Betty Neuman’s system model
\n\u2022 Assessment \u2022 Nursing diagnosis \u2022 Outcome identification and planning \u2022 Implementation \u2022 Assessment Assessment
\nMr. Am is the patient’s first name.
\n2. 66 years old
\n3. Gender-male \u2022 4. Marital Status-married
\n5. Source of referral- referred from \u2014\u2014\u2014- medical college, \u2014\u2014\u2014-
\nClient-perceived stressors \u2022 (information gathered from the patient and his wife) \u2022 Major stressors or areas of health concern
\n\u2022 The patient was experiencing severe abdominal pain, nausea, vomiting, yellowish discoloration of the eye, palm, and urine, decreased appetite, and significant weight loss (8kg with in 4 months)
\n\u2022 One week ago, the patient was diagnosed with periampullary carcinoma.
\n\u2022 On March 27, 2008, the patient underwent Whipple’s procedure- pancreatoduodenectomy.
\n\u2022 He is psychologically disturbed about his disease condition, anticipating it as a potentially fatal condition. The patient is depressed and does not interact.
\n\u2022 The patient is troubled by the thought that he has become a burden to his children due to his numerous serious illnesses, which have forced them to stay with him in the hospital.
\n\u2022 The patient has pitting edema over the ankle region that worsens in the evening and is not relieved by elevating the affected extremities.
\n\u2022 He developed bph a few months ago (in January 2008) and underwent turp surgery on January 17. He still has some difficulty starting the flow of urine.
\n\u2022 The patient has had diabetes for 28 years and has been on H.insulin injections for the last four years (4u-0-0). It is exacerbating his health-related anxiety.
\nPatterns of living
\n\u2022 Patient is a retired school teacher \u2022 He cares for his wife and other family members \u2022 He lives with his son and his family \u2022 He is active in church \u2022 He attends community group meetings, such as local politics \u2022 He has a supportive spouse and family \u2022 He follows a mixed diet \u2022 He does not smoke or drink \u2022 He spends his leisure time reading the newspaper, watching television, and spending time with family members and relatives
\nHave you encountered a similar issue?
\n\u2022 Fatigue is comparable to that of previous hospitalization (following bph surgery) \u2022 Pain severity is comparable to that of previous surgery, i.e. Turp.
\n\u2022 Was disturbed psychologically during the previous surgery, i.e. Turp.
\nWhat helped him then was psychological support from family members, which helped him overcome the crisis situation.
\nFuture expectations \u2022 Concerns about a healthy and quick recovery
\n\u2022 Anticipation of changes in lifestyle and eating habits \u2022 Anticipation of the demands of a modified lifestyle \u2022 Anticipation of future follow-up needs
\nWhat is he doing to Help himself?
\n\u2022 Talking to his friends and relatives \u2022 Reading religious materials, such as the bible \u2022 Instilling positive thoughts, such as planning activities to resume after discharge, spending time with grandchildren, going to church, returning to social interactions, and so on \u2022 Avoiding negative thoughts, such as diverting attention away from the pain or difficulties, attempting to eliminate disturbing thoughts about the disease and surgery, and so on
\nWhat are others expected to do?
\n\u2022 Family members visiting the patient and spending time with him will greatly relieve his stress.
\n\u2022 Act in a friendly and accepting manner toward him.
\n\u2022 Family members will Help him in meeting his own personal needs to the greatest extent possible.
\n\u2022 Involve the patient in making decisions about his own care, treatment, and follow-up, for example.
\nStressors as seen by the caregiver
\nSignificant stressors
\n\u2022 Constant tiredness
\n\u2022 Significant weight loss (8 kg in 4 months) \u2022 History of bph and its treatment
\n\u2022 Persistence of urinary symptoms (difficulty starting a stream of urine) and lower extremity edema
\n\u2022 Chronic hypertensive disease for the past 28 years
\n\u2022 Suicidal ideas and negative thoughts
\n\u2022 Current circumstances that differ from the usual pattern of living
\n\u2022 Acute pain (the patient had pain before the surgery due to the underlying pathology, and pain is still present at the surgical site after the surgery) \u2022 Nausea and vomiting that was present before the surgery and is still present after the surgery
\n\u2022 Anticipatory anxiety about the disease’s recovery and prognosis \u2022 Negative thoughts about becoming a burden to his children \u2022 Anticipatory anxiety about the restrictions after the surgery and the lifestyle changes that must be followed
\nClients’ previous experience with similar situations
\n\u2022 The patient stated that the severity of his pain, nausea, fatigue, and other symptoms were similar to those experienced during his previous surgery. Checked with family members to confirm what they saw.
