NMIH107 Nursing Care Plan

1. Introduction. Serves as a “map” of the essay, outlining to the reader the key points contained in the body of the work.

 

2. Discussion of Activities of Living (AoL’s) related to the Case Study – Maintaining a Safe Environment, Eating and Drinking, Personal Cleansing and Dressing and Elimination

3. Nursing Care Plan. Using the Nursing Care Plan provided identify one issue related to each AoL (3 issues in total) that has arisen from the case study. You are required to formulate a plan/goal for improving each issue, identify strategies for meeting each plan/goal and then discuss what evaluative measures will be taken to determine if each plan/ goal was met.

Introduction:

Human medical conditions and illnesses impacts on the activities of living and the general mechanisms of functioning of the patient.  The essay will focus on the case study of Mr Keith, an 86-year old male patient who has been admitted to the medical with diagnoses of dehydration and gastroenteritis. He has an history of diarrhoea and abdominal cramping for two days. He has an history of vomiting for one day. Currently, Mr. Keith is presenting with watery diarrhoea, abdominal pain, a mild temperature of 37.7⁰ C, mild dehydration, and headache. Additionally, he also has complaints of lethargy. With regard to the diagnosis, presenting complaints, and manifestations in the case study, the essay will discuss the Activities of Living in relation to the condition of the patient. The essay will discuss three Activities of Living providing an overview of how they may be impacted by the patient’s illness and diagnosis.

The essay will discuss the assessment of Mr. Keith’s in relation to the identified three Activities of Living including the kind of care and interventions would be provided and implemented to Mr. Keith. The three Activities that will be discussed in the essay are eating and drinking, elimination, and personal cleaning and dressing. The essay will develop a nursing care plan for the patient including one issue in relation to every Activity of Living. Therefore, the nursing care plan will have three issues arising from the case study.  In the development of the nursing care plan, the essay will formulate a goal or plan for the improvement of every issue including the identification of the strategies that can be implemented to meet each goal or plan. Lastly, the essay will discuss the evaluative measures or strategies that will be implemented in the determination of whether each goal or plan was met or not.

Activities of Living (AoLs)

Gastroenteritis which is also called infectious diarrhea, is the inflammation of the humans’ gastrointestinal tract particularly the small intestines and the stomach. Gastroenteritis can be caused by bacteria, viruses or parasites which are usually invasive. The pathogens cause cell damage and produce toxins leading to various manifestations seen in a patient with gastroenteritis. In most instances, the virus that is responsible for gastroenteritis is norovirus. The condition can also be attributed to food poisoning following bacterial infection. Some of the common signs and symptoms of gastroenteritis include sudden and watery diarrhea, abdominal pain, vomiting which is sometimes projectile, and mild fever. Other additional signs and symptoms of gastroenteritis include lack of energy, lethargy, loss of appetite, headaches, aching limbs, and feeling of sickness (Biagi et al., 2012).

Activities of Living are essential in an individual’s life since they maximumly promote independence. They are used in the assessment of the relative independence of an individual or the potential for independence for determination of the interventions that are appropriate in increasing his or her level of independence (Ahmed et al., 2014).  Additionally, the assessment of the Activities of Living in an individual helps in the identification of any ongoing support that should be provided the patient for the compensation of his dependency.

Some of the major activities of living include maintenance of a safe environment, breathing, communication, mobilisation, eating and drinking, sleeping, and elimination (Bunn, Jimoh, Wilsher, & Hooper,2015). Other activities of living that are essential in the life of the patient include washing and dressing, controlling temperature, expression of sexuality, working and playing, and death and dying. The Activities of Living are influences by a wide range of factors namely biological, sociocultural, psychological, politico-economic, environmental, and sociocultural factors (Labbe, & Juneja, 2013).

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Activity of Living 1: Eating and drinking

Gastroenteritis affects eating and drinking based on its signs and symptoms like degradation, loss of appetite, watery diarrhoea, vomiting, and lethargy. In the initial stages of gastroenteritis, the patient is usually at a great risk of dehydration. The significant risk of dehydration in gastroenteritis is often attributed to the excessive loss of body fluids and electrolytes through vomiting and diarrhea (Hall, Curns, McDonald, Parashar, & Lopman, 2012).  

Once the patient is experiencing diarrhea and vomiting, he may not be in a position to comfortably use much fluids or food orally. The patient may have small oral intakes that may reduce the symptoms. Loss of appetite by the patient largely impacts his nutritional and feeding patterns resulting in poor feeding leading to weight loss. The patient may have avoid eating and drinking due to the fear of vomiting and diarrhea. The abdominal pain also reduces the patient’s desire for eating and drinking hence causing inadequate nutrition which is less that the body requirements or needs (Parashar, Nelson, & Kang, 2013).

The inadequate fluid intake may consequently on the urinary functioning leading to low or no urine output by the patient. The lack of energy and lethargy in gastroenteritis may make the patient unable to prepare his own meals and take drinks. He may need assistance in the preparation and intake of fluids and drinks.  Gastroenteritis also impairs the general functioning of the patient’s body system leading the feeling of sickness which consequently impairs his level of appetites resulting in reduced food and fluid intake.   Therefore, gastroenteritis affects eating and drinking since the patient may withdraw from meals based on the physiological, biological, and psychological factors associated with the disease (Park, Richardson, Holleman, & Larson, 2013).

The activity of Living 2: Elimination

The inflammatory response involved in gastroenteritis causes inflammation of the small intestines and the stomach which consequently impacts on the patterns of elimination of the patient. First, the damage of the villous brush border of the small intestines causes malabsorption of the intestinal contents hence resulting in osmotic diarrhea. Secondly, the production and release of toxic substances that bind on the specific enterocyte receptors is often responsible for the release of the chloride ions (Payne et al., 2013).

