Running Head: NURSING PROCESS PAPER

Nursing Process Paper

Clayton Jensen
Professor Carrie Huntsman-Jones
NURS*408*01 East Midvale Elementary Clinical Site
October 3, 2014

NURSING PROCESS PAPER

2
Abstract

For a physician to be able to see into someones life in a matter of fifteen minutes or less
and be able to diagnosis them is not as easy at it seems. Often times we see this diagnosis as
enough in our society and we do what we can to resolve it, but in reality, there is much more
going on than that which is brought to the physicians attention. As much as this diagnosis is
needed from them, what is happening in their home setting is just as important and in just as
much need of care. This is where a nursing home health assessment is able to meet the many
needs of a family managing and possibly suffering from the care and management of a sick or
injured member.
The focus of this assessment is on the S family as a whole and more specifically how
five of the six children have Glycogen Storage Disease and the effect that has had on all of them.
As you can imagine this weighs heavily on the familys ability to not only provide but also create
an environment where everyone is safe and equally attended too.
The Functional health patterns will be used to conduct the assessment of the S family.
The Functional health pattern assessment provides the database for forming nursing diagnoses
and care plans to best help this family in their future endeavors and life management.

NURSING PROCESS PAPER

Pathophysiology:
Glycogen Storage Disease Type 6 (GSDVI)
According to the National Library of Medicine, Glycogen storage disease type VI (also
known as GSDVI or Hers disease) is an inherited disorder caused by an inability to break down a
complex sugar called glycogen in liver cells. A lack of glycogen breakdown interferes with the
normal function of the liver.
The signs and symptoms of GSDVI typically begin in infancy to early childhood. The
first sign is usually an enlarged liver (hepatomegaly). Affected individuals may also have low
blood sugar (hypoglycemia) or a buildup of lactic acid in the body (lactic acidosis) during
prolonged periods without food. The signs and symptoms of GSDVI tend to improve with age.
This condition is inherited in an autosomal recessive pattern, which means both copies of
the gene in each cell have mutations. The parents of an individual with an autosomal recessive
condition each carry one copy of the mutated gene. Although, they typically do not show signs
and symptoms of the condition but can.

HEALTH-PERCEPTION--HEALTH MANAGEMENT PATTERN

In the last few years the S family has gone through a lot, which is to be expected said
Mrs.S, living with and taking care of a family with 5 Glycogen Storage Disease type 6 (GSDVI)
children comes with the expectation of a number of hospital visits a year. Within just this
previous year she has taken her eight year old son to the hospital, for a few nights stay, a total of
9 times. They have also taken their eighteen-month-old daughter to the emergency room 3 times
within the past ten months. When I asked her about the previous years before this last year she
couldnt give me a definite answer because they visit the hospital so often with their children. In

NURSING PROCESS PAPER

asking her why her children visit the hospital so much she said the main reason for most of the
hospital visits is because of diet issues. As one can imagine managing one childs diet with
GSDVI would be difficult, let alone 5 children. She said the visits are usually due to the fact that
one of her children is vomiting and because of that he or shes blood sugar will drop and drop
fast until they are extremely hypoglycemic. This can also occur when a child acquires a stomach
virus or flu and maintenance of blood sugar is miscalculated. She said that does not happen often
anymore, due to her experience, but can happen very easily. I asked her how this affects not only
the child being taken to the hospital but also her and the rest of her family. She proceeded to tell
me how it is very difficult for the rest of the family just due to the stress of having a sibling so
sick that they need hospitalization. This also weighs heavily on Mr. S to be able to not only
provide financially but also manage the other children left at home.
The best way for them to avoid these situations is to avoid it all together with diet and
hygiene. In order to do so the children have a strict diet of little to no sugar and practice good
hand hygiene. As recommended by University of Florida Health Glycogen Storage Disease
Program:
In GSD types III, VI and IX, galactose and fructose can be converted in the body
to glucose. In small quantities, these sugars do not cause harm, but foods high in
sucrose and/or fructose should be avoided since it will lead to over storage of
glycogen. The increased glycogen formation can worsen hepatomegaly, and it
may contribute to increased damage of the muscles in the glycogen storage
diseases that also affect the muscle. In addition, simple sugars increase insulin
production which, in turn can cause a rapid fall in glucose concentrations and
hypoglycemia.
While management of ones sugars with GSDVI is important, it is also important to
combine that management with the right amounts of carbohydrates, proteins, calcium and
multivitamins for the maximum dietary benefit. Mrs. S has been told to provide 2 grams of

