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Norma James, Group 4

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by

Daphne Sy

on 20 November 2012

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Transcript of Norma James, Group 4

4. Non-compliance r/t restrictive lifestyle and low prioritization of self-care aeb: pt. states, "I can't afford to take all of my pills each day.... I need to save enough money to feed my cats." Short-term NOC:
By the time that pt. leaves the clinic today, pt. will verbalize understanding of proper home wound care procedures. NICs
1. Educate pt. on self dressing changes at home
2. Practice proper dressing change with patient
3. Teach pt. signs of infection and complications
4. Teach pt. risks of improper wound care (i.e. butter)
5. Create a mutually agreeable daily self-care plan for wound care with pt. Chief Complaint: Wound on leg Norma James Therapeutic communication and developing trust 1. Impaired tissue integrity r/t wound, presence of infection Norma's NANDAs 1. Impaired tissue integrity r/t wound, presence of infection Concept Map
Draft Interventions (NICs) Chief Complaint:
Wound on leg not healing Obtained wound while gardening

Was advised to apply butter to wound

Wound has gotten larger over the past month Current Condition Comorbities:
Diabetes Mellitus Type II
Peripheral vascular disease
Peripheral neuropathies
Hypertension
Peripheral vascular disease
Atrial Fibrillation
Low cardiac output
Risk for venous stasis Who is Norma James? 65 years old
Widow
Estranged from sons
Family of six cats
Longtime smoker
Thrifty
Small fixed income The Interview What NOT to do:

Request a justification
Be condescending
Reject her problems
Excessive probing
Use medical jargon Assessment of Learning Needs:
Does she understand her current conditions?
Seriousness
Risks of complications
Effective self-management behavior The Interview:
Location A place where the patient feels comfortable.

Example: Senior Community Center in a private exam room with Nurse Karen The Interview
Accepting

Empathy

Exploring

Active Listening

Confidentiality The Interview HIPAA
and Norma James Strengths All images of Norma James © Pearson Education, Inc. Reference List Ackley, B. J., Ladwig, G. B. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Giddens, J. (2010). The Neighborhood. Available from http://pearsonneighborhood.ecollege.com

Osborn, K. S., Wraa, C. E., Watson, A. B. (2010). Medical-surgical nursing: Preparation for practice (pp. 259-262). Upper Saddle River, NJ: Pearson Education, Inc.

