Comprehensive Nursing Care Plan For A Patient With Chronic C ✓ Solved

Comprehensive Nursing Care Plan for a Patient with Chronic Conditions

Develop a detailed nursing care plan based on a comprehensive patient assessment, including identifying diagnoses, establishing goals/outcomes with specific dates, planning interventions, providing rationales, and planning evaluations and revisions. The plan should cover multiple diagnoses related to the patient's physical, psychological, sociocultural, developmental, and spiritual needs. Properly cite scholarly sources supporting your interventions, ensuring content is original with appropriate APA citations. The nursing care plan should be organized, well-structured, and formatted to meet academic standards, with attention to clarity, critical thinking, and avoidance of plagiarism. The plan should include at least five diagnoses and corresponding interventions, goals, and outcomes, with relevant references.

Sample Paper For Above instruction

Introduction

Effective nursing care for patients with complex, chronic health conditions requires a comprehensive assessment, accurate diagnosis, well-structured goals, evidence-based interventions, and continuous evaluation. This paper presents a detailed nursing care plan for a patient with multiple chronic conditions, illustrating the integration of clinical judgment, scholarly evidence, and patient-centered approaches. Proper documentation and adherence to ethical standards, including APA citation, underpin the narrative, ensuring a scholarly presentation suitable for professional practice and academic evaluation.

Patient Overview

The patient is a 68-year-old male with a complex medical history including peripheral artery disease (PAD), coronary artery disease, atrial fibrillation, chronic kidney disease, pulmonary hypertension, and previous limb bypass surgeries. He lives with his wife in Wisconsin, attends church occasionally, and reports feelings of depression, activity intolerance, and concerns about his health status. His current condition involves wound care, mobility challenges, psychological distress, and social isolation. This clinical scenario necessitates a multifaceted nursing approach, targeting physical impairments, emotional well-being, and social participation.

Diagnosis 1: Activity Intolerance related to poor blood flow and decreased cardiac function

Evidence-Based Rationale

Activity intolerance often results from impaired tissue perfusion and compromised cardiac output (Fletcher, 2015). Rest periods and graduated exercise improve tolerance and prevent deconditioning (Bradley & Davis, 2012).

Goals and Outcomes

• The patient will demonstrate increased activity tolerance, able to perform ADLs without fatigue, by discharge date.
• The patient will participate in prescribed physical activities, as tolerated, at each shift.

Interventions

1. Schedule rest periods between activities to prevent fatigue.
2. Assist with mobility exercises using assistive devices to promote independence.
3. Monitor vital signs and observe for signs of overexertion, such as dizziness or pallor.

Evaluation and Revision

Patient demonstrated increased endurance, participating in activities with minimal fatigue. Adjust activity levels based on ongoing assessments.

Diagnosis 2: Ineffective Peripheral Tissue Perfusion related to obstructed blood flow secondary to PAD

Evidence-Based Rationale

Improving blood flow and minimizing tissue hypoxia are critical. Interventions include positioning, avoiding vasoconstriction, and promoting vasodilation (Fauci et al., 2011).

Goals and Outcomes

• The patient will maintain or improve peripheral pulses and skin integrity by discharge.
• The patient will verbalize understanding of PAD management strategies.

Interventions

1. Assess skin temperature, color, and capillary refill regularly.
2. Position the patient to promote lower extremity circulation.
3. Encourage smoking cessation and medication adherence as per treatment plan.

Evaluation and Revision

Signs of adequate perfusion improved, and patient expressed understanding of disease management strategies. Reinforce education as needed.

Diagnosis 3: Anxiety and Hopelessness related to chronic illness and activity limitations

Evidence-Based Rationale

Providing emotional support and facilitating expression of feelings are vital to reduce anxiety (Giske & Gjengedal, 2007). Cognitive-behavioral strategies and therapeutic communication improve psychological well-being.

Goals and Outcomes

• The patient will verbalize feelings and concerns related to his health condition by the end of hospitalization.
• The patient will demonstrate effective coping mechanisms, such as relaxation exercises, by discharge.

Interventions

1. Use active listening and empathetic communication to validate feelings.
2. Encourage participation in support groups or counseling as appropriate.
3. Educate the patient and family about disease processes to promote understanding and acceptance.

Evaluation and Revision

The patient was able to express emotions and engaged in relaxation activities. Ongoing support will be continued post-discharge.

Diagnosis 4: Impaired Skin Integrity related to ischemia and surgical wounds

Evidence-Based Rationale

Maintaining skin integrity involves regular assessment, appropriate wound care, and optimizing perfusion (Radawiec et al., 2010).

Goals and Outcomes

• The patient's wound will heal with no signs of infection or deterioration.
• The patient and caregiver will demonstrate proper wound care techniques.

Interventions

1. Assess wound characteristics daily, including size, appearance, and exudate.
2. Maintain sterile dressing changes and monitor for infection.
3. Optimize nutrition to promote wound healing and support tissue repair.

Evaluation and Revision

The wound showed signs of healing, and patient demonstrated understanding of wound management, with plans for continued care on discharge.

Diagnosis 5: Risk for Social Isolation related to activity limitations and psychological distress

Evidence-Based Rationale

Promoting social interaction and emotional support can reduce feelings of loneliness and improve quality of life (Ebell, 2010).

Goals and Outcomes

• The patient will engage in social activities, either in person or virtually, during hospitalization.
• The patient will identify at least one external support resource before discharge.

Interventions

1. Encourage participation in group activities or visits from family and friends.
2. Educate on community resources and support groups.
3. Assess the patient’s willingness and readiness to re-engage socially.

Evaluation and Revision

Patient expressed willingness to reconnect socially; ongoing efforts will be made to facilitate this post-discharge.

Conclusion

This comprehensive nursing care plan integrates physiological, psychological, and social considerations, fostering holistic patient care. Application of evidence-based interventions, ongoing evaluation, and patient engagement are essential to optimize health outcomes and enhance quality of life. Proper documentation, scholarly evidence with APA citations, and adherence to professional standards underpin effective nursing practice.

References

• Bradley, J. G., & Davis, K. A. (2012). Orthostatic hypertension. American Family Physician, 68(12), 2147–2152.
• Du, H., Newton, P. J., Salamonson, Y., et al. (2010). A review of the six-minute walk test: Implication as a self-administered assessment tool. European Journal of Cardiovascular Nursing, 8(1), 2–8.
• Fauci, A., Braunwald, E., Kasper, D. L., et al. (2011). Harrison’s Principles of Internal Medicine (17th ed.). McGraw-Hill.
• Fletcher, K. (2015). Immobility; geriatric self-learning module. Medicine-Surgical Nursing, 14(1), 35.
• Giske, T., & Gjengedal, E. (2007). The supportive relationship: A crucial aspect for able-bodied to experience health in everyday life. Scandinavian Journal of Caring Sciences, 21(4), 377–383.
• Radawiec, S. M., Howe, C., Gonzalez, C. M., et al. (2010). Safe ambulation of an orthopedic patient. Orthopedic Nursing, 29(2), 24–27.
• Yeom, H. A., Keller, C., & Fleury, J. (2011). Interventions for promoting mobility in community-dwelling older adults. Journal of Advanced Nursing Practice, 21(2), 95–100.