NURSING PROCESS PAPER

protein per kilo per day for each infant and roughly 1 gram of protein per kilo per day for each
child or to follow this graph:

Category
Infants
Children

Males

Females

University of Florida Health Glycogen Storage Disease Program

Age (yrs)
Grams of protein per kg body weight per day
0.0-0.5
2.2
0.5-1.0
1.6
1-3
1.2
4-6
1.1
7-10
1.0
11-14
1.0
15-18
0.9
>20
0.8
11-14
1.0
15-19
0.8
>20
0.8
(https://ufhealth.org)

She also provides a daily multivitamin and the correct amount of calcium recommended by her
physicians show in the graph below:
University of Florida Health Glycogen Storage Disease Program
Age
Amount (mg)/day
0-6 months
210
7-12 months
270
1-3 years
500
4-8 years
800
9-18 years
1300
19-50 years
1000
51 and older
1200
Pregnant/Lactating Women <18
1300
Pregnant/Lactating Women >18
1000
(https://ufhealth.org)
Adequate complex carbohydrate consumption is extremely important in all GSD patients
diets. A lack of sufficient carbohydrates can result in an increase in occurrences of
hypoglycemia. A lack of carbohydrates will also increase glycogen and/or fat breakdown leading
to increased ketone formation in the body.

NURSING PROCESS PAPER

Uncooked cornstarch serves as the best way to provide a carbohydrate for people who
suffer from GSDVI. This is because cornstarch is digested at a slower rate than other complex
carbohydrates and provides a slow steady amount of glucose that the body can handle without
the livers help. This creates a kind of pseudo-liver for these people since their livers can not
handle storing any excess sugar. For example:
A candy bar will provide the body with a boost of sugar obviously, but if the
sugar metabolism rate is exceeded the body will therefore store the precious
excess sugar in the liver for later use as glycogen. Well, this is not good for those
with GSDVI because they cant get rid of the sugars in their liver once they are
stored. By providing the cornstarch, the sugar acquired from its metabolism is at a
slow enough rate that the body can handle the sugar amount without ever needing
to store excess in the liver for later. This in turn prevents fatty liver and liver
damage in GSDVI suffers
The ratio that the S family uses for the cornstarch is 1 gram per kilo per dose. So in the case of
the 8 year old (A.S.) in the family who weighs 38 lbs. he would get around 17 grams per dose
per day 3 times a day. They would put that in about 6 oz. of water. They have also found that the
best brand of cornstarch to use is ARGO because it tends to have the most consistent breakdown
in comparison with all other brands. The way they take it is by mixing the ARGO cornstarch
with water and adding MIO drink-mix (no sugar added sweetener) for taste three times a day. As
you might have assumed when cornstarch mixes with water it thickens with time. So knowing
this they have to drink the mixture fast enough so that the mixture doesnt become a solid but
also slow enough so they dont get sick. Mrs. S mentioned that if her children do drink the
mixture too fast they will end up with a grainy diarrhea, which puts them in danger again for

