Mrs. Smith is a retired 62 year old lady, who lives with her husband. She has been married for almost forty years and has two sons who both live abroad. She has enjoyed a long career with a well known Market Research Company as a mentor to both new and experienced interviewers, a position that enabled her to travel around most of the country. Unfortunately due to a road traffic accident two years ago in which she suffered a broken arm, whip lash and injured her knee rather seriously, she also sustained a head injury which resulted in epilepsy.
Mrs. Smith used to be a keen gardener and line dancer, but due to her health problems she has not enjoyed these activities in recent months. Her husband took a keen interest in his wife’s care and was a good source of past information regarding the health of his wife. Whilst in a seizure Mrs. Smith had a bad fall at home in the garden, which necessitated her initial admission to hospital. She fell awkwardly down some steps leading towards the patio, striking her already injured knee, leaving herself in considerable pain.
Contribution of Nursing Care Plans
There are various models which are useful in the formulation of care plans, for example the Roper, Logan and Tierney’s twelve activities of daily living, (Roper et al, 1998). This is especially helpful because it provides a framework and logical structure for nursing assessment.
The author feels that this is an appropriate model for Mrs. Smith. The reason for this is that it is possible to get a more in-depth understanding of Mrs. Smith as an individual and identify her needs. This model advocates understanding the needs of individuals, through a detailed assessment of their physical abilities (Aggleton and Chalmers, 2000). The model also provides recognition of the nurse’s role in that it is different to that provided by the doctors and other health care professionals, because the model promotes a holistic view.
Care plans are an effective form of communication between ward staff, hospitals and the community, and need to be accurate regarding patient details and treatment (Walsh, 1997). A care plan is a means used to record the progress to smooth the process of communication between care givers and to ensure continuity of care. The care plan should be dictated by the needs of the individuals and the setting in which it is used. A care plan involves nurses to realistically assess and identify patient’s problems, involving the patient in setting goals and outcomes, (Gordon 1994).
Some models focus on the nurse striving to help the patient or client to care for him or herself. The nurse concentrates on helping patients to do things for themselves as they progress rather than doing everything for them, a principle known as self care (Orem, et al. 2001), so more then one model could be used to produce a comprehensive care plan. Care plans look not only at the aspects of
daily care within the hospital setting but also at the continuation of care in the community. (Cavanagh, 1991).
Discuss TWO problems that are a priority and identify goals that are achievable for those problems.
Problem: Patient has a painful knee
Short Term Goal:
A realistic care plan will be implemented, addressing her daily needs, and alleviating pain with the knee with analgesic therapy, including medication.
Intermediate Goals
Mrs. Smith will begin leg exercises, ice packs will be given when needed. Regular visits from the physiotherapist’s will be required, addressing her mobility problems.
Long Term Goals
Patient will be able to walk with sticks and maintain her proper body weight (Gulanick, M. 2002). Mrs. Smith should be able to return home under the care of the district nurse for knee dressings and to remove the staples.
Problem: Patients ability to cope with diagnosis
Short Term Goals
The short-term goal will be to monitor Mrs. Smith’s seizures and to take a clearly documented medical history from her which may speed up the introduction of a successful course of treatment, Mrs. Smith will need to see an epilepsy liaison nurse to help her understand and accept her epilepsy.
Intermediate Goals
Mrs. Smith’s intermediate goals will be to have regular monitoring of anti-epileptic medication which is necessary to ensure good control over seizures. Mrs. Smith will be able to discuss her fears regarding her diagnosis.
Long Term Goals
The long term-goals will be to prevent Mrs. Smith’s seizures from reoccurring. The patient will inform family/friends of her epilepsy, so they can come to terms with her condition. The patient needs to understand about her epilepsy. She needs to be aware whether she gets a warning or an aura before a seizure occurs. Patient needs to be assessed whether she is ready to learn about her epilepsy, which she comes across as not being aware of the seriousness and implications of her condition
Discuss the nursing intervention required for one of the two problems, providing rationale and supporting references
A nursing intervention is any direct care treatment that a nurse performs on behalf of a client (Gordon, 1998). The detection and diagnosis of epilepsy relies heavily on the witness account of a seizure rather than tests, so it is not surprising that up to 20% of people referred for epilepsy do not have it. (Shorvon, et al 2000). When taking a history, it is crucial to ask the patient about any drugs currently being taken and whether these are prescribed, over-the-counter or recreational. (Wehrle, E. 2003).
A patient with new onset of seizures such as Mrs. Smith will require hospitalisation for diagnosis and initiation of treatment. Follow up care is in the out-patients setting. (Gulanick et al 2003). Patient will be referred to a Neuro-consultant. The patient will change her medication to a drug that is more suitable to her type of seizures. An EEG and possibly an MRI scan would be advisable to find out where in the brain the epileptic activity is coming from. Her condition indicates she may have Temporal Lobe Epilepsy.
A nurse’s role is to make sure that the patient does not forget to take their medication which can lead to loss of control and even status epilepticus seizures, this is not only life threatening but may result in an overall deterioration in health. (Duncan et al 1995).
Patient will be able to return home with her epilepsy under control and enable her to some quality of life. Patient will have support in coming to terms with her epilepsy. An address of a local support group will be given as this may help her deal with any emotional or social problems. The BEA (British Epilepsy Association) will also be available for expert help and guidance if required. A
regular visit to see the consultant will be arranged, as she will require careful monitoring of her condition with possible adjustments to her medication as she gets older.
A nurse will arrange for an epilepsy liaison nurse to visit Mrs. Smith at her home and spend time with both herself and her husband, providing them with information on all aspects of her condition, discussing issues they wish to raise. Mrs. Smith’s family will come more proficient at managing her seizures, and their confidence will increase with their ability to support their mother/wife to live a full and active life.
Summative Evaluation
Tuesday 16th August 2005, 10.30 am
Goals were achieved within the time span set. Patient will be for discharge home today. Ambulance booked for 1.30pm. Family informed of discharge. Patient is aware of her limitations, alcohol/driving. Medication explained to the patient and her husband. Letter has been written for her epilepsy liaison nurse and GP. An appointment has been made for her to see the Neurological Consultant. Appointment card has been given to patient.
Anxieties have been spoken about with patient; leaflets on epilepsy and information about the BEA (British Epilepsy Association) have been discussed.
Appendix
- Word Processing package used, Microsoft Word
- Font used, Arial
- Font size 12
References
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Cavanagh, S. (1991) The Orem Model in Action Series. London, Palgrave
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Gordon, M. (1994) Nursing Diagnosis, Process and Application. Missouei, Mosby.
Gordon, M. (1998) Nursing nomenclature and classification system development. On-line Journal of Issues in Nursing (on-line). Available:
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Nursing & Midwifery Council (2002) Code of Professional Conduct Nursing & Midwifery Council April 2002
Orem, D. E. Taylor, S. G. & Renpenning, K. (2001). Nursing Concepts of practice (6th ed). St. Louis, MO: Mosby
Roper, N. Logan, W. and Tierney, A. J. (1998). The Elements of Nursing Based on a Model of Living. (4th ed) Edinburgh: Churchill Livingstone.
Russell, A., Wehrle, E. (1998) What is epilepsy? In: Health Care Assistant’s guide to Epilepsy. London: Unison.
Shorvon, S. (2000) Definitions and classification. In: Handbook of Epilepsy Treatment, Blackwell Science.
Walsh, M. (1997) Models and Critical Pathways in Clinical Nursing (Conceptual Frameworks for Care Planning). London, Baillere Tindall.
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Nursing Times, May Vol. 99, No. 20, Available: