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NURS6622 Clinical Practice B

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NURS6622 Clinical Practice B

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Course Code: NURS6622
University: The University Of Newcastle

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Country: Australia

Question:

This is essay based on the nursing case study. I have attached a summary of the case study. The main focus of the essay will be on the nursing problem, Disturbed thought process related to anxiety as evidenced by failing memory, difficulty managing tasks. The other listed problems and interventions can be briefly explained in the essay.
Anxiety related to health status, change in role function and status, interpersonal relationships.Risk for self-harm related to suicidal ideations.Disturbed thought process related to anxiety as evidenced by failing memory, difficulty managing things.Sleep Disturbance related to thought process as evidenced by sleeplessness, difficulty falling asleep.Risk for fall related to medication (anxiety), decreased strength over lower extremity.

Answer:
Introduction:

This case study presents madam W, an 80-year-old Indian Female. The main reason for her current admission is generalized Anxiety disorder. Her chief complaint is that she feels anxious, preoccupied with negative suicidal thoughts and she is worried about jumping off the building. This started on October 9, 2018, when she started experiencing memories of her deceased mother and elder sister. She usually takes Lorazepam to sleep so as to feel better. Madam W has a past medical history of spondylolisthesis, Hyperlipidemia, appendectomy (2008) and right cancer breast with wide excision and axillary clearance done in 2003. She feels that she is starting to lose her memory since she easily forgets things whenever she is tensed. She even put down things on paper so as to help her remember.
One of the nursing problem identified for Madam W is disturbed thought process (Gordon, 2014), related to anxiety as evidenced by failing memory and difficulty managing things. Madam W has been experiencing difficulties in her memory. She has been forgetting things to an extent of writing them down if she needs to remember. She has also a problem in decision making as her niece helps her in making her own decisions. For example, her accounts are currently being supervised by her niece. She also needs a helper while performing activities of daily living. This has become a problem as she has to be supervised when dressing, bathing and toilet use.
The desired outcomes for this nursing problem include; to ensure that madam W portrays strategies to cope up with the alteration in her mental status, to ensure that she can identify the changes in her behavior and to be able to understand the reasons for failure in her memory (Beck, 2011). To achieve those goals a nurse may apply the following nursing interventions. The nurse to regularly assess madam W neurological status and provide close supervision. This will aid in determining the extent to which her mental status is progressing. Early recognition will also let the nursing modify the plans accordingly (Melnyk, & Fineout-Overholt, 2011). The nurse to also encourage her to speak up her feelings and concerns regarding memory loss. This will help the nurse to know what the patient feels and think about herself. For example, if she is feeling worried about it, the nurse will come in to assure her and give her proper psychological and emotional support. This practice also aids in lowering anxiety and eliminating frustrations (Townsend, 2010).
The nurse may also encourage and apply the practice of keeping things in the same places. This will foster memory because it creates a regular environment thus reducing confusion and frustration (McCormack, & McCance, 2011). Aim to let madam W engage in activities which relax the brain since she forgets things when tensed which means relaxing her mind may reduce her forgetfulness. Assessing her ability to make a decision will also important so that it enables the nurses to determine her ability to take part in planning and provision of care. The nurse will know where to assist and where to let her be dependent.
Educate madam W concerning her problem. Let her know why she is starting to experience loss in memory and the risk factors associated with it. Handle all her concerns and issues which may be worrying her. Letting the patient know more about her condition will help in alleviating anxiety and moreover make the patient more cooperative throughout her management (Malamed, 2017). In addition, the nurse should assess for others factors which may be leading to her loss of memory. This is because of recognition of such factors which help in early diagnosis of the underlying factors and subsequently early and appropriate treatment.
Sleep Disturbance (Herdman, 2011) related to thought process as evidenced by sleeplessness, difficulty falling asleep is another nursing problem identified was another nursing problem identified. Explore the patient’s sleep usual sleep pattern: quantity, duration, number of times awaked and timings (Poceta, & Mitler, 2013) to establish a plan of care for correction of sleep deprivation. If the patient is sleeping during the day, Sundowning syndrome may be the problem, with the patient’s day and night mixed up. By keeping the patient up during the day, sleeping at night may return. Non-pharmacological interventions such as enhancing sleep hygiene and encouraging activities during the day may help to promote patient’s wellness and assist to revert to the routine sleep pattern. Zolpidem may be used as a pharmacological intervention however Prolonged use of medication may result in dependence and complications (Huang et.al, 2012). For example, the risk for fall.