NURSING PROCESS PAPER

hypoglycemia. So in the end they need the cornstarch to prevent hypoglycemia and fatty liver but
also they can get hypoglycemia from the cornstarch by drinking it to fast and causing vomiting
or diarrhea. Also it helps to drink the cornstarch mixture 30 minutes after eating, too soon will
also cause vomiting and ultimately hypoglycemia.
Now, you might ask, what about a baby? Are they going to drink the cornstarch too in
order to get that longer lasting, slower release of sugar in their system? No, they are not. In the
case of infants who are breastfeeding and are too young to eat the cornstarch, they have to be fed
every 2 to 3 hours no matter what. This is to keep them from getting hypoglycemic but also
preventing them from eating too much and damaging their liver. In other words, the life of a
parent with a GSDVI infant is not all that pleasant and is lacking in sleep and time for anything.
Another practice they have is to stay physically activity and healthy. Although there isnt
any research Mrs. S and her doctors know that it is theorized that exercise is beneficial, she still
makes sure her family gets it. She said that it seemed to help her kids feel better for the long run.
Of-course the right amount of sugars, carbs, proteins, etc. are calculated to provide the correct
amount needed for such activities.
No one in this family uses any tobacco products or alcohol. This is highly recommended
simply because if the children with GSDVI where to obtain the habit of drinking alcohol they
would no doubt go into liver failure and potentially die. Backing up these practices in their home
is that of their beliefs. Due to being a practicing LDS family they have not only health reasons to
not drink alcohol but also religious beliefs supporting that choice.
They participate in their recommended yearly vaccinations and screenings and have yet
to find any type of negative effect from this. If anything this is significantly helping them

NURSING PROCESS PAPER

because when one of the children that has GSDVI gets sick it isnt just something they will get
over without hospitalization and/or professional care.
Their insurance provider is Blue Cross Blue Shield and they feel quite satisfied with it
and the care they receive through it. In the past it was hard for them and their insurance to
identify if their insurance covered the management and treatment of their childrens GSDVI.
This is because of the rarity of this disease and due to that, their insurance company had to look
deeper into the policy to see if it was covered, which it was.
This is also another issue they ran into with the care of their children. All the doctors in
the state never heard of GSDVI or they had no idea how to treat it. She spoke of most of the
treatment recommended by her doctors was acquired from the Internet. This was extremely
difficult for the family and their first child. She said, not knowing what was wrong was terrible
but for the doctors to not know anything either was extremely disconcerting. They did end up
being able to put a finger on what type of disease their child had (GSD) but that also left them
with another dilemma, which type of GSD did their child have because each type is significantly
different as well as its treatment. When they had their first-born scanned for the first time they
found that his liver was the size of an adults at 7 months. When they really looked at his liver
they found that it appear to have little tumors inside it, but in fact that was actually the only
health part of the liver left. The rest of the liver was fat. Due to a lot of personal research and the
help of her doctors she was able to find a specialist on GSD that lives in Florida. This helped
tremendously to correctly diagnose the child but also relieve some of the stress of being in the
dark. He was also the first to mention the use of cornstarch and which kind is most effective.
With the extra insight from the specialist they were able to get their sons liver back to normal
through a special diet and its management.

NURSING PROCESS PAPER

Even with all the help they have gotten thus far there are still things that the family needs
more knowledge on and clarification. For one, the doctor they are working with mentioned that
they need to pay scrupulous attention to dental hygiene with these types of diseases. She didnt
know why but continued to do as they were told just in case. I said I would find out and let her
know. I have since called and confirmed that the dental hygiene is a means of preventing
infection. First and for most, it is very important that GSDVI patients can eat. If they cannot, due
to an oral infection, they will become hypoglycemic fast. Also once we get an infection the body
needs to utilize sugar for energy to fight the infection off which in turn could sends them into a
further hypoglycemic state than just not eating would.
At first glance you would not take this family for being a family that is dealing with
serious disease. Although, you also would not consider them the healthiest group of people
either. Both parents are severely over weight and their living situation is very cluttered and
messy. I dont know if I would use the description of a lack of sanitation but I would not like
to live or eat there. Despite this, the parents are the only two on prescription medication and
minimal amounts at that. The Mrs. S is taking Lisinopril for her high blood pressure and Mr. S is
taking Simvastatin for his cholesterol.

NURSING PROCESS PAPER

10

Family Genogram: Keep in mind the father does not have a strong relationship with his parents
so therefore he doesnt know much about them.

