final advance practice nursing (contents).doc

8/14/2019 FINAL ADVANCE PRACTICE NURSING (contents).doc

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FROM THEORY TO PRAXIS

ACKNOWLEDGMENT

The researcher wish to express their profound gratitude and sincere appreciation

to eer!one who is in one wa! or another gae their a"ua#"e he"p and guidance in the

preparation of this wor$%

His parents for &ora" support and adices

To Ms% Ma% 'oren (o! Mana#at) for her up"ifting words during the hard ti&es%

His c"ass&ates for the co&pan!) he"p and &a$ing each and eer!one rea"i*e the

+o! of "earning the adanced concepts of "earning

To a"" the supportie peop"e who unse"fish"! shared their $now"edge%

The ad&inistration and facu"t! of Saint Pau" ,niersit! Phi"ippines for #ringing

this progra& c"oser to us) continuous guidance) expert adices) teachings and patience%

His practicu& adiser) Ms% Sharon S% -a"i&ag for the encourage&ent) supportie

adices and superision during the progra&%

To Sister Ade"ina (ae""ana SP-) Sister -ora*on .unagan) SP-) the superisors)

head nurses and staff of the /otre 0a&e de -hartres Hospita" .aguio -it! for their

hospita"it! and $indness

To the A"&ight! Father for giing this opportunit! as we"" as the strength and

$now"edge &a$ing the author surpass o#stac"es and reach his goa"s in this aspect of his

"ife%

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Ta#"e of -ontents

Ac$now"edge&ent 11111111111111111111 i

Hospita" Profi"e1111111111111111111111111 2

Executie Su&&ar!11111111111111111111111% 3

0etai"ed -ase Ana"!ses

-ardio"og! 1111111111111111111111111 4

0ia#etes 11111111111111111111111111 54

Onco"og! 111111111111111111111%1111 67

'earning Feed#ac$ 0iar! 111111111111111111111 289

.est Practices O#sered 111111111111111111111% 2:8

Reco&&endations and Suggestions 111111111111111112:7

References 111111111111111111111111111 2:5

Appendices1111111111111111111111111112:;

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Hospita" Profi"e

A. HISTORY

A&idst the tur#u"ence in the #usiness eniron&ent where the econo&ic

conditions hae rendered patients in the hea"th care industr! power"ess) the

RE.IRTH OF /OTRE 0AME 0E -HARTRES HOSPITA'


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B. BACKGROUND

/otre 0a&e 0e -hartres is an 45#ed Tertiar! care hospita" and

TeachingCTraining Institution% The hospita" is "ocated at D85 enera" 'una Road)

.aguio -it!%

The hospita" is found within enera" 'una Road and intersects

Assu&ption Road% It is surrounded #! nuer of schoo"s) two of which are the

two #iggest uniersities in the cit!% It is near the .aguio -athedra" and +ust across

is the .aguio.enguet P-A) an e&ergenc! a"ert reporting s!ste&% /-0H is the

sa&e icinit! with the Hospita" of the Sacred Heart a"ong Assu&ption Road% The

hospita" is co&posed of co&p"ex #ui"dings and situated on a 25%83 hectares p"ain

f"at "and with so&e portion on an e"eated p"ain%

C. VISION AND MISSION STATEMENT

VISION

Prii"eged to share in od>s saing and hea"ing action) we enision

/0-H as a -hristcentered) d!na&ic and socia""! responsi#"e g"o#a" hea"thcare

institution proiding ho"istic Bua"it! hea"thcare serices%

MISSION

Faithfu""! "ie and proc"ai& od>s "oe through co&passionate care%

,pho"d #ioethica" princip"es and the teachings of the -atho"ic -hurch%

0ee"op co&petencies of hea"th care professiona"s for integra" growth and

strengthen partnerships in education) training and research%

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Pursue a"ue innoatie and socia""! responsie hea"th care serices at par with

g"o#a" standards for sustaina#i"it!%

Assure that -hristian stewardship and good goernance are practiced%

D. CORE VALUES

Transfor&ing "ies through -hristcentered hea"th care serices

E. ORGANIZATIONAL STRUCTURE

.oard of Trustees

Medica" 0irectorAd&inistrator Gice President for Education

Hu&an Resource Anci""ar! Scs /ursing Serice Support Scs Finance Pastora" -are

/urse Superisors

Head /urses

Staff /urses

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F. DUTIES AND RESPONSIBILITIES OF KEY PEOPLE

a% Hospita" Ad&inistrator

The hospita" ad&inistrator responsi#"e for the da! to da! operationa"

running of the hea"th care institution% In addition) the ad&inistrator

participates in and coordinates the setting of strategic priorities for the

direction of the hospita"% Specific duties inc"ude recruit&ent and retention of

ph!sicians) oerseeing Bua"it!) i&proe&ent of processes for efficient

de"ier! of patient care) setting standards) oersight of #udgets) creating

financia" and #usiness strategies to assure fisca" ia#i"it! and hea"th% The

hospita" ad&inistrators a"so #eco&e ino"ed in press re"ations) pu#"ic and

co&&unit! affairs) grants &anage&ent) #i""ing) co""ections) purchasing of

eBuip&ent and &eeting regu"ator! standards%

#% -hief /urse

The chief nurse is the executie head of the nursing serice% HeCShe

carries fu"" ad&inistratie responsi#i"it! and authorit! for the entire nursing

serice of the hospita"% Participates in for&u"ating hospita" po"icies) in

dee"oping and ea"uating progra&s and serices) assu&es fu"" authorit! and

responsi#i"it! for dee"op&ent of nursing serice po"icies Organi*es) directs)

coordinates) ea"uates actiities of the /ursing Serice Staff which a""ow for

satisfaction and professiona" growth Proides &eans and &ethods #! which

nursing personne" can interpret the goa"s and po"icies of hospita" and nursing

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serice to the patient and to the pu#"ic Initiates and directs studies) ea"uate

procedures for the i&proe&ent of nursing progra&s for different categories

of nursing personne" directs nursing personne" in functions re"ated to the

c"inica" training progra& of nursing students and other affi"iates Prepares

with her superisor! staff #udget proposa" for the nursing personne" 0efines

+o# description for each categor! of nursing personne" Recruits and

reco&&ends personne" for appoint&ent) pro&otion or dis&issa" depending

on staffing needs of the serices%

c% /urse Superisor

/urse Superisors proide care for patients) #ut the! a"so oersee the

nursing staff% As a nurse superisor) !ou ensure that there is adeBuate staffing

in !our unit) interact with patient and fa&i"ies) &anage issues that arise

during !our shift) and direct and superise a"" aspects of patient care%

d% ,nit Head /urse

The head nurse sha"" direct the perfor&ance of nursing functions in

hisCher units consistent with the phi"osoph!) goa"s) o#+ecties and standards

of care of the nursing serice% SheC He sha"" #e tas$ed with #ui"ding effectie

tea&wor$ of peop"e to effectie and costefficient uti"i*ation of faci"it! and

other &ateria" resources%

SheC He has contro" oer the functions of her unit and &a$es decisions

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regarding #oth patient care and staff situations as reBuired in these units% The

head nurse is direct"! responsi#"e to the depart&ent head%

e% Staff /urse

The staff nurse sha"" initiate and perfor& nursing care to &eet the needs

of the patient within the scope of nursing practice proided #! the "aw within

the context of the phi"osoph!) goa"s o#+ecties and standards of care as

esta#"ished #! the profession and the nursing serice%

The staff nurse sha"" #e actie"! ino"ed in teachingC continuing

education progra&s designed to i&proe Bua"it! of nursing care de"ier!%

f% Auxi"iar! Serice Staff

The nurse auxi"iar! is a person who) haing #een regu"ar"! ad&itted to a

progra& du"! recogni*ed and esta#"ished in the Phi"ippines) has successfu""!

co&p"eted the prescri#ed course of studies and has acBuired the reBuisite

Bua"ifications%

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Executie Su&&ar!

This narratie report is a co""ection of "earning insights acBuired during the

Adanced Re"ated /ursing Experience that too$ p"ace in /otre 0a&e de -hartres

Hospita" in .aguio -it! fro& /oeer 5 to 88) 8928%

The first part is the hospita" profi"e) histor!) ision and &ission state&ents and the

$e! peop"e that run the organi*ation as one% Fo""owing this are the se"ected cases of

patients with cancer) dia#etes and heart disease se"ected #! the author% The case studies

inc"udes the #ac$ground of the case) profi"e of the patients) &edica" histor!) "a#orator!

and diagnostic exa&inations done and the drug studies% The ita" part of the case studies

are the nursing care p"ans for&u"ated for the& #! the author to &atch their nursing need%

The "ast part of the report presents the dai"! actiit! of the author) the #est

practices o#sered in the hospita" and the reco&&endations for the areas that need

i&proe&ent%

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-ase Stud! 0ia#etes

This is a case of a 78 !ear o"d &arried wo&an diagnosed with dia#etes% She was

diagnosed with T!pe II dia#etes Me""itus in the !ear 8929 and hospita"i*ed on"! once%

Ora" antidia#etic &edication was prescri#ed #! her ph!sician #ut she on"! too$ it for ;

