Nursing Care Plans and Models

The assignment delves into the creation and implementation of nursing care plans, focusing on models such as the Roper-Logan-Tierney framework. It examines how these models are applied to real-world patient cases, including those with chronic total occlusion, coronary artery disease, Huntington's disease, and COPD. The analysis draws upon academic research articles and online resources to provide a comprehensive understanding of nursing care planning principles and practices.

CARE OF THE PATIENT WITH COMPLEX CARE
NEEDS
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TABLE OF CONTENTS
Key issues....................................................................................................................................3
Pathophysiology..........................................................................................................................3
Assessment Framework..............................................................................................................4
Pharmacology..............................................................................................................................6
Source of evidence......................................................................................................................7
Discussion...................................................................................................................................8
References......................................................................................................................................11
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Key issues
The present research essay is discussing about Bob Evans who is a 68 year old man and
who was admitted in the hospital because of decomposed heart failure. It is after accessing the
case of Mr Evans, it is ascertained that there are two major health issues which are prevailing
such as breathing problems and gross peripheral oedema (Skelly and et.al, 2016). As per the
clinical history, Bob has ischaemic heart disease for around 20 years and along with that, he has
coronary artery bypass graft which is a compete heart block. It is also analysed that Mr Evans is
very much frightened especially during nights and as a result it becomes difficult for him to sleep
properly. He is also having bilateral pitting oedema with leaking fluid from both legs. It happens
due to the presence of gross peripheral oedema; thus it also brings pain in the legs. The amount
of energy is also getting down as Mr Evans has no appetite; henceforth he eats very less.
Pathophysiology
Ischemic heart disease also known as Coronary Artery Disease directly impacts upon the
supply of blood to the heart. Being a foremost issue of Bob, this situation leads to a blocked
blood vessel that leads to a reduced supply of oxygen and nutrients to the heart muscle
(Braunwald, 2016). Any defect in the heart affects the supply of oxygen to the vital organs like
brain, liver and kidneys. This also leads to the death of tissues and eventually it leads to death in
many cases. Shortness in breath usually occurs at the time of having cardiac symptoms and most
often it also leads to development of cardiac pain.
It also increases lung disease especially in the patients who have cardiac risk. In most of
the retrospective study, it is mentioned that there are varied patients who have coronary disease
usually experience shortness in breath Similarly, this also brings chest pain and as a result it
encourages overall health complications (Preibsch and et.al, 2016).. Further, Mr Evans is also
having gross peripheral oedema which is an accumulation of interstitial fluid and has in turn
resulted in the occurrence of bilateral pitting oedema. Apparently, the volume of fluid in the
interstitial space is 20% of the normal body weight; however leakage from capillaries and
lymphatic drainage can aid in keeping the balance in the fluid.
This usually occur due to enhance plasma volume, due to reduced plasma oncotic
pressure and also because of lymphatic drainage. Oedema is also called pitting at when it is
pressed on the affected skin. This is also regarded as a classic type of oedema that is caused
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because of fluid accumulation (Oellgaard and et.al, 2016). Therefore, in this context it is evident
that non-pitting oedema occurs in conditions such as lymphoedema and myxoedema. Hence, it
can be said that because of this oedema, Mr Evans is having pain in the legs. Other symptoms are
also observed such as lack of appetite, no energy in the body and lack of sleep. It also increases
capillary hydrostatic pressure due to pulmonary hypertension.
Apart from this, renal failure is also referred to be a possible occurrence in the given case
of Mr Evans where it is referred to a chronic failure of kidney which generally occurs due to a
slow flow of blood to the kidney organs. Chronic renal failure is also linked with a higher risk of
getting cardiovascular disease and chronic kidney failure where high blood pressure or
hypertension is also an indicant for the same. However, hypertension cannot be stated to be a
complete reason for it is a common cause of many related diseases with most of the patients
suffering from an elevated blood pressure. On linking it to the presented case of Bob, some
prime causes of renal failure in his body has been found and are associated with the signs of
heart failure where he is also known to suffer from urinary issues with inadequate flow of blood
to his kidneys.
Assessment Framework
Activities of life plays a crucial role in ascertaining how a person manages all the aspects
of life. This includes the way of promoting maximum independence through carrying out
complete assessment of all the nursing intervention (Rizik and et.al, 2017). Further, according to
the health condition, diet chart can also be prepared subsequently in which Mr Evans will be
recommended to have healthy diet. In activities of life, nurses should work on maintaining a safe
environment so that while delivering palliative care services, safety and security aspects could be
maintained. In this respect, communication also holds much importance because it could direct
Mr Evans to discuss all those issues which he is facing.
Nurses should also work on managing breathing aspects as due to ischemic heart disease,
the frequency of breathing gets changed. Roper’s model is applicable in this situation because it
is a model of nursing care that helps the person to live healthy life. It is the most widely used
nursing model in the UK and it is based upon the activities of daily life (Elsherif and Noble,
2011). Thus, as per the model, there are several areas wherein Mr Evans has to bring changes so
that to proceed towards a healthy life. At the same time, the original purpose of the model is to
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assess the patient’s care and also to deliver suitable services to the patient in overall health care
provision. The model together states that there are varied factors that impacts upon the health
care services; hence it is crucial for the nurses to consider all such dimensions.
