Nursing Care Plan

Health ProblemFamily Nursing ProblemsGoal of CareObjectives of CareIntervention Plan Nursing InterventionsRationaleMethod of Nurse-Family ContactEvaluation Unhealthful lifestyle and personal habits specifically cigarette smoking as a health threat. 1. Inability to recognize the presence of the problem due to Inadequate knowledge 2. Inability to make decisions with respect to taking appropriate health action due to fear of consequences of action, specifically physical consequences 3. Inability to provide adequate nursing care to the at-risk member of the family due to: A. Inadequate knowledge about the disease or health condition B. Lack of the necessary facilities, equipment and supplies for care 4. Inability to provide a home environment conducive to health maintenance due to lack of knowledge of preventive measures 5. Failure to utilize community resources for health care due to inadequate knowledge of community resources for health care After nursing intervention, Rusty Cacal with the help of his family members will be able to lessen the cigarettes he smokes from 10 sticks to 15 sticks a day to gradual cessation of smoking Objectives 1. After discussing the definition of cigarette smoking, the family will be able to state the meaning of cigarette smoking accurately within 3 minutes. 2. After 10 minutes of discussion, the family will be able to enumerate the components of cigarette completely in 5 minutes. 3. Given the components of cigarette, the family will be able to state at least 8 out of 11 effects of nicotine in 8 minutes. 4. Given the components of cigarette, the family will be able to state the effects of tar completely in 5 minutes 5. After discussing the effects of nicotine and tar, the family will be able to distinguish the effects of addiction in cigarette smoke within 5 minutes. 6. After 15 minutes of discussion, the family will be able to discuss 7 out of 9 management on how to reduce the # of cigarette smoked per day within 8 minutes. 7. Given a sample of a time table, the family will be able to formulate a schedule on the reduction of # of sticks of cigarette smoked per day within 20 minutes. 8. In a day-to-day basis, the clients will be able to practice the formulated schedule plan in 1 month and 2 weeks. Developmental 1. The health care provider will discuss the meaning of cigarette smoking. 2. The health care provider will enumerate the components of cigarette. 3. The health care provider will discuss the effects of nicotine. 4. The health care provider will discuss the effects of tar. 5. The health care provider will distinguish the effects of addiction in cigarette smoking. 6. The health care provider will discuss the different management on how to reduce the # of cigarette smoked per day 7. The health care provider will provide a sample of a time table. She will guide the client in formulating her schedule for 1 month 8. The HCP will monitor the clients’ compliance to the formulated schedule 1. Discussing the meaning of cigarette smoking will enable the clients to have a wide understanding about this habit and be aware that smoking contributes significantly to diseases that shortens life and is leading cause of death like heart attack, stroke, respiratory diseases which make smokers â€Å"pulmonary cripples† as in asthma, emphysema, bronchitis, recurrent infections, and cancer. *Ref: http://doh. gov. ph/tobacco/aboutsmoking. tm 2. Discussing the components of cigarettes will enable the clients to be aware of the possible effects of the listed components *Ref: http://www. knowledgebasescript. com/ emo/article-393. html 3. Discussing the effects of nicotine will enable the clients to know the medical consequences of nicotine exposure *Ref: Psychology Today Staff Originally published by Psychology Today:2002/10/10 4. Disc ussing the effects of tar will enable the clients to know how it affects their respiratory tract. *Ref: Janice A. Dye and Kenneth B. Adler; http://www. pubmedcentral. nih. ov/pagerender. fcgi? artid=475133 &pageindex=1#page 5. Discussing the effects of smoking addiction give the conclusion that there are many health effects of smoking cigarettes products and not one of them are beneficial. It's not an exaggeration; it is reality that smoking tobacco does unquestionably not only destroy client's well being but also health of acquaintances and family around her. *Ref: Winn, Jackie (2008), â€Å"No Positive Effects From Smoking