as possible. This is because patients who come out of surgery are at a higher risk of developing pneumonia especially older and weaker patients.

In order to avoid falls, the daughter of the patient was able to stay in the same room as the patient to keep a further eye on the patient to avoid accidental falls

For the volume depletion/ fluid retention, careful examinations and frequent adjustments in orders were made in order to meet with the patients changing situations

For pressure sore/edema, the patient was being turned frequently and skin care was done three (3) times daily. Edema is the swelling if body part swell from injury or inflammation and can cause lack of blood flow through the body.

To avoid prolonged delirium, the daughter was able to sleep in the same room as the patient to help with mood disorder, mental status and cognitive disorder. According to Watson’s caritas process number 1 “practicing loving-kindness & equanimity for self and other” (“watson caritas”,” 2007, para. 3) by allowing the daughter to stay on the room with the mother, it helps reduce the tension and sometimes the trauma that comes after surgery.

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Human needs: elimination and activity

Elimination is a normal function which has to be carried out to be able to keep the normal functioning of the body because of elimination is altered, it alters the persons’ confidence, wellbeing and independence. This is a very intricate situation because within the time that I was taking care of my patient, due to the fact that the elimination was altered, the patient started dealing with various situations related to the lack of elimination like pains which steadily increased on a daily. In addition to that, she wasn’t able to perform her activities of daily living as she normally does.

Due to the swollen cecum, my patient was not able to disturbance and pains. According to my research, the swelling of the cecum can lead to pain, swelling, cramps, nausea and vomiting (Wilkinson, n.d) which in terms can leads to excessive and unintentional weight loss which could also lead to further complication. In my patients’ scenario, to avoid vomiting and stomach upset, the patient can avoid eating in general and that can lead to further problems down the road. The patient was experiencing dehydration at the end of the situation and this is in turn effecting the food and fluid of the patient and it is important to know that food and fluids to sustain life comfortably and to prevent the devastating consequences of nutritional and fluid derangement. I ensured that the patient was really hydrated and in order to also help the skin rejuvenate “Various skin parameters including skin visco‐elasticity and hydration level affect the formation of wrinkles” (Choi, Huh, Youn, & Park, 2012, background 1)

Caritas process

The first caritas process I will be incorporating into this essay is caritas process number 8 which is “creating healing environment at all levels (physical, non-physical, subtle environment of energy and consciousness) whereby wholeness, beauty, comfort, dignity and peace are potentiated” (“watson caritas”,” 2007). This is further simplified as preserving human dignity, providing clean, aesthetic surroundings that is conducive to healing. In my experience with my patient, I felt that Watson caritas process number 8 had a very huge impact on my nursing interventions and how I prepared the environment where the patient was going to experience healing. By allowing the daughters, the only people that she relates with to be able to stay with her during the healing process has a very huge impact on her healing. During the healing stage, she was bright and fair straight from the moment she woke up; she was also open about the situation to me, and she said that she got the motivation by waking up to the most important people in her life. She thanked me for that and I was able to see that the nurse client therapeutic relationship had been strengthened. According to my research, it shows that the feeling of stress or loneliness actually slows down the healing process (“stress related changes, 2015” para 1). Caritas process number 4 is also one of the big things that had an impact on the way I behaved towards which was Developing and sustaining loving, trusting-caring relationships. Jean Watson describes compassion as the “capacity to bear witness to, suffer with, and hold dear with in our heart the sorrow and beauties of the world” (Watson, 2008 p 78). It affected the way I behaved because I was able to fell empathy for the individual who was not able to function properly and was in pains for most of the time. That enabled me to know and understand what she was going through and help her make the situation a little bit bearable and make the healing environment more conducive.

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Conclusion

In the short time which I was able to provide care for my patient, I was given the chance and opportunity to experience and apply Watson’s theory. I was able to explore the possibilities and learn from my patient, it allowed me to fully understand my patient, analyze the situation and make the best possible intervention and implement/make the best possible healing environment. It also gave me the opportunity to see what the caritas process is able to do in real life situations. Overall Watson helped me to provide the best possible care for my patient.

References

Choi, J. W., Huh, C. H., Youn, S. W., & Park, K. C. (2012). The influences of skin visco‐elasticity, hydration level and aging on the formation of wrinkles. hydration and skin. https://doi.org/ https://doi.org/10.1111/j.1600-0846.2012.00650.x

Houghton, L. A. (2011). Bloating in constipation: Relevance of intraluminal gas handling. Retrieved from https://search-proquest-com.uproxy.library.dc-uoit.ca/nahs/docview/1032751040/CCA1699E595C40C3PQ/1?accountid=14694

Watson’s theory of human caring and subjective living experiences: carative factors/caritas processes as a disciplinary guide to the professional nursing practice. (2007). Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072007000100016

Wilkinson, J. (n.d). What You Should Know About Cecum Cancer. Retrieved march 15, 2019, from https://www.verywellhealth.com/cecum-cancer-796799

Douglas (2010) Douglas K. When caring stops, staffing doesn’t really matter. Nursing Economics. 2010;28:415–419.

Koschwanez, H., Vurnek, M., Weinman, J., Tarlton, J., Whiting, C., Amirapu., S., . . . Broadbent, E

Koschwanez, H., Vurnek, M., Weinman, J., Tarlton, J., Whiting, C., Amirapu, S., . . . Broadbent, E. (2015). Stress-related changes to immune cells in the skin prior to wounding may impair subsequent healing. Brain, Behavior, and Immunity, 50, 47-51. doi:10.1016/j.bbi.2015.06.011

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