&onths% ,nti" then) she did not #other to ta$e necessar! precautions and preentie

practices to contro" her sugar "ee"%

This case is a presentation of a possi#"e co&p"ication of dia#etes in the rena"

s!ste&% Researches present strong eidence of this co&p"ication%

Patient Pr!i"e

Sex F

Age 78

Address -a&p 3) .aguio -it! .enguet

Re"igion .aptist

Occupation Hu&an Resource Officer

Ad&ission 0ate /oeer 22) 8928

-hief -o&p"aint Feer and H!pogastric Pain

0iagnosis T!pe 8 0ia#etes Me""itus

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PAST MEDICAL HISTORY

The patient is $nown dia#etic since 8929 #ut ad&its nonco&p"iance to treat&ent

regi&en% She was adised to ta$e ora" h!pog"!ce&ic agent and referred to a dietitian for

diet &odification #ut fai"ed to co&p"!%

She has no $nown histor! of asth&a and heart attac$ and has not #een

hospita"i*ed due to 0ia#etes% Her #"ood pressure is within nor&a" &easure&ents%

On an aerage of twice eer! !ear in the past three !ears) c"ient experiences

cough and co"ds #ut did not see$ &edica" attention regarding this%

Seera" &onths after #eing diagnosed with T!pe 8 0ia#etes) it was found out that

she has nephro"ithiasis and undergone &edica" &anage&ent% /o surgica" operation has

#een done%

HISTORY OF PRESENT ILLNESS

Four da!s prior to ad&ission) the c"ient experienced undocu&ented feer which

she &edicated with paraceta&o") #od! wea$ness) "oose #owe" &oe&ent and &ucoid

stoo"%

Three da!s prior to ad&ission) she experienced h!pogastric pain% Seera" hours

prior to ad&ission) s!&pto&s are sti"" present and feer did not su#side% The c"ient

experienced co"d c"a&&! s$in% This is when the! hae decided to see$ &edica" attention%

After thorough exa&ination) the attending ph!sician diagnosed her with

P!e"onephritis%

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FAMILY MEDICAL HISTORY

The patientJs &other is a $nown dia#etic and has a histor! of congestie heart

fai"ure% Her father has asth&a and died of &!ocardia" infarction%

She has no $nown food and drug a""ergies%

HEALTH ASSESSMENT

A. Hea"t# Per$e%tin an& Hea"t# Mana'e(ent

.efore ad&ission) patient descri#es her "ife as good% She was satisfied with it

een though she is aware of her condition% She is a nons&o$er and drin$ wine in

&oderation and +ust at "east two occasions in a &onth% She had a $idne! stone diagnosed

&onths after she was diagnosed with dia#etes% She consu"ted a ph!sician regarding her

dia#etes twice in 8929 and seera" ti&es for her $idne! stones which was &anaged on"!

#! &edications% She descri#es her current wor$ing condition in San RoBue Power

-orporation as good%

Since she and her hus#and are wor$ing) she does not pa! &uch attention to the

nutritiona" contents of the food the! eat for the! prefer those that cou"d #e easi"! prepared

and accessi#"e which is in her case) &eat) pou"tr! and co&&on egeta#"es so"d in the

&ar$et near#! their ho&e%

Hea"thcare faci"it! is accessi#"e fro& 25 to :9 &inutes awa! fro& their ho&e%

In cases of &i"d headache) she on"! ta$es paraceta&o" and neer too$ an! other

&edications%

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She was prescri#ed with Metfor&in #ut stopped ta$ing it after seera" wee$s for

she fee"s as if she is nor&a" without it% According to her) she perceies no noticea#"e

s!&pto& of dia#etic after her consu"tation%

B. N)tritin an& Meta*"i$

The patientJs s$in is pa"e "oo$ing) dr! and co"d with supp"e turgor% She has no

noticea#"e s$in "esion% She has an artificia" denture and her gu&s are nor&a" with pin$ish

co"or%

The patient experienced a weight gain of 29 $i"ogra&s in the past six &onths%

Her appetite #eca&e fair seera" da!s after her ad&ission #ut she sti"" a#"e to to"erate

so"id foods #eing sered #! the hospita" dietar! depart&ent


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D. A$ti+it,-Eer$i/e

In the wor$p"ace) the patientJs actiit! is reduced due to the nature of her +o#% He

tries to wa"$ herse"f when needs to go fro& one p"ace to another as her on"! for& of

exercise%

In the hospita") when fee"ing we"" and wa"$ing is to"era#"e) she wa"$s herse"f

around the roo& or around the garden near#! the ward% She experiences no difficu"t!

&oing and difficu"t! of #reathing during actiities%

The patient needs "itt"e assistance in A0'Js due to &oe&ent restrictions of her

hands with IG "ine%

-"ient has nor&a" pu"se rate and respirator! rate upon assess&ent%

E. S"ee% Re/t Pattern

The c"ient usua""! s"eeps ; to 4 hours at night and has an afternoon nap% She

a"wa!s fee"s rested afterwards% She has no difficu"t! s"eeping and does not awa$en at

night except when fee"ing the urge to oid%

F. C'niti+e- Per$e%t)a"

Patient co&p"ains an on and off h!pogastric pain% ,pon assess&ent) it was

identified as f"an$ pain radiating to the h!pogastric area with pain sca"e of ;C29 with no

pattern of occurrence and "asts fro& 2 hour to ha"f a da!% At ho&e) she tried to &edicate

it with paraceta&o" which according to her gae a "itt"e re"ief% The pain #egan : da!s

prior to her ad&ission%

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G. Se"!- Per$e%tin an& Se"!-Cn$e%t

0uring assess&ent) patient is re"axed and ca"& and spea$s in a soft toned oice

that hasnJt changed throughout the interiew%

The patientJs &a+or concern at the &o&ent is the changes that she needs to

undergo to aoid such situation for the doctor a"read! exp"ained to her that her current

condition is possi#"! a co&p"ication of her 0ia#etes%

@ith regards to "ifest!"e &odification) she er#a"i*e that she #e"iee it wou"d not

#e a pro#"e& for her as "ong as she wi"" #e guided #! her hea"th care proiders%

H. R"e Re"atin/#i%

The patient is "iing in their residence with her hus#and and 7 chi"dren and as she

er#a"i*ed) the changes that she needs to undergo wou"d not affect her ro"e as a hus#and

and &other%

I. Se)a"it,

The patient uses contraceptie pi""s as &ethod of #irth contro" since 8995% She had

: pregnancies and a"" of which are #orn a"ie% She is not !et into &enopausa" stage and

satisfied with her sexua" re"ationship with her hus#and%

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0. C%in'-Stre//

There are no oert sign of stress that can #e o#sered during interiew and the

patient rates her stress hand"ing as good% She dea"t with eer!da! stressor #! confronting

it with the he"p of her support s!ste&%

K. Va")e/-Be"ie!

The patient is a deoted .aptist and is satisfied with the dee"op&ent of her "ife

#esides her condition% Her ad&ission &ade her c"oser to the Supre&e .eing and it does

not interfere with her re"igious practices%

LABORATORY AND DIAGNOSTIC E1AMINATIONS

URINALYSIS

PARAMETERS RESULTS

-o"or Aer

Transparenc! Tur#id

pH ;%92


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He&og"o#in 27%: 22%925%9

He&atocrit 9%7: 9%:399%:49

P"ate"et -ount 8:2 279759

@.- 0ifferentia"

/eutrophi"s 9%3; 9%79%3

'!&phoc!tes 9%87 9%89%9%79 Monoc!tes 9%99 9%999%9;

Eosinophi"s 9%99 9%999%97

."ood -he&istr!

Potassiu& :%25 :%55%:

Sodiu& 2:5 2:5274

-h"oride 292%8 64293

KOH Te/t

SPE-IME/ RES,'T

Throat Swa# Positie for Funga" Spores On"!

GRAM STAIN

Speci&en Throat Swa#

Resu"t S&ear shows a &ixture of few gra& negatie


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PATHOPHYSIOLOGY

enetic predisposition and age are the two distinct predisposing factor the patient

hae% She is 78 !ear o"d with a dia#etic &other%

T!pe 8 0ia#etes affects 69 to 65 of peop"e with disease% It occurs &ore

co&&on"! in peop"e who are o"der than :9 !ears of age and o#ese% The two &ain

pro#"e&s re"ated to insu"in in t!pe 8 0M are insu"in resistance and i&paired insu"in

secretion% Insu"in resistance refers to a decrease tissue sensitiit! to insu"in% The exact

&echanis& that resu"ts to insu"in resistance and i&paired insu"in secretion in t!pe 8

dia#etes are un$nown%

To oerco&e insu"in resistance) and to preent the g"ucose in the #"ood) increased

a&ounts of insu"in &ust #e secreted to &aintain the g"ucose "ee" at a nor&a" or s"ight"!

e"eated "ee"% This is ca""ed &eta#o"ic s!ndro&e% Howeer) if the #eta ce""s cannot $eep

up with the increased de&and for insu"in) the g"ucose "ee" rises and t!pe 8 dia#etes

dee"ops%

.ecause t!pe 8 dia#etes is associated with a s"ow progressie g"ucose into"erance)

its onset &a! go undetected for &an! !ears% If the patient experiences s!&pto&s) the! are

freBuent"! &i"d and &a! inc"ude fatigue) po"!uria


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infections which is in the case of the patient) we &a! assu&e that the dia#etes contri#uted

to the dee"op&ent of p!e"onephritis%

DRUG STUDY

Le+!"a$in

-"ass Anti#iotic) F"ouroBuino"one

Therapeutic Action .actericida"

0osage 599&g ta#"et once a da!

Indications Acute P!e"onephritis) -o&&unit! AcBuired Pneu&onia)

.acteria" Sinusitis) -hronic .ronchitis) -hronic

.acteria" Prostatitis) Postexposure inha"ationa" Anthrax

/ursing Responsi#i"ities Arrange for cu"ture and sensitiit! tests #efore #eginning

of the therap!