Can Be Found†. September 28, 2008, from http://ezinearticles. com/? No-Positive-Effects-From-Smoking-Can-Be-Found&id=1290284 6. Discussing the different management on how to reduce the use of cigarette smoke per day increases quit rates by 30 percent. Every person who uses cigarettes should be offered at least brief advice to quit smoking. More intensive counseling and medications are even more effective and should be provided to all cigarette users willing to use them. *Ref:CORINNE G. HUSTEN, ABBY C. ROSENTHAL, MICAH H. MILTON, The Gale Group Inc. , Macmillan Reference USA, New York, Gale Encyclopedia of Public Health, 2002 7. Providing sample time table will help the clients to guide the client in making a checklist or schedule on reducing and quitting smoking. Ref: The lung Asssociation; http://www. lung. ca/protect-protegez/tobacco-tabagisme/quitting-cesser/how-comment_e. php#list 8. Monitoring clients’ compliance to the formulated schedule will able the clients to apply their schedule and reduce the number of cigarettes thrysmoked per day *Ref:http://www. healthline. com/adamcontent/smoking-tips-o n-how-to-quit? utm_source=z_smoking_cessation&utm_medium=google&utm_campaign=adam&utm_term=how%20to%20quit%20smoking Home VisitEffectiveness: 1. Was the family able to define cigarette smoking? Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 2. Was the family able to enumerate the components of cigarette? Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 3. Was the family able to discuss the effects of nicotine Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 4. Was the family able to discuss the effects of tar Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 5. Was the family able to discuss the effects of addiction in cigarette smoking? Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? _ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 6. Was the family able to discuss the different management on how to reduce the # of cigarette smoked per day Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 7. Was the family able to formulate a schedule on the reduction of # of sticks of cigarette smoked per day Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Nursing Care Plan Health ProblemFamily Nursing ProblemsGoal of CareObjectives of CareIntervention Plan Nursing InterventionsRationaleMethod of Nurse-Family ContactEvaluation Unhealthful lifestyle and personal habits specifically cigarette smoking as a health threat. 1. Inability to recognize the presence of the problem due to Inadequate knowledge 2. Inability to make decisions with respect to taking appropriate health action due to fear of consequences of action, specifically physical consequences 3. Inability to provide adequate nursing care to the at-risk member of the family due to: A. Inadequate knowledge about the disease or health condition B. Lack of the necessary facilities, equipment and supplies for care 4. Inability to provide a home environment conducive to health maintenance due to lack of knowledge of preventive measures 5. Failure to utilize community resources for health care due to inadequate knowledge of community resources for health care After nursing intervention, Rusty Cacal with the help of his family members will be able to lessen the cigarettes he smokes from 10 sticks to 15 sticks a day to gradual cessation of smoking Objectives 1. After discussing the definition of cigarette smoking, the family will be able to state the meaning of cigarette smoking accurately within 3 minutes. 2. After 10 minutes of discussion, the family will be able to enumerate the components of cigarette completely in 5 minutes. 3. Given the components of cigarette, the family will be able to state at least 8 out of 11 effects of nicotine in 8 minutes. 4. Given the components of cigarette, the family will be able to state the effects of tar completely in 5 minutes 5. After discussing the effects of nicotine and tar, the family will be able to distinguish the effects of addiction in cigarette smoke within 5 minutes. 6. After 15 minutes of discussion, the family will be able to discuss 7 out of 9 management on how to reduce the # of cigarette smoked per day within 8 minutes. 7. Given a sample of a time table, the family will be able to formulate a schedule on the reduction of # of sticks of cigarette smoked per day within 20 minutes. 