May
An Exercise in Developing a Holostic Care Plan: Fill in the Gaps :-)
I had to break this holistic care plan table for nursing students into two sections. Keep in mind that columns are meant to be read across, from left to right. To aid in navigation I have numbered each column, so follow the path…
Fill in the gaps for a practical exercise in critical analysis, systematic planning, justification, implementation and evaluation.
Have fun~
| Diagnosis 1 | Assessment
2 |
Nursing Diagnosis
3 |
| The patient has had an aortic valve replacement and has a history of Transient Ischemic Attacks |
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| The patient has a history of dementia and has been diagnosed with Alzheimer’s Disease | ||
| The patient experiences urinary incontinence |
Urinary tract infections - These usually respond to treatment with medication. Prostate gland trouble - This affects men, and may be resolved with an operation.
forgetting to go to the toilet; not recognising the need to go to the toilet because of the damage caused by dementia forgetting where the toilet is. |
Urinalysis. A sample of urine is examined for the presence of infection, blood, or other abnormalities. Physical Examination. A thorough examination by a physician will give a great deal of information regarding possible causes of incontinence, such as weak pelvic muscles or an enlarged prostate. While the patient’s bladder is full, the doctor can also directly examine for and assess leakage during coughing or straining. Post-void residual measurement. After the patient urinates, the amount of urine left over in the bladder is measured. This can be done by placing a small catheter into the bladder through the urethra and measuring the urine that comes out, or by examining the bladder with ultrasound. Ultrasound. Ultrasound can be used as a more comfortable way to measure the post-void residual amount of urine. Ultrasound also demonstrates the size and shape of the kidneys, ureters, and bladder to evaluate whether urine has backed up within the kidneys (hydronephrosis).
Urodynamic testing. This in-depth examination evaluates bladder and urinary sphincter function as the bladder is filled and emptied. A small tube (known as a catheter) is placed through the urethra into the bladder to measure the pressure inside the bladder. At the same time, a catheter is place inside the rectum to measure the pressure in the abdomen. This test also assesses whether a patient has normal bladder sensation and capacity. The whole evaluation takes about 30-45 minutes. Pad tests. The patient begins an oral medication (Phenazopyridine) which temporarily turns the urine orange. Then, a sanitary pad is placed inside inside the underwear, and is changed every six hours for one 24-hour period. The amount of orange staining on the pads gives the urologist a rough estimate of the severity of the incontinence. The amount of urine leaked can also be estimated by weighing the pads. Voiding diary. The patient keeps a close record of when the urge to void occurs and when voiding and leakage occur. The amount of leakage is also recorded. This allows the physician to better understand the patient’s incontinence.
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Goals 4 |
Nursing Interventions 5 |
Rationales 6 |
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loss.9
associated with decision making in advance of loss of competence for people with dementia, including the barriers that may inhibit the process.9
Consumer Summit on Dementia in October 2005;9
making about care options’ (p. 7; ref 9)
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Approaching the problem with understanding, matter-of-factness and humour can improve the situation for everyone concerned.
try to overcome any embarrassment or distaste they may feel avoid being angry or appearing upset remember that it’s not the person’s fault. However, this may not always be as easy as it sounds.
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Evaluation 7 |
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1. World, G 2003, Basic geriatric nursing, London, Elsevier Health Sciences
2. Adams et al, 2008, Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack, Stroke, vol. 39, pp. 1647-1654.
http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.107.189063v1
3. University of Maryland, Medical Centre, 2009, Transient ischemic attacks, Accessed 25 May,
2009, http://www.umm.edu/altmed/articles/transient-ischemic-000160.htm
4. National Institute of Neurological Disorders & Stroke, 2009, NINDS Transient Ischemic Attack Information Page, Accessed 25 May, 2009, http://www.ninds.nih.gov/disorders/tia/tia.htm#Is_there_any_treatment
5. Fields, W, Lemack, N, Frankowski, R, & Hardy, R 1977, Controlled trial of aspirin in cerebral ischemia, Stroke, vol. 8, pp. 301-314, Accessed 25 May, 2009,http://stroke.ahajournals.org/cgi/content/abstract/8/3/301
6. Westmoreland et al., 2009, Improving medical student attitudes toward older patients through a “Council of Elders” and reflective writing experience. Accessed 25 May, 2009,http://pt.wkhealth.com/pt/re/jags/abstract.00004495-200902000- 00019.htm;jsessionid=KhFQj6wyDwbHJZr5X1n7fMgnDL1pZJjgFLsSCWf6hSzqzgw8T hcp!-1775402713!181195628!8091!-1
7. Fong, M, Finlayson, T & Peacock, N, 2006, The social experience of aging with a chronic illness: Perspectives of older adults with multiple sclerosis, Disability & Rehabilitation, vol. 28, no.11, pp. 695 – 705.