-ontinue therap! as indicated for condition #eing treated


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0osage 2g eer! 4 hours

Indications ,rinar! Tract Infection) "ower respiratot! infection)

gonorrhoea) intraa#do&ina" infection) pe"ic

inf"a&&ator! disease) septici&ea) #one and

+oint infections and &eningitis

/ursing Responsi#i"it! -u"ture infection and arrange for sensitiit! tests #efore

and during therap!%

Instruct patient to report diarrhea) difficu"t! of #reathing)

unusua" tiredness or fatigue) pain at in+ection site%

Pr'"ita2ne

-"ass Antidia#etic

Therapeutic Action Resensiti*es tissues to insu"in sti&u"ates insu"in receptor

sites to "ower #"ood g"ucose and i&proe the action

of insu"in) decreases hepatic g"uconeogenesis and

increases insu"independent &usc"e g"ucose upta$e%

0osage :9&g ta#"et once a da!

Indications Monotherap! as an ad+unct to diet and exercise to

i&proe g"ucose contro" in patients with t!pe 8

&e""itus

As a part of coination with a su"fon!"urea) &etfor&in

and insu"in when diet) exercise) p"us a sing"e agent

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a"one does not resu"t in g"!ce&ic contro" in t!pe 8

dia#etes

/ursing Responsi#i"it! Monitor "ier function tests #efore therap! and during the

therap! to &onitor effectieness of drug

Ad&inister without regards to &ea"s

Arrange consu"tation with dietitian to esta#"ish weight

"oss progra& and dietar! contro" as appropriate

Patient Education 0o not discontinue this &edication without consu"ting

!our hea"th care proider continue with diet and

exercise progra& for dia#etes contro"

Ta$e this drug without regards to &ea"s% If a dose is

&issed) it &a! #e ta$en on the next schedu"ed ti&e%

If the dose is &issed on the entire da!) do not ta$e dou#"e

dose the fo""owing date

Monitor urine and #"ood er! c"ose"! for g"ucose and

$etones whi"e ad+usting to drugs

,se #arrier contracepties if current"! using with

hor&ona" contraceptie

Met!r(in

-"ass Antidia#etic

Therapeutic Action Exact &echanis& is not understood possi#"! increases

periphera" uti"i*ation of g"ucose) decreases hepatic

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g"ucose production) and a"ters intestina" a#sorption

of g"ucose%

0osage 459 &g ta#"et twice a da!

Indications Ad+unct to diet to "ower #"ood g"ucose with t!pe 8

dia#etes &e""itus in patients who are 29 !ears o"d or

o"der and extended re"ease in patients 23 !ears o"d and

o"der

As part of coination therap! with su"fon!"ureas or

insu"in when either drug a"one cannot contro"

g"ucose "ee"s in patient with t!pe 8 dia#etes

&e""itus

/ursing Responsi#i"ities Monitor urine and seru& g"ucose "ee" to deter&ine

effectieness of drug and dosage

Arrange for transfer to insu"in therap! during periods of

high stress

Patient Teaching 0o not discontinue this &edication without consu"ting

hea"th care proider

Swa""ow extended re"ease ta#"et as who"e) do not crush )

#rea$ or chew%

Ketr"a$

-"ass /SAI0) /onopioid Ana"gesic) Antip!retic

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Therapeutic Action Antiinf"a&&ator! and ana"gesic actiit! inhi#its

prostag"andins and "eu$otriene s!nthesis%

0osage :9 &g a&pu"e eer! 4 hours dai"! intraenous"!

Indications Short ter& &anage&ent of pain


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Fro& Theor! to Praxis 8;

NURSING CARE PLANS

Assess&ent /ursing

0iagnosis

oa" of -are /ursing

Interention

Rationa"e Ea"uation

NMa! &ga

pag$a$ataon"ang na&ada"as

a$ong&auhaw at

&ada"as &aihi

$atu"adnga!on% As

stated #! thepatient%

"!cos!"atedHe&og"o#in

4%8

Ia"anced

/utrition MoreThan .od!ReBuire&ents

re"ated to insu"indeficienc! with

ina#i"it! to

uti"i*e nutrientsas eidenced #!

freBuenturination)

increased thirst

and e"eated#"ood g"ucose

"ee"

Short ter&

goa"

After 5 da!s

of nursinginterentions)

c"ient wi""

&aintainadeBuate

ca"oric andnutritiona"

inta$e as

eidenced #!reso"ing

s!&pto&s ofh!perg"!ce&ia

Ongoing

assess&ent

@eigh the

patient on initia"and su#seBuent

contact

Assess for signs

of h!perg"!ce&ia

Reiew #"oodg"ucose histor!

Assess current

eating ha#its

To esta#"ish

#ase"ine andco&parison for

futurereassess&ent

H!perg"!ce&i

a resu"ts whenthere is inadeBuate

insu"in%

To esta#"ish#ase"ine of #"ood

g"ucose "ee"

To identif!

the foundation fordee"oping an

indiidua"i*ed diet

After 5 da!s of

nursinginterentions)c"ient hae

&aintainedadeBuate ca"oric

and nutritiona"

inta$e aseidenced #!

reso"ings!&pto&s of

h!perg"!ce&ia

oa" &et%


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Therapeuticinterentions

Esta#"ish

goa"s with

patient% Reiew

progress towardsgoa"s on eachsu#seBuent isit%

Assistpatient to

identif! eating

pattern thatneeds changing

Refer to a

registereddietitian for an

indiidua"i*ed

instruction

Instruct

patient to ta$e

p"an%

Patient

ino"e&ent in the

treat&ent p"anenhancesadherence to

treat&entregi&ens%

To proide

the #asis for

indiidua"i*ed dietp"an

An

indiidua"i*ed&ea" p"an #ased on

weight) #"ood

g"ucose and "ipidpattern shou"d #e

dee"oped for eachpatient

Each

i


26/115


Ora"Hpog"!ce&ic

Agent as directed

Instruct thepatient to

exercise% Refer tothe Pg!sica"

therap!

depart&ent forappropriate

exercise%

&edication acts ondifferent site of

g"ucose&eta#o"is&% The

patient &ust #e

infor&ed regardingthis to &axi&i*e

each &edicationJseffects%

Exercise

i&proes "ipidpattern and assists

with weight "oss%

i


27/115


Assess&ent/ursing0iagnosis

oa" of -are /ursing Interention Rationa"e Ea"uation

NSa#i ng doctor$ai"angan $o nadaw &agsa$sa$

ng insu"inpag"a#as $o ng

ospita")hindi $o

pa nga a"a&$ung pano e)as er#a"i*ed #!

the patient%

-o&p"ex&edica"regi&enInsufficient$now"edgea#out dia#etesand itstreat&ent

Ris$ forineffectietherapeutic

regi&en&anage&ent

re"ated to

co&p"ex &edica"regi&en and$now"edge

deficits

After : da!s ofnursinginterention) the

c"ient wi""

0e&onstrate

a#i"it! to&aintain #"oodg"ucose "ee"within definedtarget range

0e&onstrate$now"edge ofdia#etes se"fcare &easures

0eter&ine patient

"earning needs%

Ea"uate se"f&anage&ent s$i""s)

inc"uding a#i"it! toperfor& procedures for#"ood g"ucose &onitoring

Assess financia" resourcesfor hea"th care

Ensure that the patient has$now"edge a#outs!&pto&s) causes)treat&ent) and preentionof h!perg"!ce&ia

Ensure that the patient has$now"edge a#out the

s!&pto&s) causes)treat&ent and preention

of h!perg"!ce&ia%

This dictates the

a&ount and t!pe ofinfor&ation

necessar!%

This deter&ines thea&ount of

educationnecessar!

The cost of

&edication &a!#eco&e #arrier to

&anage&ent of0ia#etes%

E"eated g"ucose"ee"s in patientswith preious"!diagnosed dia#etesindicate the need toea"uate dia#etes&anage&ent%

FreBuent episode

of h!pog"!ce&ia inindiidua"s with

preious"!diagnosed dia#etes

indicate the need to

After : da!s of nursinginterentions) the c"ient

0e&onstrated thea#i"it! to&aintain #"ood

g"ucose "ee"within definedtarget range

0e&onstrated$now"edge of0ia#etes and itstreat&ent

i


28/115


Teach re"ationship#etween &edication&anage&ent and #"oodg"ucose contro"

Teach the patient how touse #"ood g"ucose resu"tsin oera"" dia#etes&anage&ent reiew

#asic patterns&anage&ent%

Ea"uate effectieness ofeer! instruction

Instruct the patient on

0ia#etes &anage&entduring i""ness%

o Instruct to ta$e a""

ea"uate dia#etes&anage&ent%

Approxi&ate"!69 of personswith 0ia#etes wi""reBuire ora"antidia#etes&edications)

insu"in) or #oth

Instruction a""owsthe patient toidentif! whentherap! ad+ust&entneed to #e &ade in

dia#etes treat&ent

Ea"uationproidesopportunit! tocorrect errors intechniBue%Education is anongoing processthat reBuiresreinforce&ent oerti&e%

i


29/115


&edications%o Se"f&onitor #"ood sugar

eer! 8 to 7 hourso 0rin$ 4 ounces of f"uids

eer! 7 hours% Sugar freedrin$s are reco&&endedwhen the patient is a#"e to&aintain nor&a"car#oh!drate inta$e%

Su#stitute drin$scontaining sugar when theindiidua" cannot to"eratefood as in anorexia%

Instruct when to contactpri&ar! proider ."ood

g"ucose "ee"s higher than:99&gCd') o&iting for

&ore than 87 hours)s!&pto&s of deh!dration

or s!&pto&s suggestingdee"op&ent of HH/S%

Instruct the patient a#outp"anning for dia#etes&anage&ent whentrae""ing such as putting&edications in carr!on"uggage%

