Integrated Nursing Care Plan for Mrs. Green: Addressing Priority Needs for Rehabilitation and Nutrition

QUESTION

PNUR104 Group Assignment: Integrated Needs Nursing Care Plan

Purpose: To develop a nursing care plan based on a provided case study.

Method: Analyze a case study by applying the nursing process, critical thinking, and problem-solving strategies to identify priority needs.

Guidelines: A template will be provided to download and complete for this assignment. Utilize required course learning materials and resources to support the data analysis and care plan development (Potter et al., 2019 book)

Data must include:

• Identification of two (2) priority needs which are interrelated with an explanation to describe how they are interrelated regarding the patient in the provided case study.
• Identification of significant data from the case study which are focused and interrelated to unmet or provided needs.
• Data analysis includes a variety of cues and inferences, clusters, patterns, norms which are significant to unmet or provided needs or the primary health problem.
• Data analysis includes identification of at least one data gap with rationale for how or why that missing information would be relevant to the case study.
• Proposed evaluative measures to determine the success of the expected outcomes.

Nursing Care Plan to include:

• One (1) priority Nursing Diagnosis that reflects the data analysis from the needs analyzed.
• Two (2) Expected Outcomes which reflect the priority Nursing Diagnosis.
• Two (2) Nursing Interventions per Expected Outcome. This means that a total of four* (4) Nursing Interventions will be included. *Three interventions must be independent nursing interventions. One intervention must be a collaborative (interdependent) intervention.
• Rationale for the interventions using PNUR104 course materials as references for support.

Case Study:  

Mrs. Green is an alert & oriented 76-year-old client who has been in the hospital for six weeks while recovering from a cerebrovascular accident (CVA).  Prior to admission, Mrs. Green lived with her 78-year-old husband in a bungalow.  They have no children. Mrs. Green is an avid gardener and states that she is concerned about whether she will be able to resume her gardening when she returns home.  She also played bridge once a week with several friends and enjoyed walking in the park with her husband.  Both she and her husband are non-smokers.

Mrs. Green is in a 2-bed hospital room which she shares with another woman who is disoriented and who is often noisy at night.  Mrs. Green wears glasses and a hearing aid in her right ear.  Her speech is slightly slurred.  There is a radio in her room, but no television.  She uses her call bell frequently and states “I just wish someone would pay attention to me.”  She often asks the nurses to call her husband to ask him to come and visit her.  Her husband visits only once per week because he suffers from hypertension and has poor vision.  Driving is difficult for him.  She is anxious to return home because she is worried about her husband’s ability to manage without her.

Mrs. Green has right-sided weakness.  She requires and asks for the assistance of one nurse to pivot transfer her into her wheelchair.  She can turn herself to her right side by placing her left hand on the side rail and pulling.  However, she tends to roll back into the supine position unless her back is supported with a pillow.  She attends physiotherapy each day and is starting to ambulate with a quad cane. She tires easily and her balance is poor.  She can exercise her right arm, using her left arm, but has limited strength to exercise her right leg.

Mrs. Green can feed herself, using her left hand once containers have been opened. She has been experiencing some difficulty swallowing and is now receiving a minced diet with thickened fluids.  She finds the food unappetizing and often leaves most of the meal on the tray uneaten.  She drinks approximately 1500 mL of fluid / day.  She is 150 cm and weighs 50 kg.

Mrs. Green skin is intact, but yesterday, the nurse noted small areas of redness, about the size of a quarter, over the coccyx and outer aspect of her right heel.  Both ankles are edematous.  Lately, she has been experiencing urinary urge incontinence and is wearing adult briefs.  She states, “I am so embarrassed to wear these diapers.”  She doesn’t complain of burning.  She last had a bowel movement (BM) four days ago.  Her usual BM pattern at home was every other day.  She says she hates to use the bed pan because it is “uncomfortable and embarrassing.”  The doctor ordered laxatives to be administered, if necessary.

Today, Mrs. Green’s vital signs are: TPR 37.5°C, P80 beats/min, R20 breaths/min, BP 110/70 lying and 98/60 standing. O₂ sat is 95% on room air. She has a dry, occasional cough which she attributes to the dry hospital air.  She has minimal chest expansion, with decreased breath sounds in the lung bases.

