Pauline White Nursing Diagnosis, Rationale and Nursing Care Planning - Essay Example

Pauline white nursing diagnosis, rationale and nursing care plan Pauline white suffers from clinical depression that satisfies the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) (Ladwig, 1999). These depressive events are not subject to physical or mental disorder but may have relation with medical disorders (Ladwig, 1999). Etiology and pathology of depression is hypothesized by various theories that include psychoanalytic, cognitive, biochemical, genetic and socio-cultural but there exists no evidence of any theory that pinpoints the main cause (Kapoor, 1994). Rice (2006) indicates that depression affects women more than men. Elderly women are at a greater risk for depression secondary to medical conditions, cognitive distortions, lack of resources and side effects of commonly prescribed medication (Ladwig, 1999). The course of depression is characteristic of recurrence and remission (Kapoor, 1994). The Nursing diagnosis for Pauline is characterized by a major depressive disorder, severe with characteristic melancholic and atypical feature and portrays full remission, severe with and without psychotic feature secondary to catatonic feature (Fortinash and Hooliday-Worret, 1991). The two primary priority problems for Pauline white are risk of suicide and impaired social interaction (Orem, 1999; Rice, 2006:332). Pauline’s first rationale for nursing diagnosis and criteria subject to her impaired social interaction is based on the fact that Pauline White suffered depression episode after delivery of her daughter Mary therefore Pauline is subject to postpartum onset depression (Rice, 2006:334). Pauline has been experiencing full remission aspect of depression characterized by periodic occurrence of depression episodes for the past five years (Rice, 2006:331). Pauline exhibits psychotic feature characterized by inability to evaluate and make upright decisions regarding the effects of her actions as outlined by her failure to take care of her daughter Mary and to perform activities of daily living like attending to her work both at home and workplace and failing to keep appointments with the company psychologists (Rice, 2006:246). Pauline’s psychotic feature is concurrent to cognitive clinical signs impairment that have affected negatively her thinking faculties as illustrated by her husband’s “dissatisfaction on Pauline’s inability to plan for the future and her failure to keep appointments with the company psychologist (Rice, 2006:246). Pauline has characteristic melancholic feature portrayed by her withdrawal from activities of pleasure like sex, failure to eat food secondary to loss of appetite and failure to attend or take part in planning family outings (Ladwig, 1999). Pauline behavioral clinical signs provide a clear picture that she suffers clinical depression because of presence of catatonic feature that is a function of unusual behaviors like freaking and her difficulties to bond with other patients in the psychiatric unit (Rice, 2006:331). Pauline is very sensitive and tends personal that reinforces her unusual behavior and need to be alone in the psychiatric unit. Pauline clinical depression has been catalyzed by induced mood disorder that is a function of Pauline’s seasonal affective disorder (Kapoor, 1994). Pauline’s current elevated depression is primary to her admission with overdose of diazepam tablets that had been prescribed by her general practitioner (Rice, 2006:439). Pauline’s second rationale for nursing diagnosis and criteria subject to her risk of suicide is based on her potential to exhibits insomnia (Ladwig, 1999) by virtue of her inability to fall asleep and hypersomnia exhibited by Pauline’s long hours of sleep (Orem, 1999). Both insomnia and hypersomnia are indicators of Pauline’s state of loneliness that is secondary to Pauline’s affective clinical sign (Ladwig, 1999). Manifestation of affective diagnosis is portrayed by Pauline’s feelings of worthlessness that predisposes psychotic feature of clinical depression (Rice, 2006:440-443). By virtue of psychosis, Pauline requires supervised nursing care in order to prevent self harm or harming others (Rice, 2006:334-5). Manifestation of psychotic feature predisposed Pauline’s inability to make decisions regarding consequence of her actions as exhibited by her failure to turn up at her workplace for the past three weeks, her inability to keep appointments with the company secretary as well as failure to perform household duties (Orem, 1999). Her psychotic dominance has affected her cognitive abilities (Kapoor, 1994) and affected her social interaction exhibited by her tendencies to lie alone in her bed indicating her vulnerability to fatigue and loss of energy secondary to loss of appetite and interest in food (Rice, 2006). The Pauline’s continuity of care should be a product of collaboration between the nurse, Pauline white, her husband Rodney and community mental health provider. The continuity of care can either be fee-for-care-plan or prepaid care plan (Fortinash and Hooliday-Worret, 1991). The care plan should address the acute phase of clinical depression as well as maintenance phase (Ladwig, 1999). The family members, Pauline and the community mental health provider should stress on quality of care as a function of maintenance care (Fortinash and Hooliday-Worret, 1991). This should be guided by criteria for use of antidepressants medication and impacts of changing nursing care providers (Rice, 2006:169). Change of care provider has an effect of affecting care management and outcome measures (Fortinash and Hooliday-Worret, 1991). The cost effectiveness of the care should not be a function of cost of medication but be a function of economic value