Anxiety (Gulanick, & Myers, 2016) related to the health status of the patient, change in role function, interpersonal relationships as evidenced by irritability, increased helplessness, insomnia and decreased concentration. Identify the awareness of the patient’s level of anxiety. This is because objective data may not show evidence of anxiety and the patient can share feelings and experiences. By acknowledging the patient’s feelings, we are validating and communicating the acceptance of the feelings. Familiarizing the patient with the ward environment and health care professionals will also promote comfort and decrease the feeling of increased anxiety experienced by the patient. Communicate in a simple language since the patient may not be able to understand when she is experiencing anxiety. She will be able to also identify factors contributing to the anxious feeling. Allow the patient to talk about the anxiety feeling and precipitating factors. Recommend the use of coping strategies to enhance the patient’s confidence and personal strengths so that madam W will be able to explore various ways to manage anxiety. Appropriate use of medications for management of anxiety may also help alleviate anxiety.  Educate patient, family and caregiver about the symptoms related to anxiety and also the available community resources to enhance early response and intervention.
Risk for fall (Ackley, Ladwig, & Makic, 2016) related to medication (anxiety), decreased strength over lower extremity. The nurse role, in this case, is to monitor the patient on fall precaution measures. Collaborative management may also be of need. For example, referral to physiotherapy and occupational therapists to assist patients with gait training and limb strengthening exercises. Gait and balance training with assistive devices may also be implemented to initiate home safety measures. Advice on an assistive device to improve stability and balance when patient ambulates. Initiate home modification, for example, to recommend ramp, grab bars, raised toilet seats. Educate patient and caregiver on home safety measure and fall recovery technique. Facilitate the management of falls and decrease the risk of falls. Provide resources for home support. Assist with financial support for assisted devices and home modification.
Risk for self-harm related to suicidal ideations as evidenced by the feeling of hopelessness and thoughts of jumping off the building. Implement the appropriate level of suicide precautions to ensure patient safety during hospitalization. Assess the patient’s suicidal risk and evaluate the level of suicide precautions daily. This is because the patient’s suicidal risk may differ at any time. Observe the patient at all times. If this person must leave the unit for any reason, information and responsibility regarding the supervision of the patient must be communicated to another staff. The patient is at risk for suicidal behavior and requires close supervision. Handing over and communication within staffs minimizes the possibility that the client will have inadequate supervision. Appropriate medication management and review of antipsychotic medications to ensure pharmacological measures are adequately managed for mood disorders and suicidal ideations. Referral to community resources and helplines to enhance immediate intervention and safety of the patient.
In conclusion, it is essential to ensure that all nursing problems are intervened and evaluated to see their effectiveness. It is of importance to also note that madam W is an elderly person and therefore must be treated with the respect she deserves (Benn, 2017). She should be valued and her management throughout will be aimed at making her feel an important member of the society despite her illness. Such principles are aimed at promoting health care services.
References
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences.
Benn, S. I. (2017). Privacy, freedom, and respect for persons. In Privacy and Personality (pp. 1-26). Routledge.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford press.
Gordon, M. (2014). Manual of nursing diagnosis. Jones & Bartlett Publishers.
Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.
Herdman, T. H. (Ed.). (2011). Nursing diagnoses 2012-14: definitions and classification. John Wiley & Sons.
Huang, Y., Mai, W., Cai, X., Hu, Y., Song, Y., Qiu, R., … & Kuang, J. (2012). The effect of zolpidem on sleep quality, stress status, and nondipping hypertension. Sleep medicine, 13(3), 263-268.
Malamed, S. F. (2017). Sedation-E-Book: A Guide to Patient Management. Elsevier Health Sciences.
McCormack, B., & McCance, T. (2011). Person-centred nursing: theory and practice. John Wiley & Sons.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Poceta, J. S., & Mitler, M. M. (Eds.). (2013). Sleep disorders: diagnosis and treatment. Springer Science & Business Media.
Townsend, M. C. (2010). Nursing diagnoses in psychiatric nursing: care plans and psychotropic medications. FA Davis.

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