Refer to socia" serices tohe"p with financia"

resources

Ear"! treat&ent ofh!perg"!ce&ia

preents HH/Soccurrence%

So&e trae" &a!ino"e ti&e

changes that &a!disrupt the

patientJs usua"routines%

/onadherence to atreat&ent p"an &a!occur #ecause of

i


30/115


"i&ited resources inpurchasing

&edications and#"ood g"ucose

&onitoringsupp"ies% So&e

costs &a! not #ecoered #! hea"th

insurance%

i


31/115


Assess&ent /ursing0iagnosis

oa" of -are /ursingInterention

Rationa"e Ea"uation

NAng dahi"an

ng pagpachec$up $o eh

pagsa$it ng

pusonhanggang sa

#a"a$ang) asc"ai&ed #! the

patient

Pain sca"e of;C29 uponassess&ent

Positioning toaoid painSighingReducedinteraction withtheeniron&entE"eatedte&peratureE"eated @.-Feer


32/115


Anticipate need

for pain re"ief

Respond

i&&ediate"! toco&p"aint of

pain

Proide rest

periods tofaci"itateco&fort) s"eep

and re"axation%

ana"gesic&edications%

One can &ost

effectie"! dea"with pain #!

preenting it%

In the &idst ofpainfu"experience) a

patientsperception ofti&e &a! #edistorted%Pro&ptresponse toco&p"ain &a!resu"t decreased

anxiet! forpatients%

Patient

experience ofpain &a!#eco&eexaggeratedwith fatigue%

Pain

i


33/115


Ad&inister

ana"gesic asorderedea"uatingeffectienessand o#seringsigns ands!&pto&s of

untowardeffects

Proide

anticipator!instruction on

pain causes)appropriate

preention andre"ief &easures

Instruct the

patient toreport pain

Instruct the

patient toea"uate andreporteffectieness of

&edications area#sor#ed and

&eta#o"i*eddifferent"! #!

patients) so theireffectieness

&ust #eea"uated

indiidua""!%

Lnow"edge

a#out what toexpect can he"p

the patientdee"op

effectie copingstrategies for

pain&anage&ent

Re"ief &easures

&a! #einstructed

Re"ief &easures

cou"d #e&odified to

produce &oresatisfactor!

co&fort "ee"s

i


34/115


&easures used

A//e//(entN)r/in'

Dia'n/i/Ga" ! Care N)r/in' Inter+entin Ratina"e E+a")atin

O#+ectie

H!perg"!ce&iaPh!sica"

i&&o#i"i*ation

I&paired s$inintegrit! re"ated

to a"tered

&eta#o"ic state


35/115


Assess the circu"ator!

status of the foot #!

pa"pation of periphera"pu"ses%

Assess for infection

Exa&ine hosier! and

shoes

Teach the patient to

inspect feet dai"! for

cuts) scratches and#"ister% ,se a &irror to

exa&ine the #otto& ofthe foot% Instruct the

patient to use #oth

isua" and tacti"einspection%

decrease of #"oodsupp"! in the foot%

S!&pto&s &ight

#e present due to

neuropath!

Maceration

#etween the toes

predisposes thepatient to infection

A"" surfaces of the

foot &ust #e

exa&inedinc"uding s$in

#etween the toes%Touch wi""

identif! s$in

surface a"terationthat are not eident

#! sight%

This rep"aces

&oisturi*ing

effects "ost #!

autono&icneuropath!% Se"ect

"otion with "ow

i


36/115


Encourage use of

&oisturi*ing "otion at

"east once dai"!% Aoidareas #etween the toes%

Report signs of

infection i&&ediate"!to the pri&ar!

proider%o Area of s$in

#rea$downo Increase in

te&perature asco&pared to

the sa&e areaof the oppositefoot%

o 0ischarge that

dee"ops an

odor%

Teach patient to

a"coho" content topreent dr!ing of

the s$in

Ear"! treat&ent is

essentia" in

preention of

co&p"ications%

-arefu" dai"!

assess&ent

reduces ris$ ofin+ur! to the foot%

i


37/115


inspect the shoes dai"!#! fee"ing the inside of

the shoe forirregu"arities in the

"ining) sharp o#+ects in

the so"e of the shoe) orforeign #odies in the

shoe%

Teach the patient to

aoid ther&a" in+uries

#!o Testing the

te&perature of#ath water with

the e"#ow)wrist or

ther&o&eter)o Aoiding use

of heating pad)

hot water#ott"es or

e"ectric#"an$ets

o Maintaining a

safe distance

fro& heatsources

Instruct the patient to

a"wa!s wear protectie

Sensor!

neuropath! &a!resu"t in nor&a"

pain andte&perature

sensation% These

changes increases

ris$ for #urns%

This preents foot

in+ur!%

Soa$ing can

&acerate the s$inand increases the

ris$ of infection

i


38/115


footwear%


aoid soa$ing feet%


tri& nai"s across and to

fi"e sharp corners to&atch contour of the

toe%

This preents foot

in+ur!

A//e//(entN)r/in'

Dia'n/i/Ga" ! Care

N)r/in'

Inter+entinRatina"e E+a")atin

i


39/115


NMas!ado nangang &ada&i

ang dapaticonsider para

&a$ontro" $o

tong 0ia#etes $onga!on e%

O#+ectie

-o&p"ex &edica"regi&en

ReBuire&ent for

changes in"ife"ong #asis

Increasing se"fcare reBuire&ents

to &aintain #"ood

g"ucose contro"

Ris$ forineffectie

coping re"atedto co&p"ex

&edica"

regi&en)reBuire&ents of

change in"ife"ong #asis

and increasingreBuire&ents to

&aintain #"ood

g"ucose contro"

After 8 da!s of

nursinginterentions) the

patient wi""

.e a#"e to

perfor&

se"fcare#ehaiors

Identifies

stressors

thatinterfere

with a#i"it!to contro"

dia#etes

0ee"ops

appropriate

action p"anto dea" with

stressors

Assist

patient to

identif! thesituations

that causeanxiet! or

increased

stress%

He"p patient

identif!

thoughtsand fee"ing

associatedwith

stressors%

He"p patientto identif!

stressre"ated

A starting point

is to as$ the

patient what heor she finds

&ost difficu"t todo% The patient

&a! #e a#"e to

cope with on"!

one hea"th#ehaiourchange at a

ti&e%

Fee"ings of

anger) denia"

and depressionare freBuent"!

associated witha chronic

disease

uiding the

patient to iewthe situation

After 8 da!s of

nursing interentions)the c"ient was

A#"e to perfor&

se"fcare #ehaiors

A#"e to identif!

stressors thatinterfere with

a#i"it! to contro"dia#etes

A#"e to dee"opappropriate action

p"an to dea" withstressors

i


40/115


dia#etespro#"e&s

and issues owhich the

patient

wants towor$%

He"p thepatientidentif!

adaptiecoping

strategies

Proide

educationneeded to

ena#"e thepatient to

perfor& se"f&anage&ent

#ehaiors "i$e

into s&a""erparts &a! &a$e

the coping &ore&anagea#"e%

Anxiet! can #ereduced whenthe patient has

anticipated astressor and

dee"oped a

p"an to reduceor aoid the

stressor%

Anxiet! can #e

reduced whenthe patient has

technica"$now"edge and

a#i"it! toperfor& the se"f

care #ehaiors

reBuired for#"ood g"ucose

i


41/115


o Se"f."ood

"ucose

&onitoringo Medication

ad&inistration

o Ad+ust&ent

of therap! for

exercise and

i""nesso Mea"

p"anning

H!poCh!perg"!ce&ia

&anage&ent

Assist

patient inexa&ining

aai"a#"e

resources to

&eet goa"s%Reiewhea"th care

resourcesthat are

aai"a#"e for

use

contro"% Onadherence to

reBuire&ents&a! occur

#ecause of

patient&isunderstandi

ng ofinfor&ation%

Socia" support

increases thea#i"it! of the

patient to dea"with stress

i


42/115


Proide

positie

reinforce&ent for use of

adaptie#ehaiors

Ac$now"edge that

change &a!not #e

possi#"e

Reinforce&ent

increases the

patientJsconfidence in

his or her a#i"it!to perfor&

specific

#ehaiors

The patientsreadiness for

change &a!preent

a"terations in#ehaior

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43/115

Fro& Theor! to Praxis 75

-ase Ana"!sis Onco"og!

INTRODUCTION

-ancer is not a sing"e disease with sing"e cause rather it is a group of distinct

diseases with different causes) &anifestation) treat&ents and prognoses%

The scope) responsi#i"ities and goa"s of cancer nursing ae as dierse and co&p"ex as

those other nursing specia"t!%

-ancer nurses &ust #e prepared to support patients and fa&i"ies through a wide

range of ph!sica") e&otiona") socia") cu"tura" and spiritua" crises%

'i$e other chronic diseases) cancer can resu"t to the patientJs depression and he"p"essness

as with the fo""owing case to #e discussed%

In this report) a case of a 78 !Co housewife who was diagnosed with 'ier -ancer

in Septeer 8928 wi"" #e discussed% 'oss of appetite and difficu"t! s"eeping &ade her

see$ hea"th care attention% She was adised to undergo surger! #ut opted to tr!