8. In a day-to-day basis, the clients will be able to practice the formulated schedule plan in 1 month and 2 weeks. Developmental 1. The health care provider will discuss the meaning of cigarette smoking. 2. The health care provider will enumerate the components of cigarette. 3. The health care provider will discuss the effects of nicotine. 4. The health care provider will discuss the effects of tar. 5. The health care provider will distinguish the effects of addiction in cigarette smoking. 6. The health care provider will discuss the different management on how to reduce the # of cigarette smoked per day 7. The health care provider will provide a sample of a time table. She will guide the client in formulating her schedule for 1 month 8. The HCP will monitor the clients’ compliance to the formulated schedule 1. Discussing the meaning of cigarette smoking will enable the clients to have a wide understanding about this habit and be aware that smoking contributes significantly to diseases that shortens life and is leading cause of death like heart attack, stroke, respiratory diseases which make smokers â€Å"pulmonary cripples† as in asthma, emphysema, bronchitis, recurrent infections, and cancer. *Ref: http://doh. gov. ph/tobacco/aboutsmoking. tm 2. Discussing the components of cigarettes will enable the clients to be aware of the possible effects of the listed components *Ref: http://www. knowledgebasescript. com/ emo/article-393. html 3. Discussing the effects of nicotine will enable the clients to know the medical consequences of nicotine exposure *Ref: Psychology Today Staff Originally published by Psychology Today:2002/10/10 4. Disc ussing the effects of tar will enable the clients to know how it affects their respiratory tract. *Ref: Janice A. Dye and Kenneth B. Adler; http://www. pubmedcentral. nih. ov/pagerender. fcgi? artid=475133 &pageindex=1#page 5. Discussing the effects of smoking addiction give the conclusion that there are many health effects of smoking cigarettes products and not one of them are beneficial. It's not an exaggeration; it is reality that smoking tobacco does unquestionably not only destroy client's well being but also health of acquaintances and family around her. *Ref: Winn, Jackie (2008), â€Å"No Positive Effects From Smoking Can Be Found†. September 28, 2008, from http://ezinearticles. com/? No-Positive-Effects-From-Smoking-Can-Be-Found&id=1290284 6. Discussing the different management on how to reduce the use of cigarette smoke per day increases quit rates by 30 percent. Every person who uses cigarettes should be offered at least brief advice to quit smoking. More intensive counseling and medications are even more effective and should be provided to all cigarette users willing to use them. *Ref:CORINNE G. HUSTEN, ABBY C. ROSENTHAL, MICAH H. MILTON, The Gale Group Inc. , Macmillan Reference USA, New York, Gale Encyclopedia of Public Health, 2002 7. Providing sample time table will help the clients to guide the client in making a checklist or schedule on reducing and quitting smoking. Ref: The lung Asssociation; http://www. lung. ca/protect-protegez/tobacco-tabagisme/quitting-cesser/how-comment_e. php#list 8. Monitoring clients’ compliance to the formulated schedule will able the clients to apply their schedule and reduce the number of cigarettes thrysmoked per day *Ref:http://www. healthline. com/adamcontent/smoking-tips-o n-how-to-quit? utm_source=z_smoking_cessation&utm_medium=google&utm_campaign=adam&utm_term=how%20to%20quit%20smoking Home VisitEffectiveness: 1. Was the family able to define cigarette smoking? Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 2. Was the family able to enumerate the components of cigarette? Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 3. Was the family able to discuss the effects of nicotine Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 4. Was the family able to discuss the effects of tar Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 5. Was the family able to discuss the effects of addiction in cigarette smoking? Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? _ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 6. Was the family able to discuss the different management on how to reduce the # of cigarette smoked per day Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Why no? __ Adequacy : Was the no. of intervention sufficient? Yes__ No__ Why no? __ Appropriateness: Was the no. of intervention, setting, time table, realistic to client situation? Yes__ No__ Why no? __ Acceptability: Was the intervention suitable to client situation? Yes__ No__ Why no? __ Effectiveness: 7. Was the family able to formulate a schedule on the reduction of # of sticks of cigarette smoked per day Yes__ No__ Why? Efficiency: Was the time, materials, human resources used economically? Yes__ No__ Nursing Care Plan Nursing Care Plan Assessment equals Data Collection + Analysis| Nursing Diagnosis – Actual/Potential| Nursing Goal(SMART)| Nursing Interventions/ActionsInclude Rationale/Reference| Evaluation| Female Age : 85Code status: Full Code initially but changed to DNR on 14/Jan-2012Primary diagnosis: PancytopeniaReason for Hospital Admission: Fall at home. Allergy: PenicillinMedical History: Pacemaker, Hypertension, Fall at home, Bradycardia, Hyperlipidemia. Neurological: Alert, Oriented x 4. Diet as ToleratedActivity as tolerated. Does not want to do physiotherapy.Would prefer to remain in bed. Will only move her arms and legs and adjust as needed. | Activity Intolerance related to weakness, bed rest and immobility as evidenced by client verbalizing lack of interest/desire in activity. Risk for falls related to generalised weakness and impaired mobility as evidenced by client having a history of fall in the past. Hopelessness related to failing or deteriorating physical condition as e videnced by client stating â€Å"Why god is not calling me to him†. | 1. Client will participate in daily activity with vital signs within limit in a week’s time. 2.Client will perform ADLs with some assistance, e. g. , toilets with help ambulating to bathroom, by discharge. 1. Client will not experience a fall by identifying risks that increase susceptibility to falls by the end of the day. 2. Client and caregiver will apply tactics and ways to increase safety and provide a safe home environment. 1. Client will initiate behaviours that may reduce feeling of hopelessness by the end of week. 2. Client will be hopeful verbalizing optimistic plans after she is discharged and reaches home. | 1. Record client’s vitals before and after any activity.Rationale: Variation can be caused by temporary insufficiency of blood supply (Ackley & Ladwig, 2008, p 119). 2. Administer pain medications prior to activity. Rationale: Pain restricts client from performing maximum activi ty and may worsen the movement (Ackley & Ladwig, 2008, p 120). 3. Encourage client to change position gradually, dangle, sit, stand and ambulate as tolerated. Rationale: Performing activities slowly at client’s pace and for shorter periods minimizes fatigue (Kozier, 2010, pg. 1126). 4. Teach the client systematic performance of active ROM exercises to maintain and improve joint mobility.Rationale: These activity increases muscular strength and active movement (Kozier, 2010, pg. 1147). 5. Encourage client plan activities with alternate periods or rest and activity. Rationale: Assistance in planning daily routines that maintain a balance between activity and rest may be necessary to conserve energy (Day, 2010, pg. 1744). 6. Reinforce importance of progressive exercise, emphasizing that joints are to be exercised to the point of pain and not after that. Rationale: Pain occurs as a result of joint or muscle injury.Continued stress on joints or muscles may lead to more serious dam age and limit ability to move (Gulanick &Myers, 2010, pg 136). 1. Place objects used by the client within her reach. Rationale: Client can lose balance and might fall when she is trying to get items that are out of reach (Kozier, pg 775, 2010). 2. Emphasize and educate client about the importance of nutrition especially vitamin D supplementation in relation to reducing fall risk. Rationale: Proper diet along with Vitamin D supplement raises calcium which reduces falls and falls related fractures (Best Practice Guidelines, 2005, Rec. 05). 3. Consult with other health care team members such as OT/PT to help resolve mobility issues. Rationale: Interprofessional collaboration results in a sharing of expertise to enhance the quality of patient care (Kozier, pg 776, 2010). 4. Encourage client to do exercises and activity as tolerated to maintain muscle strength and joint flexibility. Rationale: A routine of exercises such as Tai chi can enhance balance and improve overall muscle strength (Best Practice Guideline, Rec. 2. 1, 2005). 5. Educate client to stay in the lower level of house such as bedroom/washroom or everything in one floor.Rationale: Having all daily required amenities nearby will reduce client’s risk of falling. (Kozier, pg 774, 2010). 