- Deceased
- Unknown

- Deceased
- Emphysema
- Breast caner

- HTN

- Breast
Cancer

- 65 yrs

- 64 yrs

- High
Cholesterol
- 41 yrs

- GSDVI
- 15 yrs

- GSDVI
Carrier
- 14 yrs

- GSDVI
-10 yrs

- HTN

-Rheumatoid
Arthritis
- HTN

39 yrs

- 41 yrs

- GSDVI

- GSDVI

- 8 yrs

- 3 yrs

- GSDVI
- 1 yrs

*Aunt is suspected to having GSD as well because Rheumatoid Arthritis is considered a

symptom of not treating GSD for a long period of time. *
Upon examination of their home I found that it was not a place that I would recommend a
person to raise children. It wasnt that the integrity of the home was falling apart but rather there
was so much clutter and trash everywhere that it was hard to find a place to sit, let alone live.
Also they did not appear to have a location where they could eat at a table because the table was
being used to hold things. As for their trash disposal and other waste disposal, they said that they

NURSING PROCESS PAPER

11

have no problem with that and their trash is picked up every Thursday. I asked the question to
see if I could get anyone to mention the trash throughout the house and why it wasnt in the
trash, but the topic was quickly changed as if they were ashamed by their living arrangements.
The children themselves look clean and well taken care of but the rest of the house was in
shambles. It was apparent that the parents of the home have a difficult time finding time outside
of taking care of their children to clean house. I asked her about this due to her embarrassment
and my curiosity and it was just that, she said she just doesnt have the time to do any one thing
without having to regulate something with her kids.
Potential nursing diagnoses:
Risk for Ineffective Relationship - Lack of personal time spent together between husband
and wife and even between parent and child due to there being so many with issues.
Risks for Chronic Low Self-Esteem Children have a life long disease.
Sedentary lifestyle AEB extremely messy home.
Risk-prone health behavior - Mothers diet consists of Pepsi and not much else.
Risk for Ineffective health maintenance Due to many health regulations that need to be
followed.
Risk for infection - During potential hypoglycemic states the immune system is
weakened.
Risk for sudden infant death syndrome Baby can go into hypoglycemia state very easily
and die from it.
Risk for contamination Due to filthy home.
Risk for poisoning Due to high carb high sugar foods being out for kids to eat and also
having dish detergent and cleaning supplies not put away in a safe locations.
Impaired comfort AEB the lack of places to sit and even walk.
Inadequate finances AEB mother saying they are always struggling to make ends meat.
NUTRITIONAL-METABOLIC PATTERN
Most of what is mentioned above will descriptively explain the familys nutritional
patterns due to the fact that the main issue of the family is that of the children and their GSDVI. I
did see that they had food in unusual places amongst the clutter through out the house. For
example: I saw a loaf of bread on top of the clutter all over the table, gummy snacks for the kids

NURSING PROCESS PAPER

12

on the fireplace mantel, and some kind of bread in the living room on the piano amongst other
things here and there.
On the flipside, she was very proud of the fact that her kids go through an average of six
to seven glasses a day of water. She spoke of its importance to their diet. Despite that, she knows
how good it is for them to be well hydrated. They didnt report any dental, skin, or healing
problems as well.
Potential nursing diagnoses:
Risk for Imbalanced nutrition: less than body requirements Not enough sugar consumed
results in hypoglycemia.
Risk for Imbalanced nutrition: more than body requirements Too much sugar consumed
results in fatty liver and death.
Unstable blood glucose level AEB livers inability to release glycogen when stored (aka:
hypoglycemia.
Impaired liver function AEB abnormal accumulation of sugar and fat in the liver
Readiness for enhanced fluid balance Mother knows the effect of staying hydrated for
her and her family especially those with GSDVI and wants to make sure everyone
benefits from it.
ELIMINATION PATTER
The family did not report any use of laxatives. They said if those with GSDVI really
needed to have a bowel movement all they would have to do would be to change one of the
many things in their already strict diet and that would mimic a laxative. They did not report any
constipation issues but diarrhea is something they look out for if one of the GSDVI kids does not
manage their diet properly as mentioned before.
Even though the family said there is not a problem with waste disposal I would beg to
differ. Yes, they might have all the resources to do so, but based off of the cluttered living
arrangements I would say they need to adopt a new practice in hygiene and cleanliness around
the home. They do have two dogs that live in the house as well (Chiwawas) and I would guess it
would be easy for those dogs to find a location to urinate or defecate without the family ever

