NANDA Definition: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat.
Anxiety is probably present at some level in every individual’s life, but the degree and the frequency with which it manifests differs broadly. Each individual’s response to anxiety is different. Some people are able to use the emotional edge that anxiety provokes to stimulate creativity or problem-solving abilities; others can become immobilized to a pathological degree. The feeling is generally categorized into four levels for treatment purposes: mild, moderate, severe, and panic. The nurse can encounter the anxious patient anywhere in the hospital or community. The presence of the nurse may lend support to the anxious patient and provide some strategies for traversing anxious moments or panic attacks.
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Anxiety Control
* Coping
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Anxiety Reduction
* Presence
* Calming Technique
* Emotional Support
* Defining Characteristics: Physiological:
o Increase in blood pressure, pulse, and respirations
o Dizziness, light-headedness
o Perspiration
o Frequent urination
o Flushing
o Dyspnea
o Palpitations
o Dry mouth
o Headaches
o Nausea and/or diarrhea
o Restlessness
o Pacing
o Pupil dilation
o Insomnia, nightmares
o Trembling
o Feelings of helplessness and discomfort
* Behavioral:
o Expressions of helplessness
o Feelings of inadequacy
o Crying
o Difficulty concentrating
o Rumination
o Inability to problem-solve
o Preoccupation
* Related Factors: Threat or perceived threat to physical and emotional integrity
* Changes in role function
* Intrusive diagnostic and surgical tests and procedures
* Changes in environment and routines
* Threat or perceived threat to self-concept
* Threat to (or change in) socioeconomic status
* Situational and maturational crises
* Interpersonal conflicts
* Expected Outcomes Patient is able to recognize signs of anxiety.
* Patient demonstrates positive coping mechanisms.
* Patient may describe a reduction in the level of anxiety experienced.
www1.us.elsevierhealth.com
Saturday, March 26, 2011
No Pressure
So as of now I'm passing all my classes for 2nd year. Not by a huge margin, but passing. Some better than others. BUT... I have to take the 2nd year NBME shelf exams on Tuesday and Wednesday and those count for 25% of my final grade. Which means I can still fail 2nd year. Which means I have a year of my life and $70k riding on those two days. Which is not good. I took a practice exam yesterday and it wasn't pretty folks. Sigh. Well, if I fail out you'll know what happened.
Southern Illinois University Carbondale
Southern Illinois University Carbondale (SIU) is one of the top public universities in Illinois, USA. It is classified by the Carnegie Foundation for the Advancement of Teaching as a Research University: High Research Activity.
The University has the following Colleges: College of Agricultural Sciences; College of Applied Sciences and Arts; College of Business; College of Education and Human
The University has the following Colleges: College of Agricultural Sciences; College of Applied Sciences and Arts; College of Business; College of Education and Human
Friday, March 25, 2011
Sedentary Lifestyle | Nursing Care Plan for Obesity
Nursing diagnosis: sedentary Lifestyle related to Lack of interest, motivation, resources, Lack of training or knowledge of specific exercise needs, Safety concerns or fear of injury
Possibly evidenced by
Physical deconditioning
Daily routine lacking in physical exercise
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Prescribed Activity
Verbalize understanding of importance of regular exercise to weight loss and general well-being.
Identify necessary precautions and safety concerns and self-monitoring techniques.
Formulate realistic exercise program with gradual increase in activity.
Nursing intervention with rationale:
1. Review necessity for and benefits of regular exercise.
Rationale: Exercise promotes weight loss by reducing appetite, increasing energy, toning muscles, and enhancing cardiac fitness and sense of well-being and accomplishment.
2. Determine current activity level and plan progressive exercise program tailored to the individual’s physical condition, goals, and choice.
Rationale: Commitment on the part of the client enables the setting of more realistic goals and adherence to the plan.
3. Identify perceived and actual barriers to exercise.
Rationale: Lack of resources, including proper apparel such as supportive shoes and comfortable clothing, a safe place to walk, or facility membership for water aerobics, reduces the likelihood of individual adhering to specific program. In addition, fear of discrimination or ridicule by others may limit client’s willingness to exercise in public.