The secretion of toxic substances stimulates an excessive loss of water and electrolytes from the body resulting in the watery diarrhea. Additionally, the direct invasion of the walls of the gastrointestinal tract by microorganisms’ trigger inflammation which the upsets the existing balance between the rate of nutrient absorption into the body and the secretion of wastes from the body. These mechanisms negatively impact the elimination patterns of the patient (Payne et al., 2013).

Diarrhea is the key factor that is often involved in the definition of the patterns of elimination of a patient. Diarrhea refers to the passage of watery or loose stools for more than three times in a day. The pattern of stool in an individual may change. Since the gastroenteritis causes diarrhea affects elimination of the patient by increasing the frequency of bowel opening or emptying (Wittenberg, 2012). The gastroenteritis alters the nature of human stool from normal to loose and watery hence impacting on the elimination as an activity of living in the life of the patient.

 Gastroenteritis may lead to the change of the colour of the patient’s stool from normal to bloody which is abnormal (Pruvost et al., 2013). Since gastroenteritis is causes lack of energy and lethargy, the patient may not be able to escort himself to the washrooms but instead he may end up emptying the bowels on himself or on the beddings. Consequently, this is a clear indication of an impaired elimination as an activity of living. This then calls for support of patient in elimination and maintenance of the general cleanliness and hygiene (Staroverov et al., 2014).

Activity of Living 3: Cleaning and Dressing

Like any other illness or medical condition, gastroenteritis impacts on the activities of living of patients especially cleaning and dressing. Following the pathogenesis and pathophysiology of gastroenteritis, the patient experiences diarrhea, abdominal pain, vomiting, dehydration, and loss of appetite which are the key contributors of patient’s lethargy and lack of energy. Lethargy may make the patient unable to perform cleaning and dressing leading to dirt, poor hygiene, poor grooming, and poor general appearance of the patient (Johnston et al., 2013).

Patient assessment in relation to the Activities of Living

Eating and drinking are fundamental in the life of the patient since they promote health and well being.  The patient with gastroenteritis has difficulties in eating and drinking. In the assessment of the patient, some of the factors that should be looked at include fluid loss through diarrhea and vomiting, loss of appetite, loss of weight, lack of energy, tiredness, lethargy, and inability to perform normal tasks which are essential in his daily life. These factors are important in the formulation and implementation of the appropriate interventions and measures of management (Bok, & Green, 2012).  

When assessing the patient for elimination, one should consider both bowel movements and the urine. The screening should cover the following; details about the habits of normal bowel movements, last time when the patient opened the bowels, past bowel problems, and the frequency of bowel opening (Bromfield et al.,2014). It is also good to check the nature, colour, amount, and smell of the stool produced by the patient. Regarding urine, one should consider various characteristics such as colour, odour, volume, clarity, and frequency of urination. To assess the cleaning and dressing in the patient, one should check for various factors like the general appearance, general cleanliness of the compound and other equipment used by the patient, and grooming (Guarino et al., 2012).

Patient treatment in relation to the Activities of Living

Regarding eating and drinking, the patient presented with diarrhea, abdominal pain, and vomiting. To treat this, the patient can be given broad spectrum antibiotics to treat the primary cause. The antibiotics are also important in the management of the abdominal pain, diarrhoea, and vomiting. The patient should be given adequate fluids to prevent and management dehydration. The management of these symptoms would help in the elimination patterns of the patient since it would help in the reduction of diarrhea and improve urine output due to improved hydration of the patient. The cleaning and dressing can be managed by allocating an assistant to help the patient in cleaning, dressing, and maintenance of the general hygiene (Bresee et al., 2012).

Nursing Care Plan

Activity of Living	Issue or problem	Goals	Strategies	Evaluation measures
Eating and drinking	Dehydration	Patient understands the cause of dehydration and rationale for the prescribed treatment modalities. Patient uses approximately 1500-2000 mL of clear fluids within a period of 24 hours. Patient reports reduced frequency of diarrhea within one and half days. Patient verbalizes relieved abdominal cramping and pain and less or no diarrhea	Administration of intravenous fluids (Zhang, & Li,2017). Prescription and administration of broad-spectrum antibiotics for the treatment of the primary cause of the problem (Allen?Durrance & Campos 2018). Educating the patient on the condition, its treatment and the mode of action of the treatment (Zhang, & Li,2017).	Assessment of the patient to rule out presence of the signs of dehydration. Checking the skin turgor and integrity to check for improvement.
Elimination	Increased bowel movements and diarrhea		Encouraging and providing the patient with clear and fluids every two hours while the patient is awake (Jalanka-Tuovinen et al., 2014). Educating the patient on the clear fluids that he should consume and those to avoid.  Educating the patient about the potential factors that contribute to increased bowel movements and diarrhea (Jalanka-Tuovinen et al., 2014).	Assessing the patient to check for the frequency of bowel movements and relieved diarrhea
Cleaning and dressing	Self-care deficit	Patient identifies some of the useful resources for optimizing the independence and autonomy. Patient demonstrates changes in lifestyle to meet the needs of self-care. Patient able to recognizes individual needs or weaknes.  Patient is able to safely executes the activities of self-care to utmost capability	Helping the patient in cleaning and dressing. Enlightening the patient about the need of maintaining cleanliness and dressing (Jalanka-Tuovinen et al., 2014).  Rendering supervision for all the activities until he exhibits the skill effectively and well secured in independent care (Ciccarelli, Stolfi, & Caramia, 2013).   Regularly re-evaluate the patient to be certain that he is keeping the level of skill level remains safe and secure the environment.	Assessing the patient for cleanliness and oral hygiene.

Conclusion: