Healthcare Case Study: Developing Care Goals and Interventions Plan

This healthcare case study focuses on a 70-year-old patient, John Smith, who is experiencing ego integrity versus despair, complicated by obesity, osteoarthritis, and severe depression. The study identifies nursing diagnoses related to obesity and depression, and it proposes interventions to address these issues. The primary goals include reducing depression through antidepressants, art therapy, counseling, and cognitive behavioral therapies. Additional goals involve weight management through motivational interviewing and dietary adjustments, as well as pain management for osteoarthritis using physiotherapy, occupational therapy, and environmental modifications to prevent falls. The case study highlights the importance of comprehensive assessments in developing effective care plans to improve the patient's overall health and quality of life. Desklib provides access to similar case studies and resources for students.

Running head: HEALTHCARE
HEALTHCARE ASSIGNMENT:
Name of the student:
Name of the university:
Author note:

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Introduction:
The assignment helps in developing an insight about the healthcare needs of a patient
named john Smith. Various care goals and interventions had been developed for him.
Stage of ego integrity versus despair:
The last stage of the psychosocial put forward by Erik Erikson is called the ego integrity
versus despair. This stage describes that when individuals get aged over 65 years, they start to
explore their lives as retired individuals and also their productivity tends to become low. They
begin contemplating their achievements and this helps them developing their integrity as they
acknowledge that they are leading successful lives (Westerhof et al., 2017). When the same
individual finds their lives to be unproductive, they start to feel that they have not been able to
achieve their goals and they feel guilty with their past. This often results in making them suffer
from anxiety and depression. Studies opine that success in this phase often makes them develop
the virtue of wisdom (Derdaele et al., 2017). In this stage, people are seen to look back at their
past lives with pleasure as well as completion and thereby they can happily accept death instead
of fearing it.
Mr. John Smith is found to be 70 year old man who is proceeding through this phase of
psychosocial development. He is a retired man now who lives alone in his three bedroom
apartment. When he looks back at his life, he feels guilty of not being able to provide time to his
children and his wife when they required him. His wife always longed for his presence but he
used to spend too much time at his work being consumed in his work. He wanted to earn more
money to make his family live happily as he had a impoverished childhood. While doing so, he
had failed to provide emotional support to his family. His wife expired after severe depression

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and his children rarely come to visit him as they have no bonds with him. He feels that he had
been the main contributor to his wife’s death and remains filled with grief and depression.
Another cause of his depression is his poor health condition where he is suffering from co-
morbid disorders. He had a BMI of 34 and has been suffering from obesity. He used to lead a
sedentary life completely engrossed in his work and resided on take-away foods. He never used
to actively participate in the screening sessions when his organizations used to arrange for the
employees. His present condition of obesity and osteoarthritis are making him suffer immensely.
All these have added to his despair and he does not feel like living anymore.
Two nursing diagnosis as identified in the case:
Individuals who are found to be having a BMI of 30 and above suffer from obesity
(Wilensky, 2017). Mr. Smith has BMI of 34 and therefore obesity is one of the risk factor of his
poor health that needs to be managed. Studies opine that obesity is a risk factor resulting many
complications like kidney disorders, cancer, sleep apnea, cardiovascular disorders, hypertension
as well as osteoarthritis. The SPICE assessment showed that he is having difficulty in sleeping
and this might be because he is suffering from sleep apnea that occur in obese patients. He also
has restricted mobility mainly because of his pain in the joints and this might be because of his
unmanaged osteoarthritis. Nurses, therefore, need to handle this situation and thereby help him
overcome obesity.
Another of the nursing diagnosis identified is the severe depression that the patient is
going through. Coming at the end phase of his life, he had realized that he had been careless
towards his family and considers himself to be the sole reason of his wife’s death. This guilt and
grief had affected his mental stability and resulted him in developing depression. This had been

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quite evident in the geriatric depression scale that he is suffering from severe depression and
nurses need to develop intervention for him. Moreover, the suffering he is going though his
unmanaged health complications of sleep apnea. Obesity, osteoarthritis and hypertension had
made him completely lose hope in living quality life. This had added to his depression level. He
had also been found to be addicted to alcohol as it helps him in believing that it relieves his
pressure.
First goal:
One of the main goals of the nurses would be to reduce the depression level in the patient.
For this, she should be working with that of a counselor collaboratively to help him manage his
stress, anxiety, depression as well as hopelessness.
Interventions:
One of the most important interventions is the application of anti-depressants. These
drugs help in relieving individuals from depressions and restore the normal sleeping patterns and
even reduction of anxiety and development of appetite. They work by modification of the
activities of the neurotransmitter pathways (Tate et al., 2016). The different medications are the
selective serotonin uptake inhibitors, serotonin or noradrenalin reuptake inhibitors, tricyclic, as
well as atypical antidepressants, monoamine oxidase inhibitors. Many of the studies have opined
that art therapy, pet therapy as well as music therapy has positive outcomes on depression on
individuals. Hence, the nurses can also help the patients through such interventions (Phelan et al.,
2015).
Counseling as well as psychological therapies can also successfully help the patients in
overcoming depression. The therapies mainly help the patients realize their negative thoughts

