Assignment: Health Planning

Community Health Planning

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Community Health Planning

Yodaisy lLORENTE

Florida National University

Prof. Eddie Cruz RN MSN

Community Nursing Class

12/02/2018

BSN Program

Diabetes mellitus type 1:

Assessment:

History: When collecting data, ask the caregiver about:

– The child’s symptoms leading up to the present illness

– Ask about the child’s appetite.

-Weight loss or gain.

– Evidence of polyuria or enuresis in a previously toilet-trained child,

– Polydipsia.

– Dehydration.

– Irritability and fatigue.

Include the child in the interview and encourage him or her to contribute information.

Physical exam:

– Measure the height and weight and examine the skin for evidence of dryness or slowly healing sores.

– Note signs of hyperglycemia.

– Record vital signs, and collect a urine specimen.

– Perform a blood glucose level determination using a bedside glucose monitor.

-Urine dipstick test. For ketones in the urine, the child should be tested using urine dipstick test.

Diagnosis:

1-Deficient Knowledge related to absence or deficiency of cognitive information as evidence by new diagnosis of IDDM

2-Compromised Family Coping related to Inadequate or inaccurate information as evidence by Anxiety and guilt

3-Risk for Injury as evidence by sweating, shakiness, nervousness, lightheadedness, weakness, nausea, moodiness, pale skin, loss of consciousness

4- Imbalanced nutrition: less than body requirements related to insufficient caloric intake to meet growth and development needs as evidence by patient BMI of 16.

Planning:

The major nursing care planning goals for diabetes mellitus type 1 the child.

– Client will verbalize understanding of IDDM.

– Client and parents will demonstrate appropriate blood-glucose monitoring insulin administration, dietary management, and exercise plan.

– Client and parents will identify signs and symptoms of hypoglycemia and hyperglycemia and correct response

– Family will explore feelings regarding the child’s long-term needs.

– Family will determine appropriate support systems and coping skills

– Family will show learning about and managing hypoglycemia and hyperglycemia, insulin administration, and exercise needs for the child.

– Client’s blood glucose levels will maintain between 60 mg/dL and 120 mg/dL.

– Client will maintain adequate nutrition.

Nursing Interventions

-The nurse will assess parents and child understanding of disease and ability to perform procedures and care, for educational level and learning capacity, and for developmental level.

-The nurse will provide a quiet, comfortable environment; allow time for teaching small amounts at a time and for reinforcement, demonstrations and return demonstration; start educating one day following diagnosis and limit sessions to 30 to 60 minutes.

-The nurse will instruct parents and child in insulin administration including drawing up insulin into the syringe, rotating vial instead of shaking, drawing clear insulin first if mixing 2 types in the same syringe, injecting SC, storing insulin, rotating sites, adjusting dosages, reusing a syringe, and needle, and disposing of them

-The nurse will include as many family members in teaching sessions as possible.

– The nurse will assess family coping mechanisms and its effectiveness, family dynamics and expectations related to long-term care, developmental level of family, response of siblings, knowledge, and use of support systems and resources, presence of guilt and anxiety, overprotection and overeating behaviors.

– The nurse will assist family to establish short- and long-term goals for the child and to involve the child in the activities of the family; include the participation of all family members in care routines.

– The nurse will encourage family members to verbalize feelings, to tell how they handle the chronic needs of the family member, and to define coping patterns that support or inhibit adjustment to the problems.

– The nurse will assess for signs and symptoms of hyperglycemia; Monitor serum glucose level, urine for glucose and ketones, pH and electrolyte levels. Also assess for symptoms of hypoglycemia.

-The nurse will administer insulin subcutaneously as prescribed, increase dosage depending on the glucose levels; rotate injection sites, minimize food intake during an infection or illness and modify the dosage of insulin during an illness.

– The nurse will promote exercise program compatible with insulin regimen; instruct to increase carbohydrate intake prior a strenuous activities.

– The nurse will encourage a diet with calories that balance with the energy requirements and paired with the type and action of insulin, and snacks between meals and at bedtime as appropriate.

-The nurse will ensure adequate and appropriate nutrition to maintain the blood glucose at near normal levels; the food plan should be well balanced with foods that take into consideration the child’s food preferences, cultural customs, and lifestyle.

-The nurse will prevent skin breakdown. Teach the caregiver and child to inspect the skin daily and promptly treat even small breaks in the skin; encourage daily bathing; teach the child and caregiver to dry the skin well after bathing, and give careful attention to any area where skin touches skin, such as the groin, axilla, or other skin folds; emphasize good foot care.

Evaluation

Goals are met as evidenced by:

The child/ caregiver:

•Maintained adequate nutrition.

•Promoted skin integrity.

•Prevented infection.

•Regulated glucose levels.

•Learned adjust to having a chronic disease.

•Learned about and managing hypoglycemia and hyperglycemia, insulin administration, and exercise needs for the child

Breast cancer.

Assessment:

During the history:

It is crucial to know if the nurse admitting learns that the patient her mother, two of her aunts, and one sister had been diagnosed with breast cancer. Her mother and one of the aunts died before age 45. . Risk factors include age 65 and above, two first-degree relatives diagnosed with breast cancer at an early age, high breast tissue density, and factors that affect circulating hormones like late menopause, long-term use of hormonal replacement therapy, and obesity.

Physical assessment findings

Breast cancer may present as a palpable breast mass, breast pain, lymph node swelling, or skin changes, such as dimpling or redness. Evaluation of a breast abnormality usually starts with a clinical breast examination and mammography or ultrasonography, with MRI considered for some patients. The next step is a needle biopsy or surgical excisional biopsy. To determine if the cancer has spread, the patient may undergo additional tests, such as X-ray, computed tomography (CT), a bone scan, and fluoro­deoxyglucose (FDG) positron emission tomography (PET) integrated with CT (FDG-PET/CT).Breast cancer screening includes mammography, clinical breast examination (CBE), and breast self-examination (BSE). It is important that patients understand what these examinations are all about, how they are performed, and their limitations.

Diagnosis:

1- Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs related to hypermetabolic state associated with cancer as evidence by body weight 20% or more under ideal for height and frame, decreased subcutaneous fat/muscle mass.

2- Acute Pain related to side effects of various cancer therapy agents as evidence by patient verbalize pain and alteration in muscle tone; facial mask of pain.

3- Situational Low Self-Esteem related to threat of death; feelings of lack of control and doubt regarding acceptance by others; fear and anxiety as evidence by Not taking responsibility for self-care, lack of follow-through.

Planning:

– The patient will demonstrate stable weight/progressive weight gain toward goal with normalization of laboratory values and be free of signs of malnutrition.

– The patient will verbalize understanding of individual interferences to adequate intake.

– The patient will anticipate in specific interventions to stimulate appetite/increase dietary intake.

– The patient will verbalize understanding of body changes, acceptance of self in situation.

– The patient will begin to develop coping mechanisms to deal effectively with problems.

– The patient will demonstrate adaptation to changes/events that have occurred as evidenced by setting of realistic goals and active participation in work/play/personal relationships as appropriate.

– The patient will report maximal pain relief/control with minimal interference with ADLs.

– The patient will follow prescribed pharmacological regimen.