This model could be used for Mr Evans for the purpose of assessing how much the life of
patient has changed due to this illness or after admitting in the hospital. Therefore, the overall
impact on the quality of life is required to be analysed accordingly. The model will be including
varied aspects of patient’s overall life dimensions (Sapontis and et.al, 2017). According to the
current analysis, it is identified that Mr Evans eats less; hence that develops other health issues
and because of anxiety and lack of concentration, he is unable to sleep as well. At the same time,
the model also includes all such factors that influences activities of living; therefore herein major
consideration is required to give on smoking and drinking habits.
Since, the patient has severe health conditions; therefore it is essential for the nurses to
inform the patients about the ill impacts of sedentary lifestyle. Therefore, nurses should focus on
biological, psychological, environmental and sociocultural aspects which affects the life of an
individual in many domains (Williams, 2017). Along with the same, the model also includes how
life span of a person changes in different situations. The model also emphasizes on educating the
patient so that the quantity of fluid intake can assist in preventing water. Patient education is
necessary in this case as Mr Evans has serious health consequences which needs immediate
treatment.
It is on considering the situation of Mr Evans, it can be said that nurses can make use of
Roper-Logan-Tierney activities to categorise the major nursing care priorities. Chronic
Obstructive Pulmonary Disease is typically one of the major causes of mortality in UK and it is
also known as a chronic illness that is often caused by smoking (Shortness of Breath without
Chest Pain Can Signify the Presence of High Risk Heart Disease, 2005). Since, Mr Evans is
habitual of smoking and drinking; therefore he has the issues of COPD. The disease is a life-long
illness and it can also affect a person’s life. Therefore, as per the model, chief focus will be laid
on aspects of care related to berating, eating, drinking and motioning a safe environment. These
aspects are also useful in terms of delivering the best care for the patients.
Appropriate nursing care management is essential since that could help the patient to get
recovered as early as possible. Therefore, as per Roper-Logan-Tierney, changes are required to
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be made in the eating and daily life schedule of the patient so that health prospects can be
improved accordingly (Yin and Hsiung, 2016). With the help of this model, proper treatment can
be delivered to Mr Evans so that his health prospects can be enhanced. This nursing process is a
systematic tool which is useful in ascertaining the needs of individuals. At the same time, it also
works in giving better services to the patients. COPD is considered as the 5th most common cause
of morbidity and mortality which enhances the number of patients in the country.
Pharmacology
It is in accordance to the identified health problems of Mr Bob Evans, proper services are
required to be delivered to him for changing his deteriorating health aspects (Nioi and et.al,
2016). In context to which, it is firstly important to discourse upon the pharmacology of diuretics
which is a substance used for the evacuation of water contents from the body. In simple terms, it
is used for the removal of urinary substance from the body where urinary loss gets important for
those patients who are not able to do it in a natural way. It is therefore on relating to the present
case of Mr Bob Evans, diuretics is being used as an valuable tool assisting in the removal of his
body waste for not being able to do it in a natural way.
Oxygen therapy is hereby concerned with the management of cases related to respiratory
failure. It is generally required at the time when patient is suffering from any severe type of heart
related disease, chronic bronchitis, asthma or pneumonia, etc. A prior aim of this therapy for the
administration of respiratory failure is to attain manikin sufficient exchange of gas where it also
involves a setback approach for the precipitating procedure leading to failure. It is further given
in two distinct ways namely respiratory failure 1 and 2 as per the indications given by the
patient's deteriorating condition. It is therefore on considering the case of Mr Evans where he is
dealing with a case of COPD that in turn indicates a high risk of hypercarbia. In such situation,
Bob should be given a low concentrated oxygen therapy. However, the delivery system should
be accurately monitored to avoid any sort of risks associated with it and to stop it on time.
Although, a long term oxygen therapy is also required to be administrated in a proper manner to
avoid any sort of danger with a special context of Bob where he is a COPD patient who is at a
higher chance of dealing with the risk of Cytotoxic damage.
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Source of evidence
Cury and et.al. (2016) have hereby stated anxiety to be an unrecognisable clause that is
often unidentifiable by people suffering from it. In reality, it is specified to be an alarming
situation in which the individual dealing with such similar situation is apparent to face some
risky conditions in his or her life. Anxiety is however known to integrate both emotional and
physical sensations in the mind of an individual that in turn creates some sense of nervousness
about a particular thing. This might be due to any sort of feelings that is either making a person
happy about it or even sad.
Bradshaw (2016) with a distinct opinion towards the above presented idea have hereby
specified it to be a worrisome feeling that is apparent to create a sense of fear and uneasiness in a
person dealing with it. In accordance to which, a state of anxiety is basically known to give an
unpleasant feeling to a person going through it and is a way of responding to our natural
biological instinct where a person may feel threatened due to some reason. It is therefore referred
to be a disorder that often diagnosed as an ill health in many individuals as a sign of some
disease.
End of life is referred to be yet another relative theme in context to the present study
where it has been further elaborated to play a crucial role in the life of those individuals who are
not able to cure the disease by which they are suffering. Smith (2016) have specified it as a
system of palliative care that involves such effective practices which are aimed to provide
comfortable services to a patient. Also, it includes the management of pain and distress from
which a person is going through. This is where death and dying are referred to be two inevitable
situations that largely demands for an active existence of palliative care.
Helgadottir and et.al. (2016) with an arguable consent towards the aforesaid significance
of palliative care have specified it to be a very elementary clause that refers to provide social,
mental and religious assistance to the individuals in need of such type of care. This not only
leads to support the individual suffering from a particular type of disease that cannot be cured
but also aids the entire family going through a state of trauma due to some sort of unfavourable
incident. Skelly and et.al. (2016) specified that palliative care also termed as end of life care
must be prioritised for people in situation of acquiring it. As well as, it should also involve
quality care services to provide a sense of gratification to the people for whom it will be
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designed. It is not only to support the person at the last stage of his or her life, but should also be
designed to serve those who are willing to stay with that person at that stage. This refers to an
active presence of the family members of the individual who is required to provision a palliative
care by together supporting his or her family members.
Discussion
Mr Evans wishes to be at home in his last days; therefore while delivering palliative care
services, it is crucial for the nurses to keep all the cultural and social values. Therefore, in this
respect it is vital for nurses to consider that Mr Evans is having controlling on all his activities as
then only his health values could be maintained. His family members are very much concerned
about his health dimensions; hence considering the same they have decided to give appropriate
health care services to the patients (Lock, 2011). Mr Evans is required to have proper medical
treatment about heart failure, pain management and wound assessment as his health conditions
are getting changed frequently. At present, Mr Evans is getting services from community nursing
team as his care is managed by the Community Matron and Specialist heart failure Nurses in the
community. Therefore, stating about the causes, it can be said that pitting- dependent oedema
can increase fluid pressure from venous stasis and it also increases fluid pressure from sodium
water retention. However, on the other hand it leads to develop issues because of right heart
failure.
Nurses and health care practitioners are required to keep balance between social and
cultural values as that also holds more importance in encouraging service dimensions. Further,
nursing services will also be enhanced through meeting all the requirements of patients.
Therefore, it is evident that appropriate nursing intervention and care plan is required to be
developed for Mr Evans. Apart from patient education, chief emphasis is required to be given on
proper use of techniques so that proper functioning of all the body parts can take place (Mooney
and O'Brien, 2006). Anxiety is a state in which a person gets unconscious and does not
understand what is required to manage the overall health values. In the same way, Mr Evans is
also anxious; therefore it is essential for the nurses to consider the same thing into account. As
per nursing diagnosis, it is clear that suitable medicines should be given to Mr Evans so that he
can change his eating and sleeping patterns. The concept of end life care also exist in the present
case because Mr Evans desires to die at his home in last stages of his life. Thus, palliative care
services must be given to the patient while assessing his health care requirements.
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Assessment Nursing
diagnosis
Goal Interventions Rationale Evaluation
Breathing
According
to Roper’s
framework,
safe
environment
is required
to be
maintained
Proper
analysis of
respiratory
system
(Minster and
Williams,
2016)
To maintain
suitability in
respiration
system
Analysing
blood gas and
also through
noting pH and
HCO3 level
This is
essential in
terms of
managing
oxygen
intake
capacity.
Irregular
breathing
can create
issues;
hence
suitable
monitoring
and
controlling
is required.
Analysing
respiratory
depth
changes
Proper
analysis is
essential so
as to
ascertain
breathing
pattern
To change
ineffective
breathing
pattern
Focus on
managing
COPD on
regular basis
This is useful
since it can
aid in
managing the
flow of air in
the lungs
(Mitchell,
McCormack
and
McCance,
2016).
This can
also help Mr
Evan to
identify the
impacts of
smoking
and
drinking.
Gross
peripheral
oedema
Treatment
on the basis
of causes
Several tests
such as renal
function,
The main
goal is to
reduce the
Proper
medicines and
therapies will
It is useful in
analysing
chronic pain
Therefore,
this can help
in managing
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CXR and
ECG will be
carried out
(Kahanpää
and et.al.
2016).
level of pain
in the legs.
be applied
accordingly.
in the
systems.
proper
functioning
of the heart.
Empirical
treatment
with
diuretics
Clear
diagnosis is
required to
identify the
main issue.
The main
goal is to
change the
way through
which body
parts
manages
their
functions.
Medicines are
required
along with
changes in
lifestyle.
This is useful
in reducing
other
problems
such as
cardiac and
renal.
Health
issues can
be
diminished
accordingly.
Therefore, on the basis of above defined care plan, it can be said that nurses need to
ensure that suitable intervention are being added in the care provision (Ballantyne, 2016). This is
also useful for the purpose of managing Mr Evan’s health conditions in the most suitable
manner. Thus, along with such changes suitable consideration should be given to all the habits
and Mr Evans.
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REFERENCES
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