\n\u2022 Psychologically disturbed prior to surgery as well. (taken from the patient and double-checked with relatives)
\n\u2022 The client perceived the current disease condition to be far more severe than the previous condition. He believes it is a serious form of cancer with a poor prognosis. As a result, the patient is psychologically depressed.
\nFuture expectations
\n\u2022 The client is capable of handling the situation, but will require Helpance and encouragement to do so.
\n\u2022 He intends to return home and resume the activities he was engaged in prior to his hospitalization.
\n\u2022 He also considered future follow-up, such as chemotherapy continuation.
\nWhat can the client do to help himself?
\n\u2022 The patient is adjusting to the situation by using his own coping strategies.
\n\u2022 He devotes time to reading religious books and conversing with others.
\n\u2022 He is attempting to clarify his own doubts in order to remove doubts and instill hope.
\n\u2022 He establishes his main goal, which is a healthy and quick recovery.
\n\u2022 Expectations of family, friends, and caregivers by the client
\n\u2022 He considers health-care providers to be a source of information.
\n\u2022 He tries to think of them as important family members who can help him overcome stress. \u2022 He seeks both psychological and physical support from caregivers, friends, and family members.
\nImpression Assessment\/summary-
\n\u2022 There are no obvious discrepancies between the patients’ and caregivers’ perceptions.
\nIntrapersonal variables
\n1. Physical examination and research
\n\u2022 Height: 162 cm; Weight: 42 kg; Tpr: 37o C, 74 b\/m, 14 breaths per minute; Bp: 130\/78 mm Hg
\n\u2022 Eye- vision is normal, and the appearance of the eye on examination is normal. The conjunctiva appears pale. Students reacting to light.
\n\u2022 Normal appearance of the ears. There is no wax deposition. Pinna appears normal, and hearing ability is also normal.
\n\u2022 Respiratory system-normal respiratory rate, no abnormal sounds on auscultation The rate of respiration is 16 breaths per minute.
\n\u2022 Cardiovascular system- the heart rate is 76 beats per minute. On auscultation no abnormalities detected. Edema is present over the left ankle which is non pitting in nature.
\n\u2022 Git- patient has the complaints of reduced appetite, nausea; vomiting etc. Food intake is very less. Mouth- on examination is normal. Bowel sounds are reduced. Abdomen could not be palpated because of the presence of the surgical incision. Bowel habits are not regular after the hospitalization
\n\u2022 Extremities- range of motion of the extremities are normal. Edema is present over the left ankle which is non pitting in nature. Because of weakness and fatigue he is not able to walk with out support
\n\u2022 Integumentary system- extremities are mild yellowish in color. No cyanosis. Capillary refill is normal.
\n\u2022 Genitor urinary system- patient has difficulty in initiating the urine stream. No complaints of painful micturation or difficulty in passing urine.
\n\u2022 Self acre activities- perform some of his activities, for getting up from the bed he needs some other person\u2019s support. To walk also he needs a support. He do his personal care activities with the support from the others
\n\u2022 Immunizations- it is been told that he has taken the immunizations at the specific periods itself and he also had taken hepatitis immunization around 8 years back \\s\u2022 Sleep \u2013. He told that sleep is reduced because of the pain and other difficulties. Sleep is reduced after the hospitalization because of the noisy environment.
\n\u2022 Diet and nutrition- patient is taking mixed diet, but the food intake is less when compared to previous food intake because of the nausea and vomiting. Usually he takes food three times a day.
\n\u2022 Habits- patient does not have the habit of drinking or smoking.
\n\u2022 Other complaints- patient has the complaints of pain fatigue, loss of appetite, dizziness, difficulty in urination, etc…
\n2. Psycho- socio cultural \\s\u2022 Anxious about his condition \\s\u2022 Depressive mood
\n\u2022 Patient is a retired teacher and he is christian by religion.
