Within this essay I will be discussing the care needs of a chosen patient. I will be using the nursing process which I will talk briefly about at the start of my essay before going on to discuss my patients plan of care. I will begin by assessing my patient in relation to their care, discussing the plan of care I have chosen and how that care should be implemented. Towards the end I will have an evaluation debating if the plans made have been effective.
Mrs Jones is a 78 year old lady. In the last week she has been experiencing pain in her abdomen. She has not had her bowels open for the last 4 days. Mrs Jones has lost her appetite and as a result has not been eating or drinking as much as she would normally.
Mrs. Jones will be my chosen patient. For my assignment I will be planning her care in a hospital setting. I will be focusing on trying to relieve Mrs. Jones of constipation. It has been noted that she has not her bowels open for four days, and the NHS (2016) have noted that abdomen pain and loss of appetite are other symptoms of constipation. Therefor I have made the judgement that relief of constipation is Mrs. Jones main care need. This will be my focus throughout this essay.
The Nursing Process.
The nursing process is a systematic problem-solving approach used in nursing to identify, prevent and treat actual or potential health problems (Chabeli, 2007). After being developed in America it was introduced into the United Kingdom in the 1970’s. The nursing process has changed since the 70’s, being subsequently redefined and redeveloped to further help nurses look at patients as real people and not a medical label (Nazarko Linda 2008). The stages of this process are known as APIE (assess, plan, implement and evaluate). This involves nurses using their knowledge, skills, attitudes and values along with critical thinking and decision making while working with patients, familys, and multidisciplinary teams. The nursing process is beneficial for many reasons firstly it recognises the purpose of problem solving, it enables nurses to work closely with patients and families to create realistic goals for the future, and allows for creation, evaluation, and re-evaluation of procedures until a desired outcome is achieved (Nursing theory, 2018). I will be using the nursing process throughout my essay because it is patient cantered, evidence based, and allows to address specific needs thoroughly.
The first stage of the nursing process is the assessment stage. Haidar (2008), states that patient assessment is a systemic and continuous, validation, organisation and documentation of information. This information can be gathered in two ways. First being subjective data, which is collected through verbal communication with the patient or family members, and objective data is collected through tools, observations and examinations (Nursing Theory, 2018).
The assessment tool that should be used with Mrs. Jones is communication. Effective communication is central in compassionate care and provides opportunities to gain more information on a patient leading to a quicker diagnoses and more specified care plans. Below are examples of what should be asked when assessing Mrs. Jones.
Ms. Jones should be asked what is normal for her pattern of elimination, along with frequency and consistency. It might be useful to show her the Bristol stool chart to take away the embarrassment she may feel when describing her stool. It is important to know that according to The Healthy Bowl Guide by the NHS (2018) it is normal to open bowels from three times a day to three times a week.
The association of Coloproctology of Great Britain and Ireland (2008) has stated that people can become dependent on laxatives attempting to have daily bowl movements. This abuse causes harm. The colon becomes atonic, distended, and does not respond normally to the presence of stool. Some medications are also known for causing constipation. Querying any laxatives or medication that Mrs. Jones may be taking helps towards eliminating any causing factors.
Mrs. Jones has expressed she has not been eating or drinking as she normally would. She should be asked about her usual dietary habits, how long ago she lost her appetite and about her usual fluid intake.
Mobility should also be assessed to determine if Mrs. Jones will need any assistant getting to and from bathrooms and help distinguish any specific aids that need to be put into place for her specific needs.
Mrs. Jones vital signs should be taking to form a baseline. This is an example of objective data. Weighing Mrs. Jones will be useful to ensure she stays at a healthy weight and her weight is monitored throughout her stay.
The opportunity should be giving to Mrs. Jones to speak freely about any other information she may want known such as special dietary requirements, beliefs, and/or wishes. As nurses it is important to work in partnership with patients to deliver care effectively (NMC, The Code, 2015). By giving Mrs. Jones the opportunity to voice her wishes and concerns we are following our code of conduct and delivering patient centred care.
The second phase of the nursing process is planning. Ms. Jones and if she wishes her family members must always be involved in planning her care and be giving the option to make any suitable changes. The NHS (2017) have stated that patients should always be giving the power to manage their own care and make informed decisions about their care and treatment. Support should be available to improve their health and give them the best opportunity to lead the life they want.
In planning care for Mrs. Jones achievable outcomes will need to be made. These outcomes will focus on restoring and maintaining normal bowel movements, moving towards regaining Mrs. Jones appetite, sustain pain, while maintaining dignity and preventing any further risks such as malnutrition. The overall gaol of each plan is to work towards relieving her constipation. This should start with the following:
A plan for a dietician to review Ms. Jones should be put in place. It is important that Ms. Jones meals have been planned with foods she enjoys that are rich in fibre. A new diet can help prevent the risks of malnutrition along with her bowels as fibre bulks up stool, making it softer and easier to pass (British Nutrition Foundation, 2018).
In relation to her loss of appetite Mrs. Jones will be put on a fluid balance chart. Fluid balance charts show a balance of the input and output of fluids within the body (Welch, 2010). It’s essential to patients care and can be completed by any health care professional. This will help ensure Mrs. Jones fluid levels are adequate, which in turn will again help her bowels.