ANSWER

Integrated Nursing Care Plan for Mrs. Green: Addressing Priority Needs for Rehabilitation and Nutrition

Introduction

This nursing care plan aims to address the priority needs of Mrs. Green, a 76-year-old client recovering from a cerebrovascular accident (CVA). The two identified priority needs are rehabilitation to enhance her mobility and independence and nutritional support to address her swallowing difficulties and weight management. Through the nursing process, critical thinking, and problem-solving strategies, this care plan will focus on interventions that promote her overall well-being and successful transition back to her home environment.

Priority Needs: Rehabilitation and Nutrition

Mrs. Green’s priority needs are interrelated as her ability to regain strength and mobility directly impacts her ability to feed herself and maintain adequate nutrition. As she experiences right-sided weakness, poor balance, and difficulty swallowing, her rehabilitation progress is crucial in enhancing her independence and quality of life.

Significant Data from the Case Study

Rehabilitation Data

Right-sided weakness and limited strength in the right leg
Difficulty with pivot transfer and maintaining balance
Starting to ambulate with a quad cane but tires easily
Able to exercise right arm with left arm assistance

Nutrition Data

Difficulty swallowing, receiving a minced diet with thickened fluids
Poor appetite and leaves most of the meal uneaten
Drinking approximately 1500 mL of fluid per day
Weight of 50 kg with edematous ankles

Data Analysis and Identifying Data Gap

The data analysis reveals a cluster of cues and inferences that indicate Mrs. Green’s need for rehabilitation and nutritional support. Her right-sided weakness and difficulty with balance suggest a need for ongoing physiotherapy and exercises to improve her mobility. Additionally, her difficulty swallowing and poor appetite require interventions to ensure proper nutrition and hydration.

A data gap in the case study is the absence of information regarding Mrs. Green’s emotional and psychosocial well-being during her hospital stay. Understanding her emotional needs would be relevant as anxiety and concerns about her husband’s well-being may impact her overall progress and motivation during rehabilitation.

Proposed Evaluative Measures

Rehabilitation Outcomes

Mrs. Green will demonstrate increased strength and balance, allowing her to ambulate independently with a quad cane.
She will participate in exercises to improve her right arm and leg strength.

 Nutrition Outcomes

Mrs. Green will consume at least 75% of her meals and maintain adequate hydration.
Her weight will stabilize within a healthy range.

Nursing Care Plan

Nursing Diagnosis: Impaired Physical Mobility related to right-sided weakness and balance deficits.

Expected Outcomes:
Mrs. Green will demonstrate improved strength and mobility, ambulating independently with a quad cane.
She will achieve greater stability in maintaining a sitting position without support.

Nursing Interventions

Independent Interventions:
Encourage Mrs. Green to participate in physiotherapy sessions daily to improve mobility and strength.
Teach her to perform seated exercises to enhance upper extremity strength and coordination.

Collaborative Interventions

Collaborate with the physiotherapy team to design a comprehensive rehabilitation program for Mrs. Green.

Rationale:
Mrs. Green’s participation in physiotherapy will help improve her physical strength and balance, enhancing her ability to ambulate independently.
Seated exercises will facilitate the improvement of her right arm strength, which will assist in self-feeding and other activities of daily living.
Collaboration with the physiotherapy team ensures a coordinated approach to address Mrs. Green’s rehabilitation needs effectively.

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to difficulty swallowing and reduced appetite.

Expected Outcomes

Mrs. Green will consume at least 75% of her meals, as indicated by reduced food wastage.
She will maintain hydration by drinking at least 1500 mL of fluids daily.

Nursing Interventions

Independent Interventions:
Offer Mrs. Green small, frequent meals of her preferred foods to encourage intake.
Provide thickened fluids and monitor her tolerance and ability to swallow.

Collaborative Interventions

Collaborate with the dietitian to develop a nutritious meal plan tailored to Mrs. Green’s dietary preferences and swallowing difficulties.

Rationale
Offering Mrs. Green small, frequent meals of her preferred foods will entice her to eat and improve her nutritional intake.
Providing thickened fluids ensures safe swallowing and reduces the risk of aspiration pneumonia.
Collaboration with the dietitian ensures that Mrs. Green’s nutritional needs are met while addressing her swallowing difficulties.

Conclusion

This integrated nursing care plan addresses Mrs. Green’s priority needs for rehabilitation and nutrition following her cerebrovascular accident. By focusing on improving her physical mobility and nutritional intake, we aim to promote her independence and overall well-being during her recovery. Implementing evidence-based interventions and collaborating with the interdisciplinary team will help facilitate a successful transition back to her home environment, ensuring that she can resume her gardening and social activities with confidence.