U.S. Department of Health and Human Services. (2012) Understanding HIPAA privacy. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html 2. Ineffective peripheral tissue profusion r/t smoking, sedentary lifestyle, longstanding hypertension, and poorly controlled diabetes mellitus type II. Additional NANDAs 3. Ineffective self-health management r/t economic difficulties and insufficient fixed income. 4. Non-compliance r/t restrictive lifestyle and low prioritization of self-care 5. Decreased cardiac output r/t altered electrical conduction aeb: pt. states, "Money is tight.... I can't afford to take all of my pills each day." aeb: pt. states, "I can't afford to take all of my pills each day.... I need to save enough money to feed my cats." aeb: poor peripheral perfusion resulting in slow wound healing. aeb: significant erythematous lesion with purulent drainage on lower extremity. aeb: delayed healing progression in peripheral wound
aeb: altered sensation (Giddens, 2010) (Giddens, 2010)
Would she benefit from printed materials such as pictures or brochures?
Can we provide free supplies? (Ackley & Ladwig, 2011) (Ackley & Ladwig, 2011) Nursing Outcomes (NOCs) Short-term NOC: Long-term NOC: 1. Educate pt. on self dressing changes at home
2. Practice proper dressing change with patient
3. Teach pt. signs of infection and complications
4. Teach pt. risks of improper wound care (i.e. butter)
5. Create a mutually agreeable daily self-care plan for wound care with pt. 1. Provide pt. with adequate supplies for two weeks of dressings 1. Impaired tissue integrity r/t wound, presence of infection Nursing Outcomes (NOCs) 2. Ineffective peripheral tissue profusion r/t smoking, sedentary lifestyle, longstanding hypertension, and poorly controlled diabetes mellitus type II. Final Concept Map Interventions (NICs) 2. Ineffective peripheral tissue profusion r/t smoking, sedentary lifestyle, longstanding hypertension, and poorly controlled diabetes mellitus type II. By the time that pt. leaves the clinic today, pt. will verbalize understanding of proper home wound care procedures. In one month, wound will be healed, only scar tissue (normal color for race) will remain. Short-term NOC: Long-term NOC: Short-term NOC: By the time that pt. leaves the clinic today, pt. will verbalize understanding of proper home wound care procedures. Long-term NOC: In one month, wound will be healed, only healthy scar tissue (normal color for race) will remain. NICs (Cont.) 1. Impaired tissue integrity r/t wound, presence of infection 5. Refer to free lunch program at Senior Center 4. Educate pt. on optimal nutrition for wound healing (vitamin A, C, Zinc, Copper, protein) 3. Refer to Senior Center management for aid in obtaining a Medicare prescription plan 2. Make follow-up appointment for two weeks out Primary diagnosis: Wound infection Comorbidies:
Diabetes Mellitus Type II
Hypertension
Atrial Fibrillation 3. Ineffective self-health management r/t economic difficulties and insufficient fixed income. aeb: pt. states, "Money is tight.... I can't afford to take all of my pills each day." 4. Non-compliance r/t restrictive lifestyle and low prioritization of self-care aeb: pt. states, "I can't afford to take all of my pills each day.... I need to save enough money to feed my cats." 5. Decreased cardiac output r/t altered electrical conduction aeb: poor peripheral perfusion resulting in slow wound healing. 1. Impaired tissue integrity r/t wound, presence of infection aeb: significant erythematous lesion on lower extremity. 2. Ineffective peripheral tissue profusion r/t smoking, sedentary lifestyle, hypertension, and diabetes mellitus type II. aeb: lack of healing progression in peripheral wound Primary diagnosis: Wound infection Comorbidies:
Diabetes Mellitus Type II
Hypertension
Atrial Fibrillation 3. Ineffective self-health management r/t economic difficulties and insufficient fixed income. aeb: pt. states, "Money is tight.... I can't afford to take all of my pills each day." 5. Decreased cardiac output r/t altered electrical conduction aeb: poor peripheral perfusion resulting in slow wound healing. 1. Impaired tissue integrity r/t wound, presence of infection aeb: significant erythematous lesion on lower extremity. 2. Ineffective peripheral tissue profusion r/t smoking, sedentary lifestyle, hypertension, and diabetes mellitus type II. aeb: lack of healing progression in peripheral wound Consider Norma's education and background Long-term NOC:
In one month, wound will be healed, only healthy scar tissue (normal color for race) will remain. NICs
1. Provide pt. with adequate supplies for two weeks of dressings
2. Make follow-up appointment for two weeks out
3. Refer to Senior Center management regarding Medicare prescription plan
4. Educate pt. on optimal nutrition for wound healing (vitamin A, C, Zinc, Copper, protein)
5. Refer to free lunch program at Senior Center NICs (Cont.) 2. Ineffective peripheral tissue profusion r/t smoking, sedentary lifestyle, longstanding hypertension, and poorly controlled diabetes mellitus type II. Long-term NOC: Within a month, pt. will have incorporated a daily 20 -30 minute walk. N360 Group 4
Devin, A., Kimber, S., Shiffler, A., & Sy, D. Pt. will verbalize knowledge of medication regimen by end of the visit. Within a month, pt. will have incorporated a daily 20 -30 minute walk. Short-term NOC: Pt. will verbalize knowledge of medication regimen by end of the visit. 1. Call former PCP to obtain list of current medications and pertinent medical history documents. 1. Educate patient on importance of good foot care and use of properly fitted, supportive socks and shoes. 5. Use motivational interviewing techniques to discuss smoking cessation and suggest a plan to quit 4. Refer to Senior Center Administration to obtain Medicare prescription plan. 3. Explain why each of the medications must be taken as prescribed to increase her medication literacy 2. Review list of currently prescribed medications, have pt. participate by repeating regimen verbally. 5. Educate pt. to recognize signs and symptoms that should be immediately reported to her health care provider, such as a change in skin color, sensation, presence of new lesion, etc. 4. Educate pt. on benefits of exercise as it pertains to her comorbidities 3. Collaborate with patient to form a plan to slowly increase daily physical activity until pt. can tolerate 30 minutes of walking. 2. Refer pt. to Senior Center administration to get adequate walking shoes from Medicare plan. From the U.S. Department of Health and Human Services website: "...your information can be used and shared: For your treatment and care coordination
To pay doctors and hospitals for your health care and to help run their businesses
With your family, relatives, friends, or others you identify who are involved with your health care or your health care bills, unless you object
To make sure doctors give good care and nursing homes are clean and safe
To protect the public's health, such as by reporting when the flu is in your area
To make required reports to the police, such as reporting gunshot wounds What Information Is Protected? Information your doctors, nurses, and other health care providers put in your medical record
Conversations your doctor has about your care or treatment with nurses and others
Information about you in your health insurer’s computer system
Billing information about you at your clinic
Most other health information about you held by those who must follow these laws" (U.S. Department of Health and Human Services [USHHS], 2012)
How can we help Mrs. James comprehend the education she is given and increase trust in her healthcare providers? Short-term NOC:
Pt. will verbalize knowledge of medication regimen by end of the visit. Long-term NOC:
Within a month, pt. will have incorporated a daily 20 -30 minute walk. NICs
1. Educate patient on importance of good foot care and use of properly fitted, supportive socks and shoes.
2. Refer pt. to Senior Center administration to get adequate walking shoes from Medicare plan.
3. Collaborate with patient to form a plan to slowly increase daily physical activity until pt. can tolerate 30 minutes of walking.
4. Educate pt. on benefits of exercise as it pertains to her comorbidities
5. Educate pt. to recognize signs and symptoms that should be immediately reported to her health care provider, such as a change in skin color, sensation, presence of new lesion, etc. NICs
1. Call former PCP to obtain list of current medications and pertinent medical history documents.
2. Review list of currently prescribed medications, have pt. participate by repeating regimen verbally.
3. Explain why each of the medications must be taken as prescribed to increase her medication literacy
4. Refer to Senior Center Administration to obtain Medicare prescription plan.
5. Use motivational interviewing techniques to discuss smoking cessation and suggest a plan to quit Strengths: Determined
Strong sense of self
Family of cats
Independent
Resilience
Senior Center
Unrestricted mobility
Baby boomer generation
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