Gina Fabbro – Care Plan 1 : Ineffective Coping
NURSING DIAGNOSIS ASSESSMENT DATA PLANNING
Ineffective coping r/t past situational crises, unresolved emotional conflict between patient and wife, destructive behavior towards self, increased depressive state and unpredictable episodes of anger and aggression s/t sleep apnea AEB disturbed images of past crises, demands on family imposed by the patients current condition, increased state of depression, disturbed sleeping patterns since returning from deployment, a torn ligament in wrist from episode of anger and aggression, presence of tension headaches, increase use of alcohol during the week and unable to identify triggers leading to angry and aggressive episodes.
A. Patient risk factors include the patients current state of his family, the unknown knowledge of angering triggers or stimuli, the image of the truck full of dead bodies that keeps surfacing, the increase in the patients use of alcohol, and patients current state of trying to quit smoking.
B. Patient exemplifies strengths such as having an open mind pertaining to the program. Also patient has motivation for seeking help in order to maintain his family.
C. Patient limitations include the inability to control angry outbursts, immobility of right wrist, and facility protocols restricting patient freedom. For example, taking away shoes with laces for the gym due to risk of suicide.
D. Subjective Data:
When asked about the circumstances
31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.
B) According to the “ Journal of Medical Ethics” it may not be that simple to assist with
A. Minor Point 1: Many patients can’t decide for themselves and it is not fair for family members to decide for them.
Evaluation of a patient’s outcome, to determine the effectiveness of the treatment that they received while under my care, is
D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for
a. Patients who are used to be competent are not longer competent, but they expressed their wishes before becoming incompetent.
b. A therapist allows her patient access to a video game only if he can relax himself.
a) The physical needs to be considered for a person needing end of life care are
He has difficulty sleeping. He reports difficulty in controlling his anger and that outbursts are often directed at loved ones (wife and children). Based on the above information, complete the
Psychiatric- patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services, she refused for now.
b.Risk factors- people who experience any form of abuse, traumatic events such as war, natural disasters, kidnapping, torture, and invasive medical procedures.
Per progress report dated 5/2/16, the patient complains of sleep problems, anxiety, intrusive thoughts, and low self-esteem. Objective findings include depression, crying spells, and anxiety. Techniques and interventions used in sessions included assessing the patient’s current level of functioning. Support and empathetic listening, and exploring values were done.
Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85-95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity
individual limiting his mobility and in some cases it can be fatal. This provides further
Nurses are a vital component in patient care. The importance of conducting efficient nursing assessments is critical in order to provide both patient-centered care and safe, effective patient healing. Nurses are often responsible for taking care of patients with very complex disease processes. They frequently provide care to patients with illnesses such as Chronic Obstructive Pulmonary Disease (COPD). According to the Centers for Disease Control and Prevention, in 2014, approximately 6.8 million adults were diagnosed with COPD within the Unites States. The completion of proper assessments and initiation of interventions for these patients are crucial in order to prevent further complications of the illness.