NURS FPX 6610 Assessment 2 Patient Care Plan
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At the age of 68, Mrs. Snyder (a fictional name given to the patient with multiple chronic diseases) has congestive heart failure (CHF), hypertension, and diabetes mellitus type 2. Due to these problems, she complains about shortness of breath, fatigue, and leg edema. Her husband is the principal care provider that ham it a great significance in her treatment and comfort. Given the importance of building a patient-centred strategy for Mrs Snyder, addressing her medical problems as well as the psychosocial elements that lead to health and connecting the multitude of providers and settings must be undertaken. This intervention goal of Mrs. Snyder will be to achieve maximum health outcomes for her, ensure that her quality of life is enhanced, and there is a low risk of readmission. Through our use of verified interventions that also involve her preferences and objectives, we are focused on this empowerment that will make Mrs. Snyder and her family competent in managing chronic diseases. This part defines the holistic strategies to meet Mrs. Snyder`s expectations, draws together multidisciplinary professionals, and ensures a smooth flow of care throughout the entire care cycle.
Patient’s Condition from a Coordinated-Care Perspective
Assessing Mrs. Snyder’s case from a collaborative care perspective would necessitate a multi-systemic review of the patient’s medical history, current symptoms, and psychological, as well as the integration of the care team. The evaluation outputs obtained from the simulated interviews support the nurses in the development of the health status of Mrs Snyder and the provision of nursing diagnostics that conform to her demands. Mrs. Snyder has a history of CHF, hypertension, as well as diabetes mellitus type II, being 68 years old and a female. These symptoms hit her with shortness of breath, tiredness, and swollen lower limbs. Also, her husband, who is her main caregiver, has complementary meaning in daily care management (American Heart Association, 2019). The obtained information highlighted Mrs. Snyder’s different medical conditions and the way they affected her day-to-day activities. The level of objective data like physical exam test results that suggest Mrs. Snyder is experiencing edema and subjective data that are presented by Mrs. Snyder herself when states that she feels symptoms such as shortness of breath and fatigue contributes to a clear understanding of her condition.
Nursing Diagnoses that Align with Patient Assessment Data
Through the extensive evaluation data that was attained from the simulated interviews, I came up with some nursing diagnosis that matches Mrs Snyder’s health status at the moment and also her needs. In the beginning, there are some five signs that point to a possible difficulty with her breathing that could be caused by heart failure. Thus, the SMART goals are established to recover the oxygen levels and to reduce the breathing difficultly symptoms (American Heart Association, 2019). Aside from that, the pulmonary function of Mrs Snyder was badly decreased, and her general weakness and activity intolerance prompted the establishment of several goals centred on increasing her functional abilities as well as regular exercise as part of her daily routine (National Institute of Diabetes and Digestive and Kidney Diseases, 2016). To begin with, Mrs Snyder’s husband and Mr Snyder lack knowledge of her long-term conditions and the medications required, necessitating educative interventions for them. These objectives are intended to build the couple’s abilities and understanding to effectively deal with the challenges of the illness. Along with these nursing diagnoses, PS&C care aspects should be taken into account for appropriate treatment. Customised intervention for Mrs Snyder based on her cultural background and inclusion of her husband in the educational process implies the patient-centred approach that acknowledges rather than violates their beliefs and preferences, in the long run, contributing to better adherence and results.
Appropriate Nursing or Collaborative Interventions
In addressing an area of concern of Mrs Snyder that has been detected through assessment, multiple nursing and collaborative interventions will be organised in order to meet all her needs precisely. Initially, the improved gas exchange in congestive heart failure is recognised by continuous recognition of Mrs Snydere’s breathing status monitoring, including respiratory rate, breath sounds and oxygen saturation. This antecedent would then initiate a rapid process of identifying any deterioration in her respiratory function and with subsequent interventions to maximise gas exchange and avert respiratory complications (McPhee & Hammer, 2019). Another strategic plan is on prospective Mrs. Snyder, who is reported to have activity intolerance. Therefore, interventions aimed at conserving energy and steadily increasing her activity levels have been identified. Adhering to energy preservation methods reduces Mrs. Snyder’s tiredness and gives her the confidence to carry out activities of daily living more easily. Gradual activity progression, which will reduce the risk of symptoms’ aggravation while creating favourable conditions for functional improvement and development of Mrs Snyder’s overall physical capacity, is of top priority (American Heart Association, 2019). This is the type of intervention that is necessary to fill the gaps in their knowledge of her chronic conditions and medication regimen. Education that is tailored to the comprehensive needs of the patient, including medications, food considerations and lifestyle, succinctly put Mr. Snyder on his path to recovery. Improved knowledge encourages drug adherence, dietary regulations and adoption of a healthy lifestyle, thereby preventing complications as well as improving health statuses.
Why Each Intervention is Indicated or Therapeutic
Each nursing intervention proposed for Mrs. Snyder is supported by a clear and convincing rationale grounded in evidence-based practice:
Monitoring Respiratory Status:
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Rationale:
Continuous checkup of Mrs. Snyder’s respiratory conditions is imperative because she is diseased with CHF and may have impaired gas exchange and respiratory distress. Assessment of respiratory rate, breath sounds, and oxygen saturation by nurses may signal respiratory distress, a preventable condition that can be avoided by timely intervention that is designed to promote proper oxygenation and prevent respiratory difficulties (McPhee & Hammer, 2019). Research has confirmed that prevention and early intervention increase the chances of healing and minimise the probability of respiratory complications (American Association of Critical Care Nurses, 2019).
Encouraging Energy Conservation Techniques and Gradual Activity Increase:
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Rationale:
The symptoms of Mrs. Snyder, like intolerance activity, are due to the decreased heart pump capacity and global weakness, which are the typical signs of CHF. Energy-saving techniques help Mrs. Snyder make efficient energy utilisation, resulting in less fatigue and creating conditions that encourage her to participate in daily activities(The American Heart Association, 2019). Increasing a moderate level of physical movement is essential to prevent making the symptoms worse and to aid in the promotion of improved functional capacity without placing exorbitant stress on the patient’s cardiovascular system (National Institute of Nursing Research, 2019).
Providing Education on Chronic Conditions and Medication Regimen:
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Rationale:
Mrs. Snyder’s type 2 diabetes ignorance of her disease state and the regime of medications she uses is an important educator point that mandates all patients’ education at all levels. With information provided through education, patients and their caregivers would be able to appropriately self-care and comply with the possibly demanding treatment programs (National Institute of Diabetes and Digestive and Kidney Disorders, 2016). Better health literacy related to her disease and medications may highly encourage her to comply with medicine, perform self-care activities, and be less likely to suffer complications and get rehospitalised. Furthermore, Mr. Snyder’s involvement in the clinical process assures that there is unity of care and support at home, which are attributes that are known to lead to an improvement of patient satisfaction and the outcome of diseases (Lemmens et al., 2019).
Conclusion
Ultimately, a patient-centred care strategy for Mrs Snyder is the result of a holistic approach that aims at both effectively dealing with the complexity of her health symptoms and improving the level of her outcomes. By coordinating her diagnosis from an evidence-based analysis and incorporating the interventions that will raise the quality of life and prevent the risks of complications, we will empower both Mrs Snyder and her family to play an active role in her care. The nursing diagnosis made for Mrs. Snyder addresses her reduced intake of oxygen, inability to carry out physical work, and need for education. These diagnoses give the right treatment directions. However, such problems can be resolved by effective nursing and collaborative way of interventions, which include respiratory monitoring, energy conservation methods, gradual activity increase and comprehensive patient teaching. We have mainly considered the physiological and psychological factors as the source.
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