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and motivate them to replace them through positive thoughts as in case of cognitive behavioral
therapies. Changing the thought patterns and helping individuals to cope with the situations are
the main motives of the psychotherapies (Jeon et al., 2015). This therapy would help the
professionals in boosting the mood of john, modify his dysfunctional emotions and thereby
change his thoughts and patterns. This would help him in living a successful life.
Second goal:
One of the most important goal of the nurses would be to help the patient in developing a
proper weight that helps in reduction of the development of health complications. This needs to
be achieved within 3 to 5 months.
Interventions:
One of the most important interventions that nurses need to apply is to include the patient
in motivational interviewing. It has been found that often patients lose their motivation to change
or alter their health condition as they feel that in no way they can come back to healthy life (Aree
et al., 2017). Moreover, they also seem to have poor level of health literacy for which they
remain unaware of the health habits and lifestyles that contribute to poor health conditions and
increase in weight. Therefore, it becomes important for the patients to not only develop
knowledge but also to develop motivation and dedication to bring changes in the lifestyles (Allen
et al., 2016). Motivational interviewing is a counseling approach that helps in bringing out
behavior changes in patients and helping out in exploiting as well as in resolving ambivalence.
Therefore, motivation development for reduction of weight for the patient is the new one.
One of another important intervention is the management of diet. In order to help the
patients to develop good quality food habits so that they can have the appropriate body weight,

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nurses can work collaboratively with the dieticians and then develop proper diet plans for them.
The diet plans need to be such that it would comprise of whole grains, vegetables, and whole
fruits, nuts and plant oils and also mention the food habits that need to be avoided. Exercise and
physical activity sessions should also be developed for the patient (Briani et al., 2018).
Third goal:
The patient is suffering from excessive joint pains that had resulted him from suffering
from restricted mobility issues. It had also increased his risk for fall and hence, it becomes
important for the nurses to manage his pain and handle his conditions of osteoarthritis
successfully.
Intervention:
Studies have found that obesity often acts as the risk factor for osteoarthritis where heavy
weight of the body creates pressure on the joints (Townsend et al., 2017). This results in the
cartilages at the joints gradually erode away making the bones to rub against each other. This
causes excessive pain at the joints making mobility restricted. Therefore, for this reason, nurses
need to work collaboratively with physiotherapists. They would help in development of
movement of the joints through various therapeutic techniques as this would help in reduction of
his pain. Moreover, occupational therapists also need to be allocated for him. This would help in
developing his coping ability and help him come back to his normal life (Petrovsky et al., 2015).
The second intervention would be to assess the risk of fall for the patient and accordingly
make environmental modification in the place where the patient lives. This would help in

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reduction of the chances of fall. Arranging for bed rails, bathroom bars, side rails and similar
others need to be implemented in his house. Heavy furniture should be only kept so that falling
by tripping over can be prevented (Cesseti et al., 2017). Height of the bed should be lowered.
Different assistive devices can also be provided to him and loose clothing should not be allowed
for wearing.
Conclusion:
The assignments showed how the scope of undertaking various assessments help in
diagnosing the disorders effectively. Accordingly, nurses developed care plans for him. This
would help him in developing quality health of the patient.

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References:
Allen, K. D., Choong, P. F., Davis, A. M., Dowsey, M. M., Dziedzic, K. S., Emery, C., ... &
Skou, S. T. (2016). Osteoarthritis: models for appropriate care across the disease
continuum. Best practice & research Clinical rheumatology, 30(3), 503-535.
Aree-Ue, S., Saraboon, Y., & Belza, B. (2017). Long-Term Adherence and Effectiveness of a
Multicomponent Intervention for Community-Dwelling Overweight Thai Older Adults
with Knee Osteoarthritis: 1-Year Follow Up. Journal of gerontological nursing, 43(4),
40-48.
Briani, R. V., Ferreira, A. S., Pazzinatto, M. F., Pappas, E., Silva, D. D. O., & de Azevedo, F. M.
(2018). What interventions can improve quality of life or psychosocial factors of
individuals with knee osteoarthritis? A systematic review with meta-analysis of primary
outcomes from randomised controlled trials. Br J Sports Med, 52(16), 1031-1038.
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gerontologist, 40(5), 380-391.
Derdaele, E., Toussaint, L., Thauvoye, E., & Dezutter, J. (2017). Forgiveness and late life
functioning: the mediating role of finding ego-integrity. Aging & mental health, 1-8.
Jeon, E., & Park, H. (2015). Development of a smartphone application for clinical-guideline-
based obesity management. Healthcare informatics research, 21(1), 10-20.

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Petrovsky, D., Cacchione, P. Z., & George, M. (2015). Review of the effect of music
interventions on symptoms of anxiety and depression in older adults with mild
dementia. International psychogeriatrics, 27(10), 1661-1670.
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M.
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Tate, D. F., Lytle, L. A., Sherwood, N. E., Haire-Joshu, D., Matheson, D., Moore, S. M., ... &
Michie, S. (2016). Deconstructing interventions: approaches to studying behavior change
techniques across obesity interventions. Translational behavioral medicine, 6(2), 236-
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Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care
in evidence-based practice. FA Davis.
Westerhof, G. J., Bohlmeijer, E. T., & McAdams, D. P. (2017). The relation of ego integrity and
despair to personality traits and mental health. The Journals of Gerontology: Series
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Wilensky, D. (2017). Confronting Despair on the Long-Term Care Unit.