added by the care plan (Fortinash and Hooliday-Worret, 1991). Prepaid psychiatry care plan has a poor quality of care measured in terms of measurement of care outcome, orientation of medical counseling, use of tranquilizers, continuation of care provider and evaluation of functional outcomes (Rice, 2006). The nursing care should be based on quality of life improvement which is far cost effective although its direct costs are higher. The continuity of care should be a function of visit continuity and duration of the Pauline’s-care-provider relationship termed as longitudinal continuity (Fortinash and Hooliday-Worret, 1991). The continuity of care is affected by socio-economic factors, household income and level of education, health of Pauline and her insurance status (Fortinash and Hooliday-Worret, 1991). The nursing care collaboration with family members ensures respect for family members decisions are factored while focusing and identifying the needs of Pauline (Kapoor, 1994). The family members, Pauline and community mental care provider should understand information limits on confidentiality and kind of information that is protected under federal health laws. The continuity of care should identify a person who will be part of nursing plan of care during visits (Fortinash and Hooliday-Worret, 1991). If Rodney, her husband, should volunteer to perform the task, evaluation on the household financial status should be evaluated so that his inclusion does not negatively affect the household financial security. Use of a family member is more recommended as it is associated with higher levels of patient satisfaction (Fortinash and Hooliday-Worret, 1991). The family members who interact with Pauline should be provided information on how they may influence Pauline’s clinical depression and learn to live with her clinical depression illness (Fortinash and Hooliday-Worret, 1991). This will have an effect of preventing episodes of Pauline’s clinical depression relapse and would promote Pauline’s recovery as their support would positively affect Pauline’s response to education (Orem, 1999). The family members would also help Pauline to activities, hobbies and interests that would help in her recovery path (Ladwig, 1999). Through collaboration, the patient would be encouraged to respond to phone calls and get accustomed to getting out of bed and developing new tastes and preferences (Kapoor, 1994). Pauline would also be informed on impacts of suicide and be made to make a ‘no suicide’ or ‘no harm’ contract. Pauline would also be provided with a crisis or hot-line telephone numbers that she can call or page with any concerns (Fortinash and Hooliday-Worret, 1991). Pauline will also have opportunity to be referred to support groups and encouraged to take part in sessions of medical counseling both supervised initially and unsupervised after evaluation of Pauline’s improvement is made (Rice, 2006). The community mental healthcare provider would help in providing information resources on management of clinical depression and offer community support services that will offer Pauline an opportunity to take part in active social life (Fortinash and Hooliday-Worret, 1991). Through community mental healthcare providers, Pauline and her other family members would get opportunity to meet professional caregivers whose mission is to support, educate and advocate for those with clinical depression ill-health (Rice, 2006). Pauline’s recommended clinical depression interventions should be a function of management of both acute and maintenance phases of Pauline’s clinical depression requires multi-modal intervention approach. This is because specific medications do not always result into equivalent outcomes that are recommended for usual care settings as observed in clinical trials (Fortinash and Hooliday-Worret, 1991). Evaluation of the cost effectiveness should guide the process on intervention because it is of no benefit to compare efficacy of processes of care across systems of care as this would not add value and will not be a function of cost effectiveness or quality of life improvement (Rice, 2006). The intervention approach should be a derivative of four primary approaches namely; medical intervention, psychological intervention, behavioral intervention and dietary intervention (Orem, 1999). Medicinal intervention of Pauline requires adoption of psychotropic medication that involves use of anti-depressants and minor tranquilizers. The selection criteria should try to avoid medical disorders that predispose clinical depression (Orem, 1999). Psychological intervention of Pauline requires provision of psychodynamic oriented counseling. Behavioral intervention should strive towards changing current behavioral status that predispose Pauline’s nursing diagnosis of risk of suicide and impairment of her social interaction (Orem, 1999) Dietary intervention of Pauline strive for provision of a balanced diet to supplement nutrients and help to prevent possibility of protein energy malnutrition or specific nutrient deficiencies that can predispose deficiency diseases. The dietary formulation should ensure Pauline has no likelihood of developing adverse side reaction like allergies. The principle purpose should be to provide a nutritional therapy (Orem, 1999). Routine physical assessment of Pauline should be subject to functional ability assessments to identify any limitations that she may experience when ambulating, performing activities of daily living. There should be measures to ensure that Pauline demonstrates ability to ambulate, transfer or remove cloths (Orem, 1999). The prioritization and implementation of Pauline’s nursing intervention plan should also be a product of the proposed caregiver in conjunction with Pauline (Fortinash and