&edications unti" her condition got worse%

In /oeer 6) 8928) due to diarrhea and #od! wea$ness) she was #rought to

/otre da&e 0e -hartres Hospita" .aguio -it! and after assess&ent of the &edica" histor!

and diagnostic procedures) she was ad&itted to the Mere Marie Anne @ard for further

&anage&ent%

PATIENT PROFILE

Age 78

Sex Fe&a"e


44/115


-ii" Status Married

Educationa" Attain&ent -o""ege raduate


45/115


-hartres Hospita" .aguio -it! and after assess&ent of the &edica" histor! and diagnostic

procedures) she was ad&itted to the Mere Marie Anne @ard for further &anage&ent%


The patientJs father died of Pneu&onia in 8996%

The patientJs &other is present"! "iing with the& in hea"th! condition% She


46/115


Aside fro& consu"tations "eading to the diagnosis of 'ier -ancer) she had not

aai"edCsought hea"th care assistance in the past !ear%

She is current"! an insurance sa"es agent and during her hea"th! da!s were

exposed to noise and extre&es of weather% The wor$ing eniron&ent is different fro&

ti&e to ti&e for she has #een assigned in different areas%

The patient "ies with her hus#and and four chi"dren in their ho&e at Ma% Aurora

which she rates the condition as good% The on"! pro#"e& she identified where the "i&ited

techno"og! present in the area "i$e te"eco&&unications and internet%

@hi"e waiting for her decision regarding the &anage&ent of her "ier cancer) her

ph!sician prescri#ed &u"tiita&ins which she too$ once dai"! #efore ad&ission% @hen

she was ad&itted) the doctor prescri#ed Piperaci""inTa*o#acta&) Furose&ide) Gita&in L

and Paraceta&o" &st &edications are gien intraenous"!%

She #e"iees that this regi&en is the #est for her as it is prescri#ed%

The patient does not hae histor! of accidents and fa""s the past !ear% She has

pro#"e&s with hea"ing which she noticed in the &id8928%

B. N)tritina"-Meta*"i$ Pattern

She "ost rough"! 89 $i"ogra&s since the "ast six &onths which she attri#uted to

"oss of appetite% ,sua" &ea" that she can to"erate without o&iting is soup) #read and

s&a"" a&ount of fruits% She &a$es sure that she drin$s at "east 2 "iter of water per da!%

C. E"i(inatin Pattern

i


47/115


The patient has at "east three #owe" &oe&ents per da! since her diarrhea is

contro""ed occurring not on the sa&e ti&e each da!% Most"e she passes soft to "iBuid "ight

co"ored stoo"%

D. A$ti+it,-Eer$i/e Pattern

The patient does not &anifest c!anosis) with wea$ #ut pa"pa#"e pu"ses%

Extre&ities are coo"% -api""ar! refi"" is de"a!ed


48/115


Interna" and externa" factors "ingering on the patients &ind &a$es it difficu"t to

decide on &a+or decisions to &a$e for her "ife and the situation% The one who &ost"!

decides for her is her hus#and who is her pri&ar! caregier at ho&e%

F. Se"!-Per$e%tin an& Se"!-Cn$e%t Pattern

0uring the assess&ent) the patient is ca"& with &onotonous oice and "oo$s in

the e!e of an!one ta"$ing to her%

Her &a+or concern is her death% She does not $now when or when the right ti&e

wou"d co&e and her readiness for it% She has a neutra" iew for herse"f%

G. R"e-Re"atin/#i% Pattern

/o speech or co&&unication pro#"e&s noted during the assess&ent%

In Ma% Aurora) she "ies with her fa&i"!% She finds no difficu"t! in her parenting

s$i""s and the fa&i"! did not experience an! "oss the past !ear%

She had four pregnancies in which a"" chi"dren are #orn a"ie and ter&% She has

stopped &enstruating at the age of 79 #ut prior to that) she uses #irth contro" pi""s for

contraception% 0uring her ad&ission) she had a histor! of agina" discharge that "asted for

a da! on"!%

H. C%in'-Stre// T"eran$e Pattern

-"ient ad&itted that she cries when no#od! is around due to the hope"essness she

fe"t% .ut she is now "earning to accept her situation%

i


49/115


At present) she rates her stress hand"ing as aerage and her pri&ar! wa! to do it is

to share e&otions and fee"ings to her hus#and She er#a"i*ed that #! haing a

conersation with her hus#and) she fee"s re"ief%

In her case) the intera" of s!&pto& experience and hea"th care consu"tation is 6

&onths%

H. Va")e-Be"ie! Pattern

The patient is a Ro&an -atho"ic and confessed that in the ear"! stages of her

i""ness) her faith was &oed #ut #egan to regain it again after so&e ti&e% She $eeps on

pra!ing to the Supre&e .eing and wishes to attend the &ass as soon as she can%

LABORATORY AND DIAGNOSTIC E1AMINATIONS

HEMATOLOGY REPORT

PARAMETERS RESULTS NORMAL VALUES

@hite ."ood -e""s 25%2 x 29Q: 7%929%9

Red ."ood -e""s :%5: x 29Q;Cu' :%55%9He&og"o#in 229 gC' 22%925%9

He&atocrit 9%::4 9%:399%:49

P"ate"et -ount 794 x 29Q:Cu' 279759

@.- 0ifferentia"

/eutrophi"s 9%43 9%79%3

'!&phoc!tes 9%28 9%89%9%79

Monoc!tes 9%92 9%999%9;


E"ectro"!tes

Potassiu& :%95 :%55%:

Sodiu& 275%: 2:527464293

ASCITIC FLUID

-o"or YE''O@

Transparenc! S'IHT'Y T,R.I0Go"u&e 44 &'

@.- 2: ce""sCu'

R.- 74 ce""sCu'

i


50/115


TUMOR MARKER TEST

-EA 899

AFP 2%37

HEPATITIS PROFILE

AntiH.S 8H.SAg /onreactie

AntiH-G /onreactie

FECAL OCCULT BLOOD TEST

Positie FO.T

OTHER LAB E1AM

."eeding Para&eters

I/R 2%:8

PT 25%; sec

"ucose 69%48 &gCd'

-ho"estero" Trig"!ceride 29%37

H0' 25%83


51/115


-ancer is a disease patters that #egins when an a#nor&a" ce"" is transfor&ed #!

the genetic &utation of the ce""u"ar 0/A%


52/115


-he&ica"s such as in!" ch"oride and arsenic

-arcinogenesis is a &u"tistage process that #egins when a carcinogen

causes a genetic change or da&ages the 0/A in a nor&a" ce""% This &a$es the ce""

&ore u"nera#"e to other genetic changes% This stage is ca""ed Uinitiation%U If the

process ended here) and the cancerous ce"" did not grow and rep"icate) no cancer

wou"d for&%

The next stage of carcinogenesis is ca""ed Upro&otion%U This occurs when

the initiated ce"" is exposed to an agent that enhances its growth into a "arger

&ass%

@hen a tu&or actua""! for&s) it has a"" of the sa&e #asic needs as a

nor&a" ce""% .ecause the tu&or ce""s are genetica""! da&aged) the! are inefficient

and ro# nor&a" ce""s of i&portant ox!gen and nutrients% In addition) a &a"ignant

i


53/115


tu&or grows uncontro""a#"! and can eentua""! interfere with the function of ita"

organs) such as the "ier

V Metastatic tu&ors for& when "arge progressie tu&ors shed tu&or

ce""s% These tu&or ce""s &ust #e a#"e to grow and function apart

fro& the pri&ar! tu&or

V Moe throughout the #od!) usua""! through the circu"ator! s!ste&

or the "!&phatic s!ste&%

V Often "odge in a #"ood capi""ar!) where the! &a! or &a! not grow%

The tu&or ce""s that actua""! grow are so&ehow &ore suited to the

new "ocation%

V Tend to &utate &ore Buic$"! than nor&a" ce""s) giing the& a

greater a#i"it! to adapt to their eniron&ent as we"" as a greater

a#i"it! to resist therap!%

i
http://www.livercancer.com/treatments/glossary.htmlhttp://www.livercancer.com/treatments/glossary.htmlhttp://www.livercancer.com/treatments/glossary.htmlhttp://www.livercancer.com/treatments/glossary.htmlhttp://www.livercancer.com/treatments/glossary.htmlhttp://www.livercancer.com/treatments/glossary.html


54/115


V More "i$e"! to infect p"aces the! can easi"! reach% .ecause the "ier

is c"ose to or actua""! connected to seera" significant organs) and

#ecause the "ier p"a!s an i&portant ro"e in #"ood circu"ation #!

acting as a fi"ter) &etastatic "ier cancer occurs in oer 35 of a""

ter&ina" cancer patients%

DRUG STUDY

Pi%era$i""in4Ta2*a$ta(

-"ass Antiinfectie) .eta'acta& Anti#iotic) Anti

pseudo&ona" Pennici""in


0osage 8%85g Intaenous"! eer! 4 hours

/ursing Responsi#i"ities O#tain histor! of h!persensitiit! to penici""ins)

cepha"osphorins) or other drugs prior to ad&inistration)

O#tain speci&en for cu"ture and sensitiit! prior to first

dose of the drug start drug pending resu"ts% Periodic

-.- with differentia") p"ate"et count) Hg# ? Hgt) and

seru& e"ectro"!tes%

Monitor for h!persensitiit! response discontinue drug

and notif! ph!sician if a""ergic response noted%

Monitor for he&orrhagic &anifestations #ecause

high dose &a! induce coagu"ation a#nor&a"ities%

i


55/115


Instruct fa&i"!Csignificant others to report significant)

unexp"ained diarrhea%

Monitor ita" signs #ecause of cardiac arrh!th&ias)

h!pertension and feer as aderse reactions%

Instruct the &other not to #reast feed the #a#! whi"e

ta$ing the drug without consu"ting ph!sician%

F)r/e(i&e

-"ass 0iuretic

Therapeutic Action Inhi#it rea#sorption of sodiu& and water in the ascending

"i of the "oop of Hen"e #! interfering with the ch"oride

#inding site of the 2/aK) 2LK) 8-" cotransport

s!ste&%

'oop diuretics increase the rate of de"ier! of tu#u"ar

f"uid and e"ectro"!tes to the dista" sites of h!drogen

and

potassiu& ion secretion) whi"e p"as&a o"u&e contraction

increases a"dosterone production% The increased de"ier!