4. Discuss appropriate warm-up exercises, cool-down activities, and specific techniques to avoid injury.
Rationale: Preventing muscle injuries allows client to stay active. Time spent recuperating from exercise-induced injuries may result in relapse to sedentary habits.
5. Determine optimal exercise heart rate. Demonstrate proper technique to monitor pulse and discuss signs and symptoms requiring modification of activity.
Rationale: Promotes safety as client exercises to tolerance, not peer pressure.
6. Identify alternatives to chosen activity program to accommodate weather, travel, and so forth.
Rationale: Promotes continuation of program.
7. Discuss use of mechanical devices or equipment for weight reduction.
Rationale: Fat loss occurs on a generalized overall basis, and there is no evidence that spot reducing or mechanical devices aid in weight loss in specific areas; however, specific types of exercise or equipment may be useful in toning specific body parts.
8. Recommend keeping a graph of activity as exercise program advances.
Rationale: Provides visual record of progress and positive reinforcement for efforts.
9. Suggest client identify an exercise buddy.
Rationale: Provides support and companionship, increasing likelihood of adherence to program.
10. Encourage involvement in social activities that are not centered on food—bike ride or nature hike, attending musical event, and group sporting activities.
Rationale: Provides opportunity for pleasure and relaxation not associated with food.
Possibly evidenced by
Physical deconditioning
Daily routine lacking in physical exercise
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Prescribed Activity
Verbalize understanding of importance of regular exercise to weight loss and general well-being.
Identify necessary precautions and safety concerns and self-monitoring techniques.
Formulate realistic exercise program with gradual increase in activity.
Nursing intervention with rationale:
1. Review necessity for and benefits of regular exercise.
Rationale: Exercise promotes weight loss by reducing appetite, increasing energy, toning muscles, and enhancing cardiac fitness and sense of well-being and accomplishment.
2. Determine current activity level and plan progressive exercise program tailored to the individual’s physical condition, goals, and choice.
Rationale: Commitment on the part of the client enables the setting of more realistic goals and adherence to the plan.
3. Identify perceived and actual barriers to exercise.
Rationale: Lack of resources, including proper apparel such as supportive shoes and comfortable clothing, a safe place to walk, or facility membership for water aerobics, reduces the likelihood of individual adhering to specific program. In addition, fear of discrimination or ridicule by others may limit client’s willingness to exercise in public.
4. Discuss appropriate warm-up exercises, cool-down activities, and specific techniques to avoid injury.
Rationale: Preventing muscle injuries allows client to stay active. Time spent recuperating from exercise-induced injuries may result in relapse to sedentary habits.
5. Determine optimal exercise heart rate. Demonstrate proper technique to monitor pulse and discuss signs and symptoms requiring modification of activity.
Rationale: Promotes safety as client exercises to tolerance, not peer pressure.
6. Identify alternatives to chosen activity program to accommodate weather, travel, and so forth.
Rationale: Promotes continuation of program.
7. Discuss use of mechanical devices or equipment for weight reduction.
Rationale: Fat loss occurs on a generalized overall basis, and there is no evidence that spot reducing or mechanical devices aid in weight loss in specific areas; however, specific types of exercise or equipment may be useful in toning specific body parts.
8. Recommend keeping a graph of activity as exercise program advances.
Rationale: Provides visual record of progress and positive reinforcement for efforts.
9. Suggest client identify an exercise buddy.
Rationale: Provides support and companionship, increasing likelihood of adherence to program.
10. Encourage involvement in social activities that are not centered on food—bike ride or nature hike, attending musical event, and group sporting activities.
Rationale: Provides opportunity for pleasure and relaxation not associated with food.
Imbalanced Nutrition: More than Body Requirements | NCP Obesity
Nursing diagnosis: imbalanced Nutrition: More than Body Requirements related to Food intake that exceeds body needs, Psychosocial factors, Socioeconomic status
Possibly evidenced by
Weight of 20% or more over optimum body weight; excess body fat by skinfold or other measurements
Reported or observed dysfunctional eating patterns, intake more than body requirements
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Diet
Identify inappropriate behaviors and consequences associated with overeating or weight gain.
Demonstrate appropriate change in lifestyle and behaviors, including eating patterns and food quantity and quality, and involvement in individual exercise program.
Nutritional Status
Display weight loss with optimal maintenance of health.