8. Viitanen M, Fugl-Meyer KS, Bernspång B, Fugl-Meyer AR, 1988, Life satisfaction in long-term survivors after stroke, Scandinavain Journal of Rehabilitative Medicine, vol. 20, no. 1, pp. 17-24, Accessed 25 May, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/3413451
9. Alzheimer’s Australia. (2006). Decision making in advance: reducing barriers and improving access to advance directives for people with dementia. Retrieved 26 May, 2009, http://www.alzheimers.org.au/upload/Decision_Making_in_Advance_May_2006.pdf
10. Flemming, R., Crooks, P., & Sum, S. (in press). A review of the empirical literature on the design of physical environments for people with dementia. Retrieved 26 May, 2009,http://www.dementia.unsw.edu.au/DCRCweb.nsf/resources/DCRC1+Products+3/$file/Design+of+Environment+Literature+Review.pdf
11. Gibson, D., Broe, T., Gray B., Puet, H., & Hayles, H. (in press). Pathways into and through the health and aged care system for people with dementia. Retrieved 26 May, 2009,http://www.dementia.unsw.edu.au/DCRCweb.nsf/resources/DCRC1+Products+2/$file/Transitions+in+care+of+people+with+dementia+-+final.pdf
12. Sacre, S., Prior, M., Foottit, J., Hines, S., McCrow, J. (in press). Investigation of the use of thickened fluids and/or energy supplements for people with dementia in Residential Aged Care Facilities (RACFs). Retrieved 26 May, 2009, http://www.dementia.unsw.edu.au/DCRCweb.nsf/resources/DCRC3+Products+3/$file/OLNS+Report_FINAL_31_3_09.pdf
13. National Aging Research Institute (2008). Encouraging best practice in residential aged care. Retrieved 26 May, 2009, http://www.dementia.unsw.edu.au/DCRCweb.nsf/resources/DCRC+Products+3/$file/10SummaryEBPRACApplicationNARI.pdf
14. California Workgroup on Guidelines for Alzheimer’s disease Management (2002). Guidelines for Alzheimer’s disease management. Retrieved 26 May, 2009, http://www.alzla.org/medical/FinalReport2002.pdf
15. Teri et al. (1998). Exercise and activity level in Alzheimer’s disease: A potential treatment focus. Retrieved 26 May, 2009, http://www.rehab.research.va.gov/jour/98/35/4/teri.pdf
16. Hutchinson, S., Leger-Krall, S., & Skodol Wilson, H. (1996). http://www.ncbi.nlm.nih.gov/pubmed/8954381. Journal of Gerontological Nursing, 22(10), 18- 27. Retrieved 26 May, 2009,
17. Alzheimer’s Society UK (2008). Coping with incontinence. Retrieved 26 May, 2009,http://alzheimers.org.uk/factsheet/502
18. Jelic et al. (2008). Donepezil treatment of severe Alzheimer’s Disease in nursing home settings: A responder analysis, Cognitive Disorders, 26(5),Retrieved 26May, 2009, http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ArtikelNr=1 67267&Ausgabe=241140&ProduktNr=224226
19. Rigby, D. (2008). Medications and incontinence.
20. Fonda et al. (2002). Patient and Carer self-reported incontinence evaluation: Providing guidance for management and intervention.
21. Cornell University (2008). Urinary incontinence evaluation.













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October 28th, 2009 at 2:19 pmHi,
Good exercise in developing holistic care plan in a table step by step.
It will be very helpful for the nursing students.
Thanks for this useful information.
October 18th, 2010 at 9:44 pmHi Nikita~ thanks for reading over the plan and providing feedback. Nursing is not something I have studied, but my psych degree gave me a brush with care plans ~:-)
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December 25th, 2010 at 7:02 pm