\n\u2022 Studied up to ba
\n\u2022 Married and has 4 children(2sons and 2 daughters) \\s\u2022 Congenial home environment and good relationship with wife and children \\s\u2022 Is active in the social activities at his native place and also actively involves in the religious activities too.
\n\u2022 Good and congenial relationship with the neighbors \\s\u2022 Has some good and close friend at his place and he actively interact with them. They also very supportive to him
\n\u2022 Good social support system is present from the family as well as from the neighborhood
\n3. Developmental factors
\n\u2022 Patient confidently says that he had been worked for 32 years as a teacher and he was a very good teacher for students and was a good coworker for the friends.
\n\u2022 He told that he could manage the official and house hold activities very well \\s\u2022 He was very active after the retirement and once he go back also he will resume the activities
\n4. Spiritual belief system \\s\u2022 Patient is christian by religion \\s\u2022 He believes in got and used to go to church and also an active member in the religious activities.
\n\u2022 He has a personal bible and he used to read it min of 2 times a day and also whenever he is worried or tensed he used to pray or read bible.
\n\u2022 He has a good social support system present which helps him to keep his mind active.
\nInterpersonal factors
\n\u2022 Has supportive family and friends \\s\u2022 Good social interaction with others \\s\u2022 Good social support system is present \\s\u2022 Active in the agricultural works at home after the retirement \\s\u2022 Active in the religious activities.
\n\u2022 Good interpersonal relationship with wife and the children \\s\u2022 Good social adjustment present
\nExtrapersonal factors
\n\u2022 All the health care facilities are present at his place
\n\u2022 All communication facilities, travel and transport facilities etc are present at his own place.
\n\u2022 His house at a village which is not much far from the city and the facilities are available at the place.
\n\u2022 Financially they are stable and are able to meet the treatment expenses.
\nSummary
\n\u2022 Physiological- thin body built pallor of extremities, yellowish discoloration of the mucus membrane and sclera of eye. Nausea, vomiting, reduced appetite, reduced urinary out put. Diagnosed to have periampullary carcinoma.
\n\u2022 Psycho socio cultural factors- patient is anxious abut his condition. Depressive mood. Not interacting much with others. Good support system is present.
\n\u2022 Developmental \u2013no developmental abnormalities. Appropriate to the age.
\n\u2022 Spiritual- patient\u2019s belief system has a positive contribution to his recovery and adjustment.
\nClinical features
\n\u2022 Pain abdomen since 4 days \\s\u2022 Discoloration of urine \\s\u2022 Complaints of vomiting \\s\u2022 Fatigue \\s\u2022 Reduced appetite \\s\u2022 On and off fever \\s\u2022 Yellowish discoloration of eye, palms and nails \\s\u2022 Complaints of weight loss \\s\u2022 Edema over the left leg
\nInvestigations Values
\nHemoglobin(13-19g\/dl)
\n6.9 \\sHct (40-50%)
\n21.9 \\sWbc (4000-11000 cells\/cumm)
\n12200 \\sNeutrophil (40-75%)
\n77.2 \\sLymphocyte (25-45%)
\n10.5 \\sMonocyte (2-10%)
\n4.5 \\sEosinophil (0-10%)
\n2.6 \\sBasophil (0-2%)
\n.
\n2 \\sPlatelet (150000-400000 cells\/cumm)
\n345000 \\sEsr (0-10mm\/hr)
\n86 \\sRbs (60-150 mg\/dl)
\n148 \\sPus c\/s _ \\sUsg
\nUsg shows mild diffuse cell growth at the ampulla of vater which suggests peri ampullary carcinoma of grade I with out metastasis and gross spread.
