Nursing Care Plan Patient Assessment and Implementation of Nursing Model in Addressing Patient Care Goals

The patient being assessed is a 72-year-old female brought to the gynae ward for diarrhea and vomiting and generally unwell and weakness in addition to a non-productive cough. Medical history of this patient includes Alzheimer's, Left Nephrectomy, aortic repair, asthma, and mobility problems.

Problem Solving Approach: Patient/Client Problem

The two problems identified during the assessment are those of:

(1) Asthma; and (2) Alzheimer's.

Goal Statement

The goal of care is to instruct patient on coping with asthma and Alzheimer's through use of the Roper, Logan and Tierney model. This was the first model for nursing which had as its basis a model of living. The research arose from study of Nancy Roper in 1970 in which she "sought to identify the core of nursing activities across any field of nursing practice, which could then be supported by knowledge, skills and attitudes required to working the individual specialist's fields." (Holland, Jenkins, and Solomon, 2003) Roper, Logan and Tierney published the 'Elements of Nursing' in 1980, which identified the "individual aspects of the model as a whole and how nursing could use it as a framework for the care of patients in a wide variety of situations." (Holland, Jenkins, and Solomon, 2003) The model has two parts including: (1) the model of living; and (2) the model for nursing. (Holland, Jenkins, and Solomon, 2003) This model makes identification of "five factors associated with the condition of living" including:

(1) The need to perform activities of living;

(2) The nature of a person's lifespan;

(3) The presence of a dependence/independence continuum;

(4) Factors that can influence a person's ability to perform activities of living; and (5) A person's individuality. (Timmins and McCabe, 2009)

Activities of living are inclusive of:

(1) Maintenance of a safe environment;

(2) Communicating;

(3) Breathing;

(4) Eating and drinking;

(5) Eliminating;

(6) Personal cleansing and dressing;

(7) Controlling body temperature;

(8) Working and playing;

(9) Mobilizing;

(10) Sleeping;

(11) Expressing sexuality; and (12) Dying. (Timmins and McCabe, 2009)

The largest contribution made by the RLT model is "individuality in living…assisting nurses to move away from what Fawcett (1999) terms 'romance' with the medical profession, manifested by preoccupation with the medical approach, which isn't always appropriate for nurses or patients." (Timmins and McCabe, 2009)

Considering the individuality of the patient is reported to make provision for "a more meaningful and personalized approach to patient care." (Timmins and McCabe, 2009) The RLT framework makes provision of a chance for the nurse to interview not only the patient but their family as well and to document the problems and needs of the patient in regards to each particular activity.

Nursing Care Plan One - Asthma

The nursing care plan for the patient with Asthma addresses the following daily living activities:

(1) Communicating;

(2) Breathing;

The nursing care plan for this patient with asthma includes the following:

1. Maintaining the patient's respiratory function and relieving bronchoconstriction while allowing mucus plug expulsion.

2. Controlling exercise-induced asthma by having the patient sit down, rest, and use diaphragmatic and pulse-lip breathing until shortness of breath subsides.

3. Supervising the patient's drug regimen.

4. Demonstrating the proper use of metered doe inhaler properly.

5. Reassuring the patient during an asthma attack and stay with him.

6. Placing the patient in semi-fowler position and encourage diaphragmatic breathing.

7. Assisting the patient to relax as much as possible.

8. As ordered, administering oxygen by nasal cannula to ease breathing and to increase arterial oxygen saturation during an acute asthma attack.

9. Adjusting oxygen according to the patient's vital functions and ABG measurements.

10. Administering drugs and I.V. fluids as ordered.

11. Combating dehydration with I.V. fluids until the patient can tolerate oral fluids, which will help loosen secretions.

12. Encouraging the patient to express his fears and concerns about his illness.

13. Encouraging the patient to identify and comply with care measures and activities that promote relaxation. (Nursing File, 2011)

Nursing Care Plan Goals - Asthma

The goals in the nursing care...

Assessment of the patient found that the individual cannot recall her address and that the patient cannot remember her telephone number or the names of friends and family members consistently. The home environment was assessed and findings show that the following actions should be taken to ensure the patient's safety in her home environment:
(1) Removing throw rugs from hallways, and tack down any remaining carpets.

(2) Securing the kitchen, bathroom, and workshop cabinets as well as the controls on the oven and stove.

(3) Modifying the doors so that negotiating locks requires a two-step system of unlocking, such as with a deadbolt and a key.

(4) Providing extra lighting in dark areas, especially a night-light in the bathroom. (Prentice-Hall, nd)

In both of these nursing care plans the RLT model is applied included in each of these plans is collaboration with other health care specialists including the patient's doctor who prescribes the medications necessary for the conditions of asthma and Alzheimer's disease. In addressing treatment for Alzheimer is a dietician has been consulted to ensure that the patient does not have difficulty with chewing and swallowing foods. The NMC Code which requires sharing information with colleagues, working effectively as a team and collaboration with patient's in the nurse's care have been met through collaboration with the other health care specialists who work with this patient. Consultation and collaboration with the aforementioned health care specialists was necessary in meeting the health care goals for this patient in coping with asthma and Alzheimer's disease.

Summary

The RLT Model has been applied successfully in the two nursing care plans in addressing the needs of the patient and the patient's safety and doing so in accordance with the activities of daily living as prescribed in the RLT model. In the nursing care plan for Alzheimer's disease the activities of daily living addressed included the safety of the patient's home environment and specifically the necessary modifications to the environment to ensure that the patient is safe. Included in safety precautions are the removal removing rugs from the floor and double locking the doors to ensure that the patient does not wander off as they cannot remember their address or their phone number on a consistent basis and neither are they able to consistently remember the names of friends and family. As well, the patient's environment in relation to eating and drinking, personal cleansing and dressing, working and playing, mobilizing and sleeping are addressed in the Alzheimer's nursing care plan.

The nursing care plan for asthma includes addressing daily activities of living in regards to breathing and communicating and involves the patient and her family understanding the use of oxygen and other breathing apparatuses including inhalers so that the patient can overcome asthma attacks and be reassured during these attacks to promote relaxation.

Conclusion

The…