Ms. Jones has expressed that she has been experiencing abdominal pain, her pain needs to be monitored and controlled. Controlling her pain will help towards making her feel relaxed and comfortable while improving her sense of wellbeing. As a patient she must be giving the choice for pain relief and a decision between her doctor, nurse and Ms. Jones herself must be agreed upon for a suitable pain relief.
A prescription of laxatives will also be nessessary. Laxatives are a type of medicine that help empty bowels, there main use is for constipation, they should be taking until the constipation has eased and the patient is able to pass soft stools (NHS 2016). The nurse should consult with Ms. Jones to find out if she has a preferred laxative, and gain permission to consult with a doctor to get a suitable laxative.
The implementing phase is where the plan of care specific to each patient is put into practice. Before the plan starts everyone involved in the planning of care including Mrs. Jones should be happy and agreed upon.
In implementing the care plan for Mrs. Jones she will be encouraged every morning and if needed she will be assisted to try open her bowels by using the bathroom. The NHS recommend a toileting routine such as in the mornings when using the bathroom, she should rest her feet on a low stool and if possible raise her knees (2017). This will encourage possible bowel movements. Her dignity and privacy must always be respected as toileting can be a very private factor of life.
As it has been planned for Mrs. Jones to see a dietician, afterwards she should be asked if she is entirely happy with the advice that has been giving, at meals times it is important to encourage her to try her meals. Encouragement should happen regularly even when her appetite has returned. It should also be documented in her care plan if she has eaten or has not eaten. (The Christie, NHS Foundation Trust 2017) states that protected meal times allow patients to eat their meals in a calm environment without interruption, while allowing nursing staff to monitor and assist patients if needed, this will be a beneficial factor is helping Mrs. Jones gain her appetite back.
Mrs. Jones has also been put on a fluid balance chart, at the protected meal times it can give the nurses opportunities to complete these as it is vitally important that these charts are constantly being updated. Accuracy in recording fluid intake and output is required for the overall management of patients and can correct the prescribing of intravenous and subcutaneous fluids (Western Health Care and Social Trust, 2008).
In the planning stage Mrs. Jones care she will have received information about the pain relief prescribed. She will have been giving risks, side effects and other relevant information. This information must be giving as it is in within the patients rights (NHS Treatment:Your rights, 2016). These rights have also stated that patients are allowed to refuse any treatments if they request. The goal has been set to keep her pain levels at an acceptable level, therefor weather she wants or does not want pain relief her choice should be respected but she still be giving the choice. If she accepts/denies pain relief this should be documented. The same rules apply for her prescribed laxatives. Within the nurses code of conduct (2015) it also states that nurses should respect, support and document a persons right to accept or refuse care or treatment.
To finalise the nursing process an evaluation must be completed. This determines if the goals for a patient’s wellness have been met and if the desired outcomes have been achieved.
When evaluating Mrs. Jones she will be advised to continue toilet training until her bowel movments have become regular. Arrangements for her to have a low stool available in her home should be made. Mrs. Jones could also be advised to keep a stool diary until her bowels movements return to what is normal for her.
The Bristol Stool chart should be used to assess what type Mrs. Jones stool is, this should be used each time she has eliminated stool to track if her stools are returning to normal again.
Mrs.Jones has been monitored and a meal plan has been put into place to ensure she is getting the correct amount of nutrients, minerals and fibre that is needed to suit her body. Taking Mrs. Jones age into consideration it was important to ensure she was not at risk of malnutrition, this will also benefit in helping her to open her bowels and keep her generally healthy. The overall goal nutrition wise was to regain her appetite again and by following the care plan this goal should be achieved. On release Mrs. Jones will be giving adequate information on how to keep her diet correct and plans can be made with family members in helping to ensure this.
Mrs. Jones also needed to increase her intake of fluids. Regular visits to her bed side ensured that she always had water available and was offered any preferable drink. It is a basic human right for patient to have fluid available. Any fluid intake has been documented on her fluid chart. Bennett (2010) says that fluid intake recording is notorious for being inadequately or incorrectly completed but the Nursing and Midwifery Council (2007) recognises its importance and states that record keeping is an intergral part of nursing, and not something that should be completed when circumstances allow. This gaol should will have been achieved because it is within a nurses role to ensure it is completed correctly.
As for pain management, the goal for Mrs. Jones was to ensrue her pain levels were low and she was not feeling any discomfort. If Mrs. Jones is happy with her pain management then the plan should be continued and she can be prescribed pain relief for her discharge if needed. If Mrs. Jones is still in pain a review will need to be done and a new method will be put into place.
In conclusion the nursing process is a series of actions promoting a patient centred, systemic and gaol centred system (Chitty and Black, 2011). It highlights the importance of involving patients in their care by giving them power to manage their own health, make informed decisions about their care and treatments, while providing support to help improve a patients health an give them the best opportunity to lead the life they want (NHS England 2015). The nursing process that will not work without the collaboration of nurses, patients, familys, and multidisciplinary teams which is why it is a ‘holistic’ plan of care because it gives the opportunity to provide the best care possible that everyone involved is happy with. Throughout the nursing process it is most important to take the patient into consideration. Constipation can be unpleasant and distressing leading to reduced patient comfort and diminished quality of life (Glia and Lindberg, 1997) therefor Mrs. Jones should be kept comfortable and her dignity must be maintained in all aspects of her care. Mrs. Jones care plan has been designed to meet her specific needs and this must be remembered at all times to ensure she has a positive patient experience and her goals are achieved as desired.
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