and high a"dosterone "ee"s pro&ote sodiu&

rea#sorption at the dista"tu#u"es) thus increasing the "oss

of potassiu& and h!drogen ions%

0osage 89 &g after 7thR.- Transfusion

i


56/115


/ursing Responsi#i"ities O#sere patients receiing parentera" drug carefu""!

c"ose"! &onitor .P and ita" signs% Sudden death

fro& cardiac arrest has #een reported%

Monitor .P during periods of diuresis and through period

of dosage ad+ust&ent%

O#sere o"der adu"ts c"ose"! during period of #ris$

diuresis% Sudden a"teration in f"uid and e"ectro"!te

#a"ance &a! precipitate significant aderse

reactions% Report s!&pto&s to ph!sician%

'a# tests O#tain freBuent #"ood count) seru& and urine

e"ectro"!tes) -O8) .,/) #"ood sugar) and uric acid

a"ues during first few &onths of therap! and

periodica""! thereafter%

Monitor for S?S of h!po$a"e&ia%

Monitor I?O ratio and pattern% Report decrease or

unusua" increase in output% Excessie diuresis can

resu"t in deh!dration and h!poo"e&ia) circu"ator!

co""apse) and h!potension% @eigh patient dai"! under

standard conditions%

Monitor urine and #"ood g"ucose ? H#A2- c"ose"! in

dia#etics and patients with deco&pensated hepatic

cirrhosis%

0rug &a! cause h!perg"!ce&ia%

i


57/115


Via(in K

-"ass Gita&ins

Therapeutic Action An antihe&orrhagic actor that pro&otes hepatic

for&ation of actie prothroin%

0osage 2 A&pu"e


58/115


Monitor PT to deter&ine dosage effectieness as ordered%

If seere #"eeding occurs) donJt de"a! other &easures)

such as fresh fro*en p"as&a or who"e #"ood%

A"ert watch for signs of f"ushing) wea$ness) tach!cardia

and h!potension &a! progress to shoc$%

.e aware that ph!to&enodione therap! for he&orrhagic

disease in infants causes fewer aderse reactions than do

other ita&in L ana"ogues%

Fai"ure to respond to ita&in L &a! indicate coagu"ation

defects%

i


59/115

Fro& Theor! to Praxis ;2

NURSING CARE PLANS

A//e//(ent Dia'n/i/ P"annin' Inter+entin/ Ratina"e E+a")atin

Su#+ectie

N/anghihina naa$o) a!o$o na

&aggaga"aw

as stated #! thec"ient

O#+ectie

.od! &a"aisenoted

0iaphoresis Ina#i"it! to

concentrate Ina#i"it! to

perfor& usua"

A0's @ea$ in

appearance 'i&ited ROM

Actiit!

into"erancerCt

genera"i*ed#od!

wea$ness

After 4

hours ofnursing

interentions) patient wi""

participatewi""ing"! in

necessar!

actiit!) wi"""earn how to

consereenerg! and

er#a"i*ere"ief fro&

fatigue%

Ea"uate ptJs current

actiit! to"erance Ad+ust actiit! and

reduce intensit! oftas$ that &a! cause

undesiredph!sio"ogica"

changes Increase exercise

and actiit! "ee"s

gradua""!

Teach &ethods to

consere energ!

such as sitting thanstanding whi"e

dressing 0e&onstrateCAssist

the patient whi"e

doing A0'

Proide

cooperatie#ase"ine

To preentoer exertion

Enhances

actiit!to"erance

He"ps

&ini&i*e

waste ofenerg!

After 4 hours

of nursinginterentions

) patientparticipated

wi""ing"! innecessar!

actiities)

"earned howto consere

energ! ander#a"i*ed

re"ief fro&fatigue

oa" &et


60/115


0ifficu"t!initiating

&oe&ents

ie the patientinfor&ation that

proides eidenceprogress

Encourage c"ient to

do whateerpossi#"e e%g% se"f

care

Protect patientfro& in+ur!

To sustain

patientJs&otiation

Proides for

sense of

contro" andfee"ing of

acco&p"ish&ent

i


61/115



i


62/115


Su#+ectie

N/apansin $o na

"u&a"a$i ang ti!an

$o as er#a"i*ed

#! the patient

O#+ectie

@ea$ inappearance

(aundice A#do&ina"

distentionnoted

A#do&ina"

girth of :8

F"uid o"u&e

excess rCtco&pro&ised

regu"ator!&echanis&

secondar! to

cirrhosis ofthe "ier as

&anifested #!)wea$ in

appearance)

+aundice)a#do&ina"

distention)a#do&ina"

girth of :8

After 8 da!s


patient wi""de&onstrate

sta#i"i*ed

f"uid o"u&eand decreased

a#do&ina"girth%

Monitor ita"

sign

Measure

inta$e andoutput

Monitor .P

Assessrespirator!

status

Monitor

a#do&ina"girth

Esta#"ished

#ase"ine data

Ref"ects

circu"ating

o"u&e status)dee"oping f"uid

shifts) and inresponse to

therap!

.P e"eationsare usua""!

associated withf"uid o"u&e

excess

Indicatie of

pu"&onar!

congestionCede&a

Ref"ects

accu&u"ation off"uid


63/115


Restrict

sodiu& andf"uids as

ordered

Ad&inister

diuretics asordered

Sodiu& &a! #e

restricted to&ini&i*e f"uid

retention in

extraascu"arspaces% F"uid

restriction &a!#e necessar! to

preentdi"utiona"

h!ponatre&ia

,sed with

caution tocontro" ede&a

and ascites)#"oc$ effect of

a"dosterone) and

increase waterexcretion whi"e

sparing

potassiu&

i


64/115



Su#+ectie N@a"a

a$ong ganang

$u&ain as er#a"i*ed

Report of weight "oss

O#+ectie

@ea$ in

appearance Poor &usc"e

tone (aundice noted E&aciated E"ectro"!te

ia"ance

Ia"ancenutrition "ess

than #od!reBuire&ents rCt

"oss of appetite

After : da!s ofnursing

interentions)patientJs

appetite wi""

i&proe fro& 8t#sp to at "east

5 t#sp per &ea"%And wi""

de&onstratec"ose to nor&a"

"a#orator!

a"ues

Monitor ita"signs

Assist in ora"

h!giene #efore&ea"s%

0iscuss eating

ha#its inc"udingfood preferences%

Sere faoritefoods that are not

contraindicated% Preent or

&ini&i*e

unp"easant odorsduring &ea" ti&e%

Sere foods that

are attractie andpa"ata#"e%

Reco&&end

s&a"") freBuent&ea"s

For #ase"ine data

A c"ean &outhenhances

appetite

To appea" to

c"ient "i$es and

dis"i$es

Ma! haenegatie effect

on appetite

To sti&u"ate the

appetite

Poor to"erance to"arger &ea"s &a!

After 4 hours ofnursing

interentions)patientJs

appetite

i&proed fro&8 t#sp to 5 t#sp

per &ea" andde&onstrated

c"oser tonor&a"

"a#orator!

a"ues

%

i


65/115


Restrict inta$e of

caffeine) gasproducing or

spic! andexcessie"! hot or

co"d foods

Proide

assistance withactiities as

needed% Pro&oteundistur#ed rest

periods)especia""! #efore

&ea"s Adise to

consu&enutritious foods

#e due toincreased intra

a#do&ina"pressureCascites

Aids in reducinggastric irritation

? a#do&ina"disco&fort that

&a! i&pair ora"inta$eCdigestion

-onsering

energ! reduces

&eta#o"icde&ands on the

"ier andpro&otes ce""u"ar

regeneration%


i


66/115


Su#+ectie

NPa&insan

&insan) hirappadin a$o

&a$atu"og asc"ai&ed

O#+ectie

Sun$en

e!e#a""s Fatigue Mood

a"terations .od! wea$ness

noted

0istur#ed

s"eep pattern

After 7 hours


patient wi""esta#"ish

adeBuate s"eep

pattern andreport rested%

Ea"uate "ee"

of stress

Adise to

reduce f"uidinta$e at night

Proide soft&usic or

Nwhite noise

if aai"a#"e

Increasing

confusion)disorientation)

anduncooperatie

#ehaior &a!

interfere withattaining restfu"

s"eep

0ecreases need

to get up to goto #athroo&

during s"eep

Reducessensor!

sti&u"ation #!

#"oc$ing outother

eniron&enta"

sounds thatcou"d interfere

with restfu"s"eep

After 7 hours


patientesta#"ished

adeBuate s"eep

pattern andreported

rested%

oa" &et

i


67/115



Su#+ectie

NLada"asan

nangangatia$o as

c"ai&ed #!the patient

O#+ectie

Pruritus noted

0r! s$in Er!the&a

noted Sca"! s$in

Ris$ fori&paire

d s$inintegrit

!


interentions)patient wi""

&aintain s$inintegrit! and

identif!

indiidua" ris$factors and

de&onstrate#ehaiorsCtechni

Bue to preent

s$in #rea$down%

Inspect s$insurfaceCpressure

points routine"!%ent"! &assage

#on! pro&inencesor areas of

continued stress

EncourageCassist

with repositioning

on a regu"arschedu"e whi"e in

#ed) chair andactie passie

ROM exercises as

appropriate

Ede&atoustissues are &ore

prone to#rea$down and

to the for&ationof decu#itus

u"cers% Ascites

&a! stretch thes$in to the point

of tearing inseere cirrhosis

Repositioning

reducespressure on

ede&atoustissues to

i&proe

circu"ation%Exercises

enhancecircu"ation and

i&proe)&aintain) +oint

&o#i"it! Moisture


interentions)patient

&aintained s$inintegrit! and

identified

indiidua" ris$factors and

de&onstrated#ehaiorsCtechniB

ues to preent

s$in #rea$down%

i


68/115


Leep "inen dr!and free of

wrin$"es

Suggest c"ippingfinger nai"s short

aggraatespruritus and

increases ris$ ofs$in #rea$down

Preents c"ient

fro&inadertent"!

in+uring thes$in especia""!

whi"e s"eeping

i


69/115


-ase Stud! -ardio"og!

