Foundations of Health Care 112: Nursing Care Plan

Client Description:

Client is an Australian female in her mid 20’s, she is 175cm tall and weighs 68kg.
Client lives at home with her husband and works full time in an office as a
Conveyancer. Client is well groomed, alert and cheerful with no apparent signs of
physical distress. Client appears outwardly confident but states she suffers from
anxiety and is sometimes inwardly distressed. Client states she has a very strong
bond with her husband and turns to him, friends and family as her support network.
Client occasionally sees a therapist to overcome belated issues about her parent’s
divorce.

Client exercises 4x/wk for one hour, participating in recreational netball, walking and
the gym. Client’s typical daily meal pattern is well balanced with a variety of
coloured vegetables, fruit, proteins and fats. Client states she has a very good appetite
and rates her health 8/10. NKA. Client’s fluid intake is 2000-2500ml per day. Client
states she does not smoke, drink alcohol or engage in recreational drugs.

Client states she had chickenpox as a child and has the influenza vaccination annually,
she states she is unsure of any other immunisations. Client takes Norinyl tablets
daily- 1/7- 1mg/50mcg 1 tablet- to prevent pregnancy. Client states she takes Panafen
plus approx 2/7- 250mg 1 tablet- for back pain. Client’s chief complaint is back pain
and has been diagnosed with a congenital deformity of the lower spine. Client states
that sitting down for long periods of time and strenuous exercise provokes pain,
massages and lying flat on her back palliates symptom. Client regularly visits the
local physiotherapist and chiropractor.

Client states she gets 8-9 hrs of sleep per night and feels well rested in the morning.
Bowel elimination is daily, soft-medium, brown and well formed. Client’s urinary
elimination is 6-7 times daily and pale yellow in colour. Client has GP checkups
annually, pap smears every 2 yrs and states she does not perform BSE.

Client has a family hx of schizophrenia on her Mother’s side and states she is worried
about herself or future children inheriting it. Client is orientated to TPP and thought
processes are logical and relevant. Client states she is sexually active, uses
contraception against pregnancy but is not protected against STD’S. Client states she
is confident of a monogamous relationship.

Client describes herself as friendly, outgoing and concentrated on self-growth and

learning. Client states she has a very structured lifestyle and is highly stressed when
things don’t go her way. Client states she suffers stress over her parent’s divorce 7yrs
ago. Client states she is working on overcoming these issues and is otherwise content
with life and looking forward to starting a family.

Client comes into contact with a nurse through massage and annual influenza
vaccinations. Client may come into contact with nurses through future plans to have
children and the occupational health nurse in the workplace.

1
Problem list:
• Pain and discomfort r/t congenital spine deformity
• Risk of further injury and pain in the back r/t occupation as an office worker
and exercise.
• Anxiety r/t family hx of mental illness (schizophrenia)
• Risk of mental illness (schizophrenia)
• High levels of stress and anxiety r/t high expectation of self and others

2
Nursing Diagnosis #1: Acute pain in lower back r/t congenital abnormality of the
spine m.w.u: strenuous exercise and sitting down for long periods.
Outcomes/Goals:
The client will have decreased physical discomfort in back, as evidence by low impact
exercise and correcting the client’s workplace environment.

The client will gain a better understanding about her spine abnormality, low-impact
exercise and workplace safety to prevent further injury or damage to the back.
Nursing Intervention Rationale
Inform/educate client on preventative Ensuring a healthy working environment
pain measures while working at a desk prevents acute
back pain. Good posture, sitting up
straight and making sure the lower back
is supported while working at a desk
prevents repetitive strain to the lower
back. (Health and safety: Back pain,
2009) Nurses need to provide the client
with education about preventative pain
measures to ensure no further damage
occurs to the back. (Berman et al., 2008)

Promote optimal mobility and movement
through a range of low impact exercises
Exercises should be low-impact and non-
weight bearing integrating a range of
stretching and strengthening techniques to
prevent muscle damage and strain.
Exercising to restore motion and strength
to the lower back can be very helpful in
relieving pain. Nurses should recommend
the client try pilates or yoga instead of the
usual gym workout routine, as these
forms of exercise integrate low-impact
core, spine and muscle strengthening
movements. (Your orthopaedic
connection: low back pain, 2009)

Recommend client visit the occupational
health nurse in workplace.
Working at a desk all day pulls the body
forward and puts strain on the lower back.
Nurses need to recommend the client to
visit their workplace occupational health
and safety officer to talk about
making/changing the clients work
environment into a pain-free one. If pain
still persists nurse may need to
recommend the client consider a change
in occupation. (Back injury prevention:
OSH standards, 2009)

Discuss with the client understanding
about her spine deformity.
The nurse needs to clarify/explain to the
client that she does have a spinal
deformity for life, not just an injury. The
nurse needs to help the client accept her
congenital deformity.
3
Expected Outcomes:
Client will report less physical discomfort in the back.
Client understands and accepts her congenital spine deformity.
Evaluation:
Client will be able to accept her deformity over time.
Client will report less pain in the back over a couple of weeks once work environment
and exercise regime is changed.

Nursing Diagnosis #2: Moderate to high anxiety r/t multiple life stressors, a.m.b: the
need for a perfect marriage and a structured lifestyle.
Outcomes/Goals:
The client will show decreased levels of anxiety, as evidence by no expression of
distress.

