Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

312

Nutrition

Blurred vision

Impaired activities of daily living

Bowel and bladder elimination

Impaired vision

Double vision

One-sided vision loss

Hygiene and skin

John Brown

Sitting

Confusion

Standing

Impaired mobility

Impaired cognition

Poor comprehension

Transferring

Mobilising

Figure 17-4 This concept map identifies self-care problems for John Brown, a 58-year-old man, admitted to the medical ward with a medical diagnosis of a right-sided stroke

S T U D E N T P L A N O F C A R E 1 7 - 1 for Mrs Jones

Problem 2 • Inability to cope with illness, recent death of husband and relocation with daughter

Case history Mrs Jones is a 76-year-old woman who has been admitted to your unit with a diagnosis of transient ischaemic attack. Her husband passed away 6 months ago and Mrs Jones has moved in with her daughter Lisa after selling the family home. Her daughter is with her as you take the assesment history. Assessment findings Subjective data ‘Will I get a stroke now? I don’t think I could handle that.’ ‘How can I help myself prevent it?’ Her daughter reports her mother had been a very inde- pendent, strong woman in the past and seemed to ‘crumple’ after her husband’s death. Objective data Admitting diagnosis: Transient ischaemic attack (TIA) BP: 184/120 Past history of headaches Identified health problems Problem 1 • Lack of knowledge relating to preventing further TIA or stroke Problem 1 care interventions 1. Assess what Mrs Jones knows about TIA and stroke (correct any misinformation). Assess learning needs, readiness to learn and factors that will influence learning.

Planning achievable goals Before discharge, Mrs Jones will:

• Describe the terms ‘TIA’ and ‘stroke’, identifying the underlying disease process, causes and symptoms • Correctly describe the treatment plan: 1. Medications (drugs, intended effect, dose, time, route) 4. Signs and symptoms to report 5. Follow-up appointment date. After consultation with the social worker, Mrs Jones will: • Verbalise her feelings related to the loss of her husband, loss of her family home, loss of her health • Identify personal strengths and supports that will help her now. Before discharge, Mrs Jones will: • Verbalise that she feels ‘okay’ (sufficiently in charge of her life) about returning home. Rationale Each person’s learning needs are different; each person learns in their own unique way; learning is dependent on readiness. 2. Dietary modifications 3. Exercise prescription