INTRODUCTION

M!ocardia" infarction is the "eading cause of death in the ,nited States and in &ost

industria"i*ed nations throughout the wor"d%

The fo""owing case is a case of a 7: !ear o"d &a"e who was rushed to the hospita" due

to co&p"ains of consistent chest pain and shortness of #reath% Thorough c"inica"

assess&ent reea"ed occurrence of M!ocardia" Infarction and i&&ediate treat&ent

&easures are rendered%

PATIENT PROFILE

Age 7:

Sex Ma"e

Address Taca! Rd%) Pinsao Proper) .aguio -it!) .enguet

Occupation House -areta$er

Ad&itting 0iagnosis Acute -orona! S!ndro&e) ST E"eation M!ocardia" Infarction)

Midd"e Inferior @a""

-o&p"ete Heart ."oc$ 8O

HISTORY OF PRESENT ILLNESS


70/115


In Octo#er 8928) patient had seera" episodes of chest pains which "ast for :9

&inutes &ost"! re"ieed with rest%

Few hours #efore his ad&ission) patient sudden"! co&p"ains of continued

episode of chest pain with heainess) characteri*ed as chest tightness) shortness of #eath

and pa"pitations%


PatientJs father has a contro""ed dia#etes &e""itus% His &other has no fa&i"!

histor! of chronic i""ness%

LABORATORY AND DIAGNOSTIC E1AMINATION

COMPLETE BLOOD COUNT 75545846956:


@hite ."ood -e""s 6%3 x 296C ' 7%929%9

R.- Morpho"og! /or&oc!ticCnor&ochro&ic

He&og"o#in 253 gC' 22%925%9

He&atocrit 9%73 9%:399%749P"ate"et -ount 724 x 296C ' 279759

@.- 0ifferentia"

/eutrophi"s 9%;3 9%79%3

'!&phoc!tes 9%83 9%89%9%79

Monoc!tes 9%9; 9%999%9;

Eosinophi"s 9%999%97

COMPLETE BLOOD COUNT 75545;46956:


@hite ."ood -e""s 29%6 x 29:Cu' 7%929%9

Red ."ood -e""s :%6; x 29;Cu' 7%95%59

He&og"o#in 28: gC' 2892;9He&atocrit 9%:39 'C' 9%7999%599

P"ate"et -ount 898 x 29:Cu' 259%9759%9

@.- 0ifferentia"

/eutrophi"s 9%38 9%799%39

'!&phoc!tes 9%84 9%899%79

Monoc!tes 9%99 9%99%9;


i


71/115


Ot#er La*ratr, Ea(inatin/ 75545


72/115


Moderate tricuspid regurgitation

Mini&a" epicardia" effusion%

/or&a" Pu"&onar! arter! pressure%

CORONARY ANGIOGRAPHY 75545846956:

-O/-',SIO/

-oronar! Arter! 0isease) 8esse" ino"e&ent


73/115


Patient is oriented with date) ti&e and p"ace%

He descri#es his hea"th status as poor% He is a cigarette s&o$er


74/115


A$ti+it,-Eer$i/e Pattern

The patient #efore his ad&ission is not engaged in exercise regi&en%

He is a house careta$er and the usua" actiit! inc"udes c"eaning of the house and

gardening% 0uring his free ti&e) he usua""! s"eeps or watch te"eision or so&eti&es find

so&eone to drin$ an! a"coho"ic #eerage%

On the ti&e of assess&ent) .P is 289C49 and a"" pu"ses are pa"pa#"e%

Shortness of #reath occurs during actiities and .P increases up to 89&&Hg

s!sto"ic) pu"se rate increases to 225 .PM%

Patient co&p"ains of wea$ness and needs assistance when doing A0's #ut

er#a"i*es that he hi&se"f o#seres i&proe&ent as the da!s pass #!%

S"ee% Re/t Pattern

The patient usua""! s"eeps fro& 6PM to 5AM%

0uring his first da!s in the hospita") he finds it difficu"t to s"eep whi"e in pain #ut

&anages to s"eep we"" when &edicated%

C'niti+e-Per$e%t)a" Pattern

Patient is oriented with date) ti&e and p"ace%

He exhi#its no signs of pain as co&pared to the ti&e he is ad&itted% 0ecision

&a$ing is eas! and can restate current therapeutic regi&en%

Se"!-Per$e%tin an& Se"!-Cn$e%t Pattern

The patient appears ca"&%

i


75/115


His &a+or concern at the current ti&e is the fear of the experience to recur% He is

read! to change his "ifest!"e for preention of possi#"e recurrence% He is wi""ing to attend

fo""ow up consu"tations with his cardio"ogist%

Though thin$ing that he is wea$er as co&pared #efore) he has sti"" positie iew

of hi&se"f% He #e"iees that he can pass this eent in his "ife and "ie hea"thi"! starting the

present da!%

R"e Re"atin/#i% Pattern

He is a father of four chi"dren and "ies happi"! with the& together with his wife%

His wife owns a sari sari store which seres as their pri&ar! source of inco&e%

His socia" interaction is sti"" &aintained and expects it to #e the sa&e on the ti&e

of his discharge fro& the hospita"%

In ter&s of the usua" fa&i"! ro"e) he sa!s there wou"d #e no change in his parenta"

ro"e and his occupation as a house careta$er except for so&e restrictions i&posed #! his

present i""ness which he #e"iees &anagea#"e with the right "ifest!"e &odification and

consu"tation%

Se)a"it,-Re%r&)$ti+e Pattern

He ad&its that there wou"d #e so&e changes with regards to sexua" functioning as

expected with other patients with histor! of M!ocardia" Infarction%

C%in'-Stre// T"eran$e Pattern

i


76/115


At this point of his "ife) according to the patient) his present condition and the

s!&pto&s he fe"t was the &ost stressfu" eent in his "ife fee"ing that he is near death%

In a"" the stressfu" eents of his "ife) his fa&i"! is his co&panion and ta"$ing his

pro#"e& with his wife is his out"et of re"ief% He rates his stress hand"ing as good%

Va")e-Be"ie! Pattern

He is not er! satisfied with the dee"op&ent of his "ife dea"ing with his present

i""ness at the age of 78 for he said his ad&ission is a financia" #urden for his fa&i"!%

His ad&ission wi"" change his future p"ans in a positie wa!%

He is a -atho"ic #ut does not attend the &ass regu"ar"! and does not pra!

freBuent"!% .ut after his "ifethreatening experience) he ad&its that he p"ans to change his

practice for the #etter for he #e"iees his second "ife was a gift fro& od and he wi"" #e

foreer than$fu" for it%

PATHOPHYSIOLOGY

Six pri&ar! ris$ factors hae #een identified with the dee"op&ent of

atherosc"erotic coronar! arter! disease and MI h!per"ipide&ia) dia#etes &e""itus)

h!pertension) to#acco use) &a"e gender) and fa&i"! histor! of atherosc"erotic arteria"

disease% The presence of an! ris$ factor is associated with dou#"ing the re"atie ris$ of

dee"oping atherosc"erotic coronar! arter! disease%

A&ong the &entioned ris$ factors) the ris$s that is assessed present to the c"ient

are gender) h!per"ipide&ia) cigarette s&o$ing and ph!sica" inactiit!%

i


77/115


In &!ocardia" infarction) an area of the &!ocardiu& is per&anent"! destro!ed)

t!pica""! #ecause p"aBue rupture and su#seBuent throus for&ation resu"t in co&p"ete

occ"usion of the arter!%

The &ost co&&on triggering eent is the disruption of an atherosc"erotic p"aBue in

an epicardia" coronar! arter!) which "eads to a c"otting cascade) so&eti&es resu"ting in

tota" occ"usion of the arter!% Atherosc"erosis is the gradua" #ui"dup of cho"estero" and

fi#rous tissue in p"aBues in the wa"" of arteries


78/115


antiinf"a&&ator!) antirheu&atic

Therapeutic Action Inhi#ition of p"ate"et aggregation is attri#uta#"e to

the inhi#ition of p"ate"et s!nthesis of

throoxane A8) a potent asoconstrictor and

inducer of p"ate"et aggregation%

0osage :99&g once a da!