Hooliday-Worret, 1991). Considerations should be made to ensure the Pauline’s household provides an environment to support safe delivery of home care rehabilitation (Kapoor, 1994). The intervention should also factor the number of days that Pauline will be in clinical, the quantity of clinical hours, the period of contact hours between Pauline and her nursing care giver (Rice, 2006). An outline of Pauline’s activities during clinical should be formulated and their supervision followed to the letter in order to improve Pauline’s thinking abilities and also improve Pauline’s ability to make decisions regarding consequences of her actions (Fortinash and Hooliday-Worret, 1991). Pauline’s motivational factors for self care should address clinical depression process, cognitive development, perceived healthcare needs, informed and active decisions making development, interpersonal perception of health, management of her belief system and management of her degree of autonomy (Fortinash and Hooliday-Worret, 1991). Pauline indicators of optimal health should attain physiological stability, interpersonal harmony, participation with the plan of care, competent and independent self care at home and satisfaction with nursing care plan and quality of life (Kapoor, 1994). Pauline’s education life line should be built on cognitive ability development, affective ability development and psychomotor learning development (Orem, 1999). Pauline case management strategy should be a function of assessment, implementing and coordinating nursing care plan between the patient and caregiver as well as multi-disciplinary team for instance the community mental healthcare providers, liaison for multi-service healthcare needs and control of quality of nursing care advanced to Pauline, management of sustainable leadership and teamwork to ensure visit continuity and longitudinal continuity is maintained, conformance with ethical considerations including adherence to professional standards of practice, adoption of a holistic caring approach where the patient is acknowledged for what she is and what she wants and promotion of Pauline’s aesthetic spiritual communication (Fortinash and Hooliday-Worret, 1991). Pauline should also undergo a battery of medical and psychological tests like physical examinations to measure her height, weight, confirmation of her heart rate, blood pressure and temperature, secondly, laboratory tests to determine Pauline’s complete blood count, screening for alcohol and drug use as well as check her thyroid function and thirdly Pauline should undergo periodic psychological evaluation to determine her level of clinical depression (Fortinash and Hooliday-Worret, 1991). Table 1: nursing diagnosis: Risk of violence management Patient outcome Nursing intervention with rationale used Evaluation and recommendations Pauline will not cause self-harm or harm others Pauline’s behavior to be observed during routine care Close observation and supervision required to protect self harm or harming others If Pauline remains safe and unharmed Pauline will refrain from suicidal threats or behavior By listening to Pauline’s suicidal statements Observing for Pauline’s non-verbal indication of suicidal intentions Ensuring Pauline has no verbal or behavioral indications of suicidal intentions By asking Pauline direct questions to investigate her possible suicide intention and how she may be planning to commit suicide and tools that she is likely to use If Pauline denies that she has any active suicide plans and intentions Table 2: nursing diagnosis Pauline coping subject to isolation behavior Patient outcome Nursing intervention with rationale used Evaluation and recommendations Pauline identifies positive coping strategies for instance planning a leisure time By building a relationship build on trust between Pauline and other caregivers By ensuring Pauline practices new skills in a safe therapeutic manner If Pauline expresses trust in the care-giver relationship Pauline develops ability to combine past coping methods with newly acquired coping strategies By praising Pauline for adaptive coping abilities By giving Pauline positive feedback If Pauline is able to discuss plans for future use from newly learned coping strategies Table 3: Nursing diagnosis: self-care deficiency (potential of grooming, dressing and feeding) associated with manic hyperactivity, concentrations and making decisions Patient outcome Nursing intervention with rationale used Evaluation for recommendations Pauline develops ability to dress appropriately for age and status By offering Pauline help in selecting clothing to provide room for appropriateness of dressing and hygiene to avoid her harassment If Pauline is able to dress appropriately and maintains a recommended standard of hygiene Pauline eats and drinks sufficiently to sustain fluid balance and right nutrition By encouraging and reminding Pauline to eat food and drink fluids by focusing her on needs of feeding and preventing dehydration and starvation If Pauline is able to eat food and drink fluids that are required to maintain physical health By providing Pauline with recognition and positive reinforcement for feeding and dressing By reinforcing Pauline’s appropriate behavior and enhancing her self-esteem If Pauline is able to eat food and drink fluids that are required to maintain physical health References Hooliday-Worret, K. N. (1991). Psychiatric Nursing Care Plans. Chaper 1; page 1. Kapoor, B. (1994). A Textbook for Psychiatric Nursing. chapter 5 , page 223-224. Ladwig, A. (1999). Nursing Diagnosis Handbook: A Guide for Planning Care. section 1:5. Orem, D. (1999). Nursing: Concepts and Practice. St Louis: Mosby. Rice, R. (2006). Home Care Nursing Practice: Concepts and Applications (Fourth edition ed.). Mosby. Read More