Escolar Documentos
Profissional Documentos
Cultura Documentos
Plan of Care
Brean Simms
Plan of Care
retired and lives at home with her husband, Lionel, who is 71 years of age. Deborah was forced
into early retirement with an arthritis laden body which limited her mobility, and eventually
caused her to be wheelchair bound. She reluctantly underwent back surgery in 2013, which led
to her obtaining a DVT in her left leg which resulted in lymphedema of her bilateral lower
extremities. For years, she visited a rheumatologist that would give her cortisone injections in
her hips, but one day it just wasn’t enough. The following year she had bilateral total hip
replacements, and once she healed from that surgery, she had bilateral total knee replacements.
Deborah’s mobility and strength were extremely impaired after undergoing these surgeries and
from being wheelchair bound for a few years. Today she can ambulate with a walker or cane but
continues to have chronic pain and limited ROM in her bilateral lower extremities.
During Deborah’s holistic assessment, she was asked what her sources of strength were.
She replied that her husband and her religious beliefs were her major sources. Deborah is a
Jehovah’s Witness and believes that one day God will wipe away all the pain and suffering from
the earth. Her convictions give her strength to cope with her ailments and unexpected life
changes. “Many older adults frequently use and highly value religious coping strategies such as
prayer. Evidence shows spiritual well-being to be directly correlated with mental health and less
medical illness among older adults” (Trakalo, Horowitz, & McCulloch, 2015, p. 1874). Risk for
Spiritual Distress is an applicable diagnosis since her spiritual health may be challenged by her
unexpected life changes. Her ailments prevented her from going to the Kingdom Hall of
Jehovah’s Witnesses weekly and associating with her brothers and sisters in the congregation.
PLAN OF CARE 3
The goal in the care plan is for her to maintain a dynamic, personal relationship with a supreme
being in the face of unpleasant circumstances. Interventions include being physically present
and actively listen to Deborah with open discussions about suffering and dying using open ended
questions. “Presencing is often the best and sometimes the only intervention to support a client
who suffers under circumstances that medication interventions cannot address. When a client is
helpless, powerless, and vulnerable, a nurse’s presencing can be most beneficial” (Trakalo,
Horowitz, & McCulloch, 2015, p. 1891). The projected evaluation is that Deborah participates
in religious observance and articulates a sense of hope about the future, faith in a higher power,
how to access spiritual resources. With referrals to the local Kingdom Hall in Smyrna, DE, to
reach out to the elders and fellow brothers and sisters of the congregation, the projected
evaluation is that Deborah will find meaning and existence in the present situation.
Deborah’s chronic back and joint pain from her arthritis and past surgical procedures
limits her endurance, impairs her gait, affects her completion of activities of daily living, and
requires her to take narcotic medication one to two times daily for pain management. Thus,
applicable nursing diagnosis for her include: Impaired Walking, Chronic Pain, and Activity
Intolerance. Her goals for these diagnoses include to demonstrate increased tolerance to
nonpharmacological therapies, and to report that the pain management regiment achieves
A nursing intervention for impaired walking and activity intolerance is to allow Deborah
extra time to carry out physical activities. Her impaired walking may not only be from her pain
but also can be attributed to “fear of falling, decreased strength in muscles, reduced balance, or
PLAN OF CARE 4
visual acuity” (Ackley & Ladwig, 2014, p. 123). To prevent falls in the home, an important
nursing intervention is to assess and modify any barriers to walking in the home environment.
Effective precautions include removing small rugs or mats that may slip or slide, making sure
handrails are strong and secure, postmining furniture to create a unobstructed pathway and
remove electrical cord and loose objects from walking paths (Ackley & Ladwig, 2014). In
addition, it would be in Deborah’s best interest to make referrals for home health services for PT
home visits, support, and assistance with ADL’s. “Research shows that the use of simple
stretching program for geriatric clients counteracts age related decline in gait function” (Ackley
Deborah is prescribed Vicodin and takes it daily to manage her chronic back and joint
pain. Therefore, an appropriate nursing intervention for activity intolerance is to assess and treat
her pain before activity. “Pain restricts the client from achieving a maximal activity level and is
often exacerbated by movement” (Ackley & Ladwig, 2014, p. 122). It would be beneficial to
refer Deborah to physical therapy for functional training and for strength training because
functional decline is common amongst older adults and intensive functional training improves
balance and coordination. Strength training improves function (Ackley & Ladwig, 2014).
Because of her narcotics use, a necessary nursing intervention for chronic pain diagnosis
is to educate Deborah and her family about proper medication administration, medication side
effects, and non-pharmacologic methods of pain relief. Pharmacological interventions are the
supplement, not replace pharmacological interventions, and may play a significant role in holistic
enhanced pain control and increased quality of life” (Ackley & Ladwig, 2014) (Trakalo,
PLAN OF CARE 5
Horowitz, & McCulloch, 2015, p. 172). The expected outcome is that Deborah will experience
References
Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based guide to
Trakalo, K., Horowitz, L. S., & McCulloch, A. R. (Eds.). (2015). Spirituality. Nursing: A
concept-based approach to learning (2nd ed., pp. 1871-1894). Boston, MA: Pearson
Education, Inc.
Trakalo, K., Horowitz, L. S., & McCulloch, A. R. (Eds.). (2015). Comfort. Nursing: A concept-
based approach to learning (2nd ed., pp. 141-174). Boston, MA: Pearson Education, Inc.