Nursing intervention with rationale:
1. Review individual cause for obesity—organic or nonorganic.
Rationale: Identifies and influences choice of some interventions.
2. Ascertain previous dieting history. Determine which diets and strategies have been used, results, and individual frustrations and factors interfering with success.
Rationale: Client may have tried multiple diets, with little lasting change in body weight and feel negatively about embarking on another plan.
3. Implement and review daily food diary, for example, total caloric intake, types and amounts of food, and eating habits and associated feelings.
Rationale: Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring change and a base on which to tailor the dietary program.
4. Determine client’s motivation for weight loss, for instance, health issues, own satisfaction, and to gain approval from others. Discuss client’s and SO’s view of self, including what being fat does for the client. Notice occurrence of negative feedback from SO(s).
Rationale: Helps to clarify client’s motivation and potential for success in weight reduction. Client’s family and cultural practices greatly influence client’s self-view regarding food and body image. Feedback from family may reveal control issues impacting motivation for change.
5. Formulate an eating plan with the client, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, as well as energy and nutrient requirements.
Rationale: An important factor in the success of any weight loss program is adherence to a sound nutritional plan. Although there is little basis for recommending one commercial diet plan over another, a good reducing diet should contain foods from all basic food groups, with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to client’s usual eating pattern as possible. A plan developed with and agreed to by the client is more likely to be successful.
6. Emphasize the importance of avoiding fad diets.
Rationale: Elimination of needed components can lead to metabolic imbalances; for example, excessive reduction of carbohydrates can lead to fatigue, headache, instability, weakness, and metabolic acidosis (ketosis), thus interfering with effectiveness of weight-loss program.
7. Discuss need to give self permission to include desired or craved food items in dietary plan.
Rationale: Denying self by excluding favorite foods results in a sense of deprivation and feelings of guilt and failure when individual “succumbs to temptation.” These feelings can sabotage weight loss.
8. Be alert to binge eating and develop strategies for dealing with these episodes, such as substituting other actions for eating.
Rationale: The client who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts.
9. Identify realistic incremental goals for weekly weight loss.
Rationale: Reasonable weight loss of 1 to 2 lb/week results in longer-lasting effects. Excessive or rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting “stair-step” goals.
10. Weigh periodically as individually indicated, and obtain appropriate body measurements.
Rationale: Provides information about effectiveness of therapeutic regimen and visual evidence of success of client’s efforts. During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.
Possibly evidenced by
Weight of 20% or more over optimum body weight; excess body fat by skinfold or other measurements
Reported or observed dysfunctional eating patterns, intake more than body requirements
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Diet
Identify inappropriate behaviors and consequences associated with overeating or weight gain.
Demonstrate appropriate change in lifestyle and behaviors, including eating patterns and food quantity and quality, and involvement in individual exercise program.
Nutritional Status
Display weight loss with optimal maintenance of health.
Nursing intervention with rationale:
1. Review individual cause for obesity—organic or nonorganic.
Rationale: Identifies and influences choice of some interventions.
2. Ascertain previous dieting history. Determine which diets and strategies have been used, results, and individual frustrations and factors interfering with success.
Rationale: Client may have tried multiple diets, with little lasting change in body weight and feel negatively about embarking on another plan.
3. Implement and review daily food diary, for example, total caloric intake, types and amounts of food, and eating habits and associated feelings.
Rationale: Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring change and a base on which to tailor the dietary program.
4. Determine client’s motivation for weight loss, for instance, health issues, own satisfaction, and to gain approval from others. Discuss client’s and SO’s view of self, including what being fat does for the client. Notice occurrence of negative feedback from SO(s).
Rationale: Helps to clarify client’s motivation and potential for success in weight reduction. Client’s family and cultural practices greatly influence client’s self-view regarding food and body image. Feedback from family may reveal control issues impacting motivation for change.
5. Formulate an eating plan with the client, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, as well as energy and nutrient requirements.
Rationale: An important factor in the success of any weight loss program is adherence to a sound nutritional plan. Although there is little basis for recommending one commercial diet plan over another, a good reducing diet should contain foods from all basic food groups, with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to client’s usual eating pattern as possible. A plan developed with and agreed to by the client is more likely to be successful.