Indications Reduction of ris$ for death of nonfata" MI in

patients with histor! of infarction or

unsta#"e angina pectoris

MI proh!"axis

Mi"d to &oderate pai) feer) inf"a&&ator!

conditions

/ursing Responsi#i"ities ."ac$ .ox @arning 0o not use in chi"dren and

teenagers to treat chic$enpox or f"u s!&pto&s

without reiew for Re!eJs S!ndro&e) a rare #ut fata"

disorder%

ie drug with food or after &ea"s if I upset occurs%

ie drug with fu"" g"ass of water to reduce ris$ of

ta#"et or capsu"e "odging into the esophagus%

0o not use aspirin that has strong inegar"i$e odor

Ta$e extra precaution to $eep this drug out of reach

of chi"dren this drug can #e er! dangerous for

chi"dren

i


79/115


Report di**iness) ringing in the ear) di**iness)

confusion) a#do&ina" pain) rapid or difficu"t

#reathing) nauseas) o&iting and #"ood! stoo"%

C"%i&'re"

-"ass Antip"ate"et) Adenosine diphosphate antagonist

Therapeutic Action Inhi#its p"ate"et aggregation #! #"oc$ing A0P

receptors on p"ate"ets%

0osage 35&g .I0

Indications Treat&ent of patients at ris$ for ische&ic eents

recent MI) recent ische&ic -GA) periphera"

arter! disease

Treat&ent of patients with A-S

/ursing Responsi#i"ities Proide freBuent s&a"" &ea"s if I upset occurs

Proide co&fort &easures and arrange for ana"gesic if

headache occurs

Instruct patient to ta$e dai"! as prescri#ed

Report s!&pto&s of a""ergic reaction

Ir*e/artan

-"ass Antih!pertensie

Therapeutic Action Se"ectie"! #"oc$s the #inding of angiotensin IIto

specific receptors

0osage 259&g O0

i


80/115


Indications H!pertension

/ursing Responsi#i"ities Ad&inister without regards to &ea"s

."ac$ .ox @arning Ensure that if patient is

fe&a"e) she is not pregnant #efore #eginning

the therap! suggest using #arrier #irth contro" whi"e

using Ir#esartan feta" in+ur! and death hae #een

reported%

Monitor patient c"ose"! in an! situation that &a! "ead to

decreased .P secondar! to reduction of f"uid o"u&e


81/115


/ursing Responsi#i"ities 0i"ute and ad&inister s"ow"! IG to &ini&i*e

"i$e"ihood of aderse effects

Te"" patient to "ie down duing IG ad&inistration

Leep opioid antagonist and faci"ities for assisted or

contro""ed respiration readi"! aai"a#"e

Car+e&i""

-"ass A"pha and #eta adrenergic #"oc$er)

Antih!pertensie

Therapeutic Action -o&petitie"! #"oc$s a"pha) #eta) and #eta8)

0osage 28%5&g .I0

Indications H!pertension

,n"a#e"ed ,se Angina

/ursing Responsi#i"ities @arning 0o not discontinue a#rupt"! after chronic

therap!


82/115


Monitor patient for an! sign of hepatic i&pair&ent


83/115


Therapeutic Action Exact &echanis& is not understood possi#"!

increases periphera" uti"i*ation of g"ucose) decreases

hepatic g"ucose production) and a"ters intestina"

a#sorption of g"ucose%

0osage 459 &g ta#"et twice a da!

Indications Ad+unct to diet to "ower #"ood g"ucose with t!pe 8

dia#etes &e""itus in patients who are 29 !ears o"d or

o"der and extended re"ease in patients 23 !ears o"d

and o"der

As part of coination therap! with su"fon!"ureas or

insu"in when either drug a"one cannot contro"

g"ucose "ee"s in patient with t!pe 8 dia#etes

&e""itus

/ursing Responsi#i"ities Monitor urine and seru& g"ucose "ee" to deter&ine

effectieness of drug and dosage

Arrange for transfer to insu"in therap! during

periods of high stress

Patient Teaching 0o not discontinue this &edication without

consu"ting hea"th care proider

Swa""ow extended re"ease ta#"et as who"e) do not

crush ) #rea$ or chew%

i


84/115


i


85/115


NURSING CARE PLANS

Assess&ent /ursing 0iagnosis /ursing oa"s Interentions Rationa"e Ea"uation

N Sa nga!on

pa$ira&da& $o&ada"i a$ong

&apagod $a!a hindia$o gaanong

$u&i$i"os) as

er#a"i*ed

O#+ectie@ea$ in

appearanceW

Actiit! Into"erance

re"ated togenera"i*ed

wea$ness andia"ance #etween

ox!gen supp"! and

de&and

After 8 da!s of


c"ient wi"" #e a#"e toto"erate progressie

actiit!) as

eidenced #! HRand .P within

expected range andno co&p"aints of

d!spnea or fatigue%

Assess the patientsrespirator! and

cardiac status #eforeinitiating actiit!

O#sere response

to actiit!% Signs ofa#nor&a" response

inc"udes thefo""owing

Pro"onged #edrestare indicated on"!

for he&od!na&icunsta#"e patients% If

the patient is sta#"e)

actiities can #egradua""!

progressed% Assistedh!giene and

au"ation areappropriate to

reduce ph!sica"

deconditioningassociated with #ed

rest%

-"ose &onitoring

seres as a guide foropti&a" actiit!

progression

After 8 da!s of


c"ient was a#"e toto"erate progressie

actiit!) as

eidenced #! HRand .P within

expected range andno co&p"aints of

d!spnea or fatigue%


86/115


Increased HR of

89 #eatsC&in

oer resting rateduring actiit!)

or 289 #eats per&inute

Increased .P of89 && Hg

s!sto"ic during

actiit!

-hest disco&fort

diaphoresis

Pa""or

d!spnea

"a#ored

#reathing

excessie

fatigueCwea$ness

EncourageadeBuate rest

periods) especia""!#efore actiities


87/115


&ea"s

Instruct patient not

to ho"d #reath whi"e

exercising or&oing a#out in

#ed and not to strainduring #owe"

&oe&ent

Proide e&otiona"support when

increasing actiit!

digestion and

reduces energ!needs

These actiities

sti&u"ate Ga"sa"a

Maneuer) whichaffects endocardia"

repo"ari*ation andpredisposes the

patient to

entricu"ard!srh!th&ias%

This reduces

reduces possi#"eanxiet! a#out

oerexertion of the

heart

i


88/115



NSan pa #a ito

na$u$uha &a"i#ansa pag$ain $o ng

&atata#a) #a#a"i$ pa

#a a$o sa nor&a"

as er#a"i*ed

Lnow"edge 0eficit

re"ated tounfa&i"iarit! to

disease process)

treat&ent and

recoer! aseidenced #!&u"tip"e Buestions

After 4 hours of


patient wi""

er#a"i*e

understanding ofcondition) need foro#seration in

critica" care unit)diagnosis of

treat&ent of MI and

hea"ing process ofMI

Encourage patient

to er#a"i*econcerns%

Proide

infor&ation on thefo""owing

0iagnosing

MI

Hea"ing

Process

Medications

Expected

return toprior

"ifest!"e


89/115


or : &onths=


NAng i$inatata$ot

$o "ang) #a$a

&au"it ito% Munti$na a$o &a&ata!%As stated%

/arrowed focus onthe source of the

fear

Fear re"ated to

threat to hea"th

status as eidenced#! narrowed focuson the source of the

fear

After 4 hours of

nursing

interention) thepatient wi""er#a"i*e reduce

fear) and

de&onstratepositie coping

&echanis&

Ac$now"edge

awareness of

patientJs fear

A""ow patient to

er#a"i*e fears ofd!ing% Reassure

patient that &ost

deaths occur #eforereaching the

hospita"%Offer rea"istic

assurances thatrecoer! is fu""!

anticipated

Maintainconfident assured

&anner

Ac$now"edge&en

t of patientJs

fee"ing a"idates thefee"ing andco&&unicates

acceptance of those

fee"ings

Anxiet! can #ereduced when

patient has accurate

$now"edge ofrea"istic prognosis

hospita" &orta"it!rate is on"! 5

These &easuresenhance the

patients opti&is&

a#out recoer!

The staffJs anxiet!

&a! #e easi"!

perceied #! the

After 4 hours of

nursing

interention) thepatient was a#"e toer#a"i*e reduce

fear) and

de&onstratepositie coping

&echanis&

i


90/115


Exp"ain in si&p"eter&s arious

aspect of MI andc"arif!

&isconceptions

Assure patient and

significant others acontinuous

&onitoring that wi""

ensure pro&ptinterention

Reduce

unnecessar! sti&u"i%

Exp"ain a""

procedures asappropriate)

$eeping exp"anation#asic%

Proidediersiona" &ateria"

Esta#"ish rest

periods during careand procedure%

patient% The

patientJs fee"ing ofsta#i"it! increases

in a ca"&eniron&ent

This reducesanxiet!

This proides a

&easure of safet!

Anxiet! &a!

esca"ate withexcessie

conersation) noiseand eBuip&ent

around patient%

Infor&ation a""a!s

anxiet!%

0iersion can #e

re"axing) preentanxiet! and preent

fee"ings of iso"ation

Pacing actiitieshe"ps the patient

re"ax and gain

i


91/115


e&otiona" #a"ance


N Pa"aga! $o sir

&ag#a#ago ang#uha! $o pag"a#as

$o pagdating sa&ga na$agawian

$o) sa pag$ain at sa

&g adapt $oingatan) as

er#a"i*ed

O#+ectie

Recent change inhea"th status

Perceied change inhea"th status

Ris$ for ineffectie

coping

After 4 hours of


patient wi"" #e a#"eto identif! his own

coping #ehaior)

identifies hisps!cho"ogica" and

socia" supports!ste& and

i&p"e&ent positie

coping &echanis&

Assess specific

stressors

Assess aai"a#"eor usefu" past and

present coping&echanis&

Ea"uate resources

of support s!ste&saai"a#"e to patient

at ho&e

Assess the "ee"

of understandingand readiness to

"earn needed

Accurate appraisa"

faci"itatesdee"op&ent of

appropriate copingstrategies

Successfu"ad+ust&ent is

inf"uenced #!preious coping

success

O"der persons

with "ife"ongcardiac disease &a!

final advance practice nursing (contents).doc

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