6. Increase client’s awareness by highlighting the risk factors associated with falls within home; removing unsafe objects. Rationale: Risk factors such as clutter, unsecure rugs, extra loose tripping clothing and inadequate lighting hampers the motivation for mobility (Kozier, pg 774, 2010). 1. Creating a therapeutic nurse-client relationship by listening attentively and increasing her positivity by talking about her past pleasant experiences.Rationale: Encourage client to share feeling and reflecting on past accomplishments, positive memories and significant milestones (Day, 2010, pg. 434). 2. Encourage client to become involved in activities on the unit like interacting with staff, other clients, particip ating in therapy and recreational activities. Rationale: This will help distract her mind from a preoccupation with her illness (White, 2005, pg. 1326). 3. Provide things to do when client is feeling down, like, crossword puzzle, reading books, watching TV.Rationale: This provides time to shift her attention to more creative activities, and will see the situation not so utterly and hopeless (White, 2005, pg. 1326). 4. Teach client to substitute negative self-talk with positive self-talk. Rationale: Focusing on individual’s strengths and abilities enables and support hope (Day, 2010, pg. 434). 5. Encourage client to spend increased time with family and loved ones. Rationale: Clients who live alone with no family support are more prone to hopelessness (Carpenito-Moyet, 2008, pg. 329). 6.Encourage client to engage in creative activities to tap their resources. For example, music, art, storytelling, quilting etc. Rationale: Expressive arts are framework for identifying personal s trengths (Kozier, 2010, pg. 1440). | 1. Client performs activities within daily limits of vital signs. 2. Based on the pain scale verbalized by client, pain medication is administered 30 minutes prior to the start of daily activity. 3. Client demonstrates changing of positions within her tolerance limits. 4. Client understands and demonstrates ROM exercises to improve her mobility. 5.Client discussed importance of activity and rest patterns to manage energy and prevent fatigue. 6. Client understands importance of exercise and looks forward to physiotherapist appointment and also does regular exercise at home as tolerated. 1. Nurse makes sure that client has all the necessary things in within reach before leaving the room. 2. Client understands importance of nutrition in reducing risk for fall and eats appropriately. 3. Client looks forward to Occupation/Physical Therapy appointments. 4. Client understands importance of exercise and also does regular exercise at home as tolerated. . Client verbalized a plan to make changes at home to ensure safety. 6. Client is aware of potential risk for falls and keeps home clutter free and safe. 1. Client seems positive about her life talking to health care team. 2. Client socializes with other people on the floor and looks forward to any recreational activity. 3. Client sets target to finish some part of her magazines and puzzles book before a certain time of day like before breakfast or lunch comes. 4. Client understands and verbalizes the improvement in her health rather than her initial diagnosis. 5.Client makes plans to meet with family and friends every one or two week as per everyone convenience. 6. Client keeps herself occupied either by reading books, watching TV, listening to music or knitting etc. | References (Day,R. A. , Paul, P. ,Willaims, B. , Smeltzer, S. C. , Bare, B. (2010). Textbook of Canadian Medical-Surgical Nursing (pp. 982-983). Williams & Wilkins. White, L. (2005). Foundations of nursing. Australia U nited States Clifton Park, NY: Delmar Learning. Carpenito-Moyet, L. J. (2008). Nursing care plans & documentation, nursing diagnoses and collaborative problems. 5 ed. ). Philadelphia, PA: Lippincott Williams & Wilkins. Ackley, B. J. , & Ladwig, G. B. (2008). Nursing diagnosis handbook: An evidence-based guide to planning care (8th ed. ). St. Louis: Mosby Elsevier. Kozier, B. , Erb, G. , Berman, A. , Synder, S. , Bouchal, S. R. , & Hirst, S. (2010). Fundamentals of canadian nursing, concepts, process and practice. (2 ed. ). Toronto: Pearson Canada. Gulanick, M. , & Myers, J. L. (2010). Nursing care plans, diagnoses, interventions, and outcomes. (7 ed. ). PA: Mosby.