6. Emphasize the importance of avoiding fad diets.
Rationale: Elimination of needed components can lead to metabolic imbalances; for example, excessive reduction of carbohydrates can lead to fatigue, headache, instability, weakness, and metabolic acidosis (ketosis), thus interfering with effectiveness of weight-loss program.
7. Discuss need to give self permission to include desired or craved food items in dietary plan.
Rationale: Denying self by excluding favorite foods results in a sense of deprivation and feelings of guilt and failure when individual “succumbs to temptation.” These feelings can sabotage weight loss.
8. Be alert to binge eating and develop strategies for dealing with these episodes, such as substituting other actions for eating.
Rationale: The client who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts.
9. Identify realistic incremental goals for weekly weight loss.
Rationale: Reasonable weight loss of 1 to 2 lb/week results in longer-lasting effects. Excessive or rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting “stair-step” goals.
10. Weigh periodically as individually indicated, and obtain appropriate body measurements.
Rationale: Provides information about effectiveness of therapeutic regimen and visual evidence of success of client’s efforts. During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.
Risk for Impaired Skin Integrity | Nursing Care Plan for Anorexia/Bulimia
Nursing diagnosis: risk for impaired Skin Integrity
Risk factors may include
Altered nutritional and metabolic state, edema
Dehydration, cachectic changes—skeletal prominence
Desired Outcomes/Evaluation Criteria—Client Will
Risk Control
Verbalize understanding of causative factors and absence of itching.
Identify and demonstrate behaviors to maintain soft, supple, intact skin.
Nursing intervention with rationale:
1. Observe for reddened, blanched, and excoriated areas.
Rationale: Indicators of increased risk of breakdown, requiring more intensive treatment.
2. Encourage bathing every other day instead of daily if this is an area of concern.
Rationale: Frequent baths contribute to dryness of the skin.
3. Use skin cream twice a day and after bathing.
Rationale: Lubricates skin and decreases itching.
4. Massage skin gently, especially over bony prominences.
Rationale: Improves circulation to the skin and enhances skin tone.
5. Discuss importance of frequent position changes and need for remaining active.
Rationale: Enhances circulation and perfusion to skin by preventing prolonged pressure on tissues.
6. Emphasize importance of adequate nutrition and fluid intake.
Rationale: Improved nutrition and hydration will improve skin condition.
Risk factors may include
Altered nutritional and metabolic state, edema
Dehydration, cachectic changes—skeletal prominence
Desired Outcomes/Evaluation Criteria—Client Will
Risk Control
Verbalize understanding of causative factors and absence of itching.
Identify and demonstrate behaviors to maintain soft, supple, intact skin.
Nursing intervention with rationale:
1. Observe for reddened, blanched, and excoriated areas.
Rationale: Indicators of increased risk of breakdown, requiring more intensive treatment.
2. Encourage bathing every other day instead of daily if this is an area of concern.
Rationale: Frequent baths contribute to dryness of the skin.
3. Use skin cream twice a day and after bathing.
Rationale: Lubricates skin and decreases itching.
4. Massage skin gently, especially over bony prominences.
Rationale: Improves circulation to the skin and enhances skin tone.
5. Discuss importance of frequent position changes and need for remaining active.
Rationale: Enhances circulation and perfusion to skin by preventing prolonged pressure on tissues.
6. Emphasize importance of adequate nutrition and fluid intake.
Rationale: Improved nutrition and hydration will improve skin condition.
Communicating with a Person with Alzheimer's Disease
Communicating with a Person with Alzheimer's Disease
Trying to communicate with a person who has Alzheimer's disease can be a challenge. Both understanding and being understood may be difficult.- Choose simple words and short sentences and use a gentle, calm tone of voice.
- Avoid talking to the person with Alzheimer's like a baby or talking about the person as if he or she weren't there.
- Minimize distractions and noise—such as the television or radio—to help the person focus on what you are saying.
- Make eye contact and call the person by name, making sure you have his or her attention before speaking.
- Allow enough time for a response. Be careful not to interrupt.
- If the person with Alzheimer's is struggling to find a word or communicate a thought, gently try to provide the word he or she is looking for.
- Try to frame questions and instructions in a positive way.
- Be open to the person's concerns, even if he or she is hard to understand.
Source : www.medicinenet.com
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