\nUrea (8-35mg\/dl)
\n28 \\sCreatinine (0.6-1.6 mg\/dl)
\n1.8 \\sSodium (130-143 meq\/l)
\n136 \\sPotassium (3.5-5 meq\/l)
\n4 \\sPt (patient)(11.4-15.6 sec) (11.4-15.6 sec)
\n12.3 \\sAptt- patient (24- 32.4 sec) (24- 32.4 sec)
\n26.4 \\sBlood group A+
\nHiv
\nNegative \\sHcv
\nNegative \\sHbsag
\nNegative \\sUrine protein (negative) (negative)
\nNegative \\sUrine wbc (0-5 cells\/hpf)
\nNil \\sRbc (nil ) (nil )
\nNil<\/p>\n
Initial treatment<\/p>\n
Post operative period (immediate post op) (immediate post op)<\/p>\n
Patient got admitted to \u2014\u2014 medical college for 3 days and the symptoms not relieved. So they asked for discharge and came to \u2014-this hospital. There he was treated with:
\n\u2022 Inj tramazac iv sos
\n\u2022 Iv fluids \u2013 dns
\nTreatment at this hospital…
\nPre operative period
\n\u2022 Tab clovipas 75 mg 0-1-0 \\s\u2022 Tab monotrate 1-0-1 \\s\u2022 Tab metalor xl 1-0-0 \\s\u2022 Inj h insulin s\/c 6-0-6u \\s\u2022 Inj tramazac 50 mg iv q8h \\s\u2022 Inj emset 4 mg q8h \\s\u2022 Tab pantodac 40 mg 1-0-0 \\s\u2022 Cap beneficiale 0-1-0 \\s\u2022 Syp aristozyme 1-1-1
\n\u2022 k bind I sachet tid
\nSurgical management
\n\u2022 Patient underwent whipple\u2019s procedure (pancreato duodenectomy) \u2022 Inj pethedine 1mg sos
\n\u2022 Inj phenargan sos \\s\u2022 Inj pantodac 40 mg iv od \\s\u2022 Inj clexane 0.3 ml s\/c od \\s\u2022 Inj vorth p 40 mg im q12h \\s\u2022 Inj calcium gluconate 10 ml over 10 min \\s\u2022 Iv fluids \u2013 dns
\nLate post op period after 3 days of surgery) \\s\u2022 Inj h insulin s\/c 6-0-6u \\s\u2022 Tab pantodac 40 mg 1-0-0 \\s\u2022 Cap beneficiale 0-1-0 \\s\u2022 Tab clovipas 75 mg 0-1-0 \\s\u2022 Tab monotrate 1-0-1 \\s\u2022 Tab metalor xl 1-0-0
\nOther instructions
\n\u2022 incentive spirometry \\s\u2022 steam inhalation \\s\u2022 eearly ambulation \\s\u2022 diabetic diet<\/p>\n
Nursing process
\nI. Nursing diagnosis \\s\u2022 Acute pain related to the presence of surgical wound on abdomen secondary to periampullary carcinoma
\nDesired outcome\/goal : patient will get relief from pain as evidenced by a reduction in the pain scale score and verbalization.<\/p>\n
Nursing actions
\nPrimary prevention
\nSecondary prevention
\nTertiary prevention
\n\u2022 Assess severity of pain by using a pain scale
\n\u2022 Check the surgical site for any signs of infection or complications \\s\u2022 Support the areas with extra pillow to allow the normal alignment and to prevent strain \\s\u2022 Handle the area gently. Avoid unnecessary handling as this will affect the healing process
\n\u2022 Lean the area around the incision and do surgical dressing at the site of incision to prevent any form of infections
\n\u2022 Provide non-pharmacological measures for pain relief such as diversional activity which diverts the patients mind.
\n\u2022 Administer the pain medications as per the prescription by the pain clinics to relieve the severity of pain.
\n\u2022 Keep the patients body clean in order to avoid infection \u2022 Teach the patient about the relaxation techniques and make him to do it
\n\u2022 Encourage the patient to divert his mind from pain and to engage in pleasurable activities like taking with others
\n\u2022 Do not allow the patient to do strenuous activities. And explain to the patient why those activities are contraindicated.
\n\u2022 Involve the patient in making decisions about his own care and provide a positive psychological support
\n\u2022 Provide the primary preventive care when ever necessary.
\n\u2022 Educate the client about the importance of cleanliness and encourage him to maintain good personal hygiene.
\n\u2022 Involve the family members in the care of patient \\s\u2022 Encourage relatives to be with the client in order provide a psychological well being to patient .
\n\u2022 Educate the family members about the pain management measures.
\n\u2022 Provide the primary and secondary preventive measures to the client whenever necessary.<\/p>\n
Assessment \u2013 patient verbalized that the pain got reduced and the pain scale score also was zero. His facial expression also reveals that he got relief from pain.
