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Presentation Overview
Brief Patient History Hendersons Need Theory and Maslows Hierarchy of Needs Theory 2 Priority patient needs and diagnoses Details of first Priority and need (key assessment findings, nursing interventions, goals and evaluations of these) Details of second Priority and need (Key assessment findings, nursing interventions, goals and evaluations of these)
Conclusion
Patient History
Male, age 59 History of hypertension, pneumonia, osteoarthritis and newly diagnosed with prediabetes Chief complaint of pain in left knee Current diagnosis of left total knee replacement Osteoarthritis can be confirmed through a few ways......
http://www.velocitypress.com/knee_replacement_surgery.shtml
Osteoarthritis for this patient was confirmed through an x-ray of his left knee
http://www.cleburneorthopedics.com/arthritis.html
Was on the medication testosterone to increase bone mass (Adams et al., 2010)
http://dinamehta.com/blog/2010/01/12/twitter-maslows-hierarchy-of-needs-nay-hierarchy-of-tweets/
Comparison
Maslows Hendersons
Breathe normally Eat and drink adequately Eliminate by all avenues of elimination Move and maintain desirable posture Sleep and rest Select suitable clothing to maintain body temperature Keep body clean and well groomed and protect the integument
Physiological needs
Safety Needs
work at something providing a sense of accomplishment Play or participate in various forms of recreation Learn, discover or satisfy curiosity
Hendersons concepts are borrowed but it is how they are used that makes them unique to nursing (George, 2011)
8th component - Keep the body clean and well groomed and protect the integument (George, 2011)
Nursing Diagnosis:
Impaired
physical mobility related to pain and prescribed activity restrictions as manifested by limited range of motion and by a pain score of 8 out of 10 with physical activity and 7 out of 10 pain score with rest (CarpenitoMoyet, 2009) Goals:
Interventions
The nurse will enquire of pain rate and inform buddy nurse when it is above 3 out of 10 or when there will be PT activity
The nurse will support the exercise program tailored to the patients ability in consult with the PT. The nurse will reinforce use of ambulatory aids as taught by PT and supervise client ambulation as necessary which will include the intervention of instruct and assist in position changes and transfers
Nursing Diagnosis:
Knowledge
deficit of how pre-diabetes develops into Type II Diabetes Mellitus related to information misinterpretation as manifested by verbalizing inaccurate information and denial of the need to learn (Carpenito-Moyet, 2009) Goals: Patient will be able to verbalize an accurate understanding of how pre-diabetes progresses to Type II diabetes 4 days post op Patient will be able to verbalize the changes needed to stop pre-diabetes from progressing 5 days post op
Interventions
Learning Facilitation The nurse will observe the patients ability and readiness to learn Teaching: individual The nurse will assess the patients barriers to learning The nurse will present material that is the most significant to the patient first and then build on that
Learning Facilitation: promoting the ability to process and comprehend information Educated on making easy lifestyle changes Different health care workers, have different ways to motivate their clients such as...
http://cdn.hivehealthmedia.com/wordpress/wp-content/uploads/2010/12/exercise-humor.jpg
With my first intervention concluding with that he was not ready to learn I needed to switch to an alternate intervention for my patient to reach the goals I had set out for him Teaching: Individual, is defined as a planning, implementation, and evaluation of a teaching program designed to address a particular patients needs.
On the day the patient was suppose to be discharged I had a conversation alone with him at his bedside
Patient asked wife if she could get the car and if I could bring him down in his wheelchair to his car In the elevator he looked at me and said so really, if I don't change what I eat and go exercise this will get to the point that it cant be reversed. I said yeah. He then stated guess I better change things then.
Evaluation of Interventions
Learning Facilitation The nurse promoted the ability to process and comprehend information by observing the patients ability and willingness to learn Teaching: Individual intervention was implemented by the nurse assessing the patients barriers to learning and presenting material that was most relevant to the patient
Goal Evaluation
The patient was be able to verbalize an accurate understanding of how pre-diabetes progresses to Type II diabetes 5 days post op so it did not meet my original goal of 4 days post op The patient was be able to verbalize the changes needed to stop prediabetes from progressing 5 days post op Both goals were achieved as evidenced by When he stated so really, if I don't change what I eat and go exercise this will progress to the point that it cant be reversed, guess I better change things then.
Conclusion
Osteoarthritis is a degenerative joint disease characterized by destruction of the articular cartilage and overgrowth of bone Hendersons Need theory has 14 components and is very similar to Maslows Hierarchy of Needs. Hendersons Theory does borrow content from other theories but is unique to nursing in how they are used. 2 priority needs were ability to ambulate and education on the progression of pre-diabetes to Type II Diabetes Mellitus 2 priority diagnosis were Impaired physical mobility related to pain and prescribed activity restrictions as manifested by limited range of motion and by a pain score of 8 out of 10 with physical activity and 7 out of 10 pain score with rest Knowledge deficit of how pre-diabetes develops into Type II Diabetes Mellitus related to information misinterpretation as manifested by verbalizing inaccurate information and denial of the need to learn Goals for first priority need and diagnosis, which was the ability to ambulate, included ambulating with walker (3 days post op), having a reduced rate of pain (4 days post op) and being able to independently put weight on affected limb (3 days post op). The interventions included such things as reduction of pain, supporting the exercise program, assisting the client with proper use of ambulatory aides and helping with transfers when needed. All goals were achieved accept for the timeline of reduction of pain, which implies that goals that are subjective need to be made after getting to know the patient
Goals for the second priority need and nursing diagnosis, which was education on the progression of pre-diabetes to Type II Diabetes Mellitus included that the patient will be able to verbalize an accurate understanding of how pre-diabetes progresses to Type II diabetes (4 days post op) and the changes needed to stop pre-diabetes from progressing (5 days post op). The Interventions included learning Facilitation which included that the nurse will observe the patients ability and readiness to learn and then the intervention of Teaching: individual which include The nurse assessing the patients barriers to learning and the nurse presenting material that is the most significant to the patient first and then building on that. All goals were achieved but were both achieved in 5 days so the first goal was not achieved in the specified time.
Cleburne Orthopedic and Sports Medicine Center. (2010). Understanding Artritis. Retreived from http://www.cleburneorthopedics.com/arthritis.html
Day, R. A.., Paul, P., Williams, B., Smeltzer, S. C. & Bare, B.. (2010) Brunner & Suddarths Textbook of Canadian medical-surgical nursing. Second Canadian edition. Philadelphia: Lippincott Williams & Wilkins.
George, J. B. (2011). Nursing Theories - The base for professional Nursing Practice. (6th ed.) New Jersey: Prentice Hall.
Hannon, R. A., Pooler, C., & Porth, C. (2009). Porth Pathophysiology: Concepts of altered health states (First Canadian Edition). Lippincott, Williams and Wilkins.
Hive Health Media. (2011). Top 15 Benefits of Exercise. Retrieved from http://cdn.hivehealthmedia.com/wordpress/wpcontent/uploads/2010/12/exercvise-humor.jpg
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