Client will be able to demonstrate effective coping mechanisms for dealing with
anxiety.
Nursing Intervention Rationale
Provide support and comfort. Nurses need to reassure the client they
can help her. Presence of a competent
caregiver reduces fear. (Berman et al.,
2002)

Acknowledge awareness of patient’s A cause for anxiety cannot always be

anxiety. identified, the patient may feel as though
the feelings being experienced are
counterfeit. Acknowledgement of the
patient’s feelings validates the feelings
and communicates acceptance of those
feelings. (Nursing Diagnosis: Anxiety,
2009)

Identify and reinforce coping strategies Coping strategies include learning to

patient has used in the past.
Discuss advantages and disadvantages of
existing coping methods.
accept situations that are beyond our
control, and finding ways to help us feel
better in spite of the fact that the problem
still exists. Two types of coping
strategies can be used: problem focused
coping and emotion focused coping.
(Berman et al., 2002. p.1076)

Discuss alternative strategies for handling Using anxiety-reduction strategies

anxiety. enhances patient’s sense of personal
mastery and confidence. (e.g relaxation,
deep breathing, positive visualisation,
reassuring self statements.) (Nursing
Diagnosis: Anxiety, 2009)

4
Encourage exploration of specific events Recognition and exploration of factors
preceding both the onset and reduction of leading to or reducing anxious feelings
the anxious feelings are important steps in developing
alternative responses. Patient may be
unaware of relationship between
emotional concerns and anxiety. (Nursing
Diagnosis: Anxiety, 2009)
Help establish short-term goals that can
be attained. The main purpose of goal setting is to
provide direction and purpose. Short-
term goals break the task of dealing with
anxiety into smaller, more manageable
parts. Having a goal gives the client
awareness of the task, this helps to give
the planner priority in terms of mind
space. Taking a small step as part of a
short-term goal will bring the reality of
achieving long term goals closer. (Short-
term goal setting, (n.d)
Expected Outcomes:
The client will feel supported and comfortable to be around and discuss issues with
nurse.
Identify effective and ineffective coping patterns.
Report decreased feelings of anxiety and the need for a perfect marriage and
structured lifestyle.
Realistic and appropriate goals established in relation to coping patterns and desired
outcomes.
Evaluation:
Client establishes goals both short term and long term.
Client will have effective coping strategies set in place.
Client does not express distress or dwell on the need for a perfect marriage and a
structured lifestyle.

Supporting Statement:

Overall, the approach I took is what I believe would be the best beneficial care for the
client. With contributed research into nursing diagnosis, care plans, assessments and
theories I compiled the care best suited to my individual client and their situation. I
focused mainly on preventative measures, identifying and promoting coping strategies
and understanding and awareness. Maintaining wellness and preventing stressors
links in with Neuman’s system model of health, whereas caring and supporting the
client links in with Watson’s theory. Nursing diagnosis 1 and 2 had links of both
theories within the care plan, yet diagnosis 2 related to the clients stress and anxiety,
therefore that plan was based around the Neuman’s model. Diagnosis 1 combined a
combination of both models as evidence through promoting prevention and creating
awareness. My goal in this care plan was to create the best outcomes of health for the
client through the interventions.

5
Neuman’s System Model

Betty Neuman’s model focuses on the person as a complete system, the subparts of
which are interrelated as physiological, psychological, sociocultural, spiritual and
developmental factors. (Betty Neuman’s system model, 2008.) Neuman refers to
these factors as energy resources in the client surrounded by two concentric
boundaries or rings referred to as lines of resistance. (Berman et al., 2002. p.46)

The lines of resistance represent internal factors that help the client defend against a
stressor. Outside the lines of resistance are two lines of defence. The inner line of
defence, depicted as a solid line, represents the person’s state of equilibrium. The
flexible line of defence, depicted as a broken line, is dynamic and can be rapidly
altered over a short period of time. It is protective that prevents stressors from
penetrating the inner line of defence. Neuman categorizes stressors as ‘interpersonal
stressors, those that occur within the individual’. (Berman et al., 2002. p.46)

The Neuman’s system model has two major components i.e. stress and reaction to
stress. The client in the Neuman’s system model is viewed as an open system in
which repeated cycles of input, process, out put and feedback constitute a dynamic
organizational pattern. The client may be an individual, a group, a family, a
community or an aggregate. Neuman believes that the nurse’s perception will
influence the care given, then not only must the client’s perceptions be assessed, but
so must that of the nurse. The role of the nurse is seen in terms of degrees of
reactions to stressors, and the use of primary, secondary and tertiary interventions.
(Application of Betty Neuman’s System Model, 2009.)

6
Watson’s Human Caring Theory

Watson believes the practice of caring is central to nursing and the most valuable
attribute nursing has to offer to humanity. Watson believes that without caring health
is not fully attained. Watson contends that caring can assist the person to gain
control, become more knowledgeable and thus promote health changes. (Nursing
Theories, 2008.)

Some of Watson’s major assumptions about caring are:

-Caring connotes a personal response
-Caring is an intersubjective human process and is the moral ideal of nursing.
-Effective caring promotes health and individual or family growth.
-Caring promotes health more than does curing
-Caring responses accept a person not only as they are now, but also for what the
person may become.
-A caring environment offers the development of potential while allowing the person
to choose the best action for the self at a given point in time.
-Human caring involves values, a will and commitment to care, knowledge, caring
actions and consequences. (Berman et al., 2002, p.47)