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The following care plan will be based on a personal experience with a patient who was nursed in a private sector care home. This interaction took place during a practice placement in the care of the elderly area.

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Introduction

Introduction The following care plan will be based on a personal experience with a patient who was nursed in a private sector care home. This interaction took place during a practice placement in the care of the elderly area. The care plan will incorporate the Roper et al (1998) model of nursing based on the twelve activities of living which aims to prevent actual and/or potential complications or problems and to set expected outcomes or goals. The focus of this care plan will be the potential risk of pressure sores. Pressure area care is an excellent example of an area of nursing intervention that benefits from good use of assessment skills, care planning and thorough evaluation following implementation of interventions (Maylor & Roberts, 1999). Moreover, pressure sores pose a very significant threat to the health of compromised individuals. A threat that can be greatly minimised by preventative, therapeutic and assessment based interventions (Rycroft-Malone & McInnes, 2000). Introduction of subject patient. The particular patient was chosen as the subject of this assignment because the student carried out the initial assessment. During this preadmission assessment a good rapport was developed. This made for positive communication. Moreover, the patient had many different and complex needs. Having these different needs would illustrate the benefit and the importance of carrying out a structured and holistic assessment to create a total picture of an individual from which to plan care. Through discussion with the subject of this assignment and his sister we agreed the pseudonym Mr X. Confidentiality and privacy were assured and they were both made aware of the nature of the exercise and were quite happy to continue on that basis. ...read more.

Middle

Potential for compromised peri-anal hygiene due to loss of continence and reduced ability to independently attend to activities in this area. Potential for compromise of skin integrity due to loss continence. Personal cleansing and dressing: Mr X requires one to one support and assistance to carryout this activity. Close assistance required for cleansing and hygiene activities. Enjoys being assisted with a bath once or twice a week. A minimal amount of prompting required to help select garments for the day. Physical support and guidance required when putting on and taking off clothes. Actual/potential problems: Potential of injury due to fall whilst putting on clothes. Potential of loss of dignity and privacy whilst being assisted with this activity of living. Potential of loss of individuality due to potential loss of freedom to choose own clothes. Controlling body temperature: Temperature on admission was 36.4 Centigrade which was within normal limits (Heath, 2000). He was capable of adjusting his bed clothing to regulate his temperature in bed. During the day he was able to ask for a blankets or such like. He did not appear to have any problems with this area. The unit had climate/temperature control systems operating the heating, which tended to keep the home at a comfortable temperature. Actual/potential problem: Risk of overheating in bed. Risk of becoming too cold during the night. Risk of not being able to communicate his feeling too hot or cold during the day. Mobilisation: Mr X was dependent on one to one support to mobilise. Attempts to walk without assistance, frequently wandering and falling. ...read more.

Conclusion

Observe pressure area for changes, for example, redness. Assess skin integrity during personal cleansing and dressing assistance Assess risk to pressure areas daily using the Waterlow scale Rationale: Friction to the skin is increased with moisture such as sweat (Alexander et al, 2000). Non-blanchable erythema of intact skin is the first stage of classification of pressure sores (NHS On-Line 2003) Intervention Three Conclusion Summarising and on reflection the student realised that nurses are in a key position to make a difference when people are in their care. Facilitating processes to maximise an individual's quality of life. Central to increasing their and their family's satisfaction is the careful use of nursing assessment and care planning models. Roper, Logan and Tierney's model of nursing lends itself to this individualising process. Reflecting further, the process of carrying out the care plan emphasised to the student the importance of the nurse/patient relationship. This is no better illustrated by the fact that the student favoured using a subject with whom they had a good rapport. Future action based on this reflection may involve focusing on communication skills and rapport building as an integrated part of the care planning process. Dealing with pressure area care represents a challenge to nurses to become aware of the coping strategies, interventions and best practice available. Whilst remembering that these activities are only as effective as the assessments that underpin them. This challenge to nurses is emphasised further when one considers that on the whole the development of pressure sores is completely avoidable (Deeks, 1996). It is hoped it has been shown here that, with the proper use of nursing models, assessments and careplanning, the modern nurse is equipped with both the skills and the tools to meet that challenge. ...read more.

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