\nIi. Nursing diagnosis
\nActivity intolerance related to fatigue secondary to pain at the surgery site, and dietary restrictions
\nOutcome\/ goals: client will develop appropriate levels of activity free from excess fatigue, as evidenced by normal vital signs & verbalized understanding of the benefits of gradual increase in activity & exercise.
\nNursing actions
\nPrimary prevention
\nSecondary prevention
\nTertiary prevention
\n\u2022 Adequately oxygenate the client \\s\u2022 Instruct the client to avoid the activities which causes extreme fatigue
\n\u2022 Provide the necessary articles near the patients bed side.
\n\u2022 Help the patient in early ambulation \\s\u2022 Monitor client\u2019s response to the activities in order to reduce discomforts.
\n\u2022 Provide nutritious diet to the client.
\n\u2022 Avoid psychological distress to the client. Tell the family members to be with him.
\n\u2022 Schedule rest periods because it helps to alleviate fatigue
\n\u2022 Instruct the client to avoid the activities which causes extreme fatigue.
\n\u2022 Advice the client to perform exercises to strengthen the extremities& promote activities \\s\u2022 Tell the client to avoid the activities such as straining at stool etc \\s\u2022 Teach the client about the importance of early ambulation and Help the patient in early ambulation \\s\u2022 Teach the mobility exercises appropriate for the patient to improve the circulation \u2022 Encourage the client to do the mobility exercises \\s\u2022 Tell the family members to provide nutritious diet in a frequent intervals
\n\u2022 Teach the patient and the family about the importance of psychological well being in recovery.
\n\u2022 Provide the primary and secondary level care if necessary.
\nAssessment \u2013 patient verbalized that his activity level improved. He is able to do some of his activities with Helpance. Fatigue relieved and patient looks much more active and interactive.
\nNursing diagnosis-iii
\nImpaired physical mobility related to presence of dressing, pain at the site of surgical incision
\nOutcomes\/goals: patient will have improved physical mobility as evidenced by walking with minimum support and doing the activities in limit.
\nNursing actions
\nPrimary prevention
\nSecondary prevention
\nTertiary prevention
\n\u2022 Provide active and passive exercises to all the extremities to improve the muscle tone and strength.
\n\u2022 Make the patient to perform the breathing exercises which will strengthen the respiratory muscle.
\n\u2022 Massage the upper and lower extremities which help to improve the circulation.
\n\u2022 Provide articles near to the patient and encourage doing activities within limits which promote a feeling of well being.
\n\u2022 Provide positive reinforcement for even a small improvement to increase the frequency of the desired activity.
\n\u2022 Teach the mobility exercises appropriate for the patient to improve the circulation and to prevent contractures
\n\u2022 Mobilize the patient and encourage him to do so whenever possible
\n\u2022 Motivate the client to involve in his own care activities \\s\u2022 Provide primary preventive measures whenever necessary \u2022 Educate and reeducate the client and family about the patients care and recovery
\n\u2022 Support the patient, and family towards the attainment of the goals \\s\u2022 Coordinate the care activities with the family members and other disciplines like physiotherapy.
\n\u2022 Teach the importance of psychological well being which influence indirectly the physical recovery
\n\u2022 Provide primary preventive measures whenever necessary
\nConclusion
\nThe neuman\u2019s system model when applied in nursing practice helped in identifying the interpersonal, intrapersonal and extra personal stressors of mr. Am from various aspects. This was helpful to provide care in a comprehensive manner. The application of this theory revealed how well the primary, secondary and tertiary prevention interventions could be used for solving the problems in the client.<\/p>\n","protected":false},"excerpt":{"rendered":"
Betty Neuman’s system model \u2022 Assessment \u2022 Nursing diagnosis \u2022 Outcome identification and planning \u2022 Implementation \u2022 Assessment Assessment Mr. Am is the patient’s first\u2026<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9443],"tags":[9456],"class_list":["post-115658","post","type-post","status-publish","format-standard","hentry","category-phd-dissertation-help-service","tag-betty-neumans-system-model"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/115658","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=115658"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/115658\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=115658"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=115658"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=115658"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}