NURSING PROCESS PAPER

13

knowing in that home. I am not trying to say that the dogs arent potty trained but that it would
be easily overlooked if one would have an accident in the home due to the present mess.
When I asked about potential insect or rodent problems they did mention ants and
roaches here and there but that was it. I would wager though that there is a lot more than they
think going on under all the clutter. If I were a pest, that would not only be an optimal location
for me to live but also the fact that food seemed to be everywhere it wasnt suppose to be would
provide me easy access to food as well.
Potential nursing diagnoses:
Risk for Diarrhea Drink Cornstarch too fast or too soon.
Risk for dysfunctional gastrointestinal motility High chance of diarrhea due to diet ill
management.

ACTIVITY-EXERCISE PATTERN
Like mentioned previously, the mother mentioned the importance of exercise in their
family. They said they all love to hike in the mountains and play sports. The sports of choice for
her and her children are soccer, softball, baseball, and swimming. She said her kids spend most
of their time outside playing while it is light out. Upon examination on her children, each showed
no sign of obesity our lack of nutrition. They looked as fit as children their age should be. As for
the mother she definitely falls into the obese category but from her description of what a day is
like for her she is by no means sitting around doing nothing. She is constantly on the move doing
something productive. So, if I had to say, her obesity probably is due to not only genetics but
also due to a high stress lifestyle, which would be hard to avoid in her scenario.
When they are not outside playing and have a moment to sit down, they enjoy watching
movies together or playing cards or a board game. Mrs. S said that usually the kids get a little
time at night to do just that before they have to go to bed for the next day but she rarely gets

NURSING PROCESS PAPER

14

around to taking a moment for herself. This posed an interest in getting her a chance to talk about
how she manages her stress and when she gets time for herself, if ever. (Discussed further in
COPING-STRESS-TOLERANCE PATTERN/VALUE-BELIEF PATTERN)
For their transportation they have a van and a sedan. Mr. S usually is driving the sedan
from work and back so that leaves the van for Mrs. S and her children. She said it recently has be
a great car as well for the sedan. In the past they have had to make repairs here and there for both
cars but noting extremely expensive. Like their home though, theirs cars were very cluttered and
messy and trying to talk about this with them was quickly avoided. As mentioned before it
seemed as though Mrs. S was quite embarrassed about her house and its cleanliness so
apparently there are some issues and sensitivity in the area. According to her houses integrity is
in good shape.
Potential nursing diagnoses:
Fatigue AEB mothers testimony of always needing Pepsi to keep her running.
Impaired home maintenance AEB filthy home
Readiness for enhanced self-care Mother wants to be able to find a way to take time for
herself while still adequately taking care of her family.
Self-neglect AEB mothers account of how her and her husband never have time for
anything else but their children.

SLEEP-REST PATTERN
This is an area that really needs some work in the family, especially for the mother. This
obviously will improve with time because the one year old will eventually be able to take the
cornstarch. So, currently the baby needs to be fed every two to three hours in order to keep
satiated as well as prevent any GSDVI issues that can occur due to too much food at a time. So,
since this is the job of the mother of the family you might guess that she is always lacking in
sleep. She said she might get something like four hours of sleep a night, more or less. This is not

NURSING PROCESS PAPER

15

only due to the feeding regime of her youngest but also get up in time to get her other children
off to school with a proper breakfast that is all calculated and a lunch that has the same values
met. This would include not only counting carbs and sugars but also measuring out the
cornstarch for each child for their morning does and lunchtime doses. They also test each childs
ketone levels with ketone strips and put together a calculated snack for school. She said
mornings are probably the most difficult time of day just because of the organized chaos
combined with her lack of sleep. She mentioned hoping she would get used to the lack of sleep
but she has yet to do so. The family does seem to find time to rest here and there but for the most
part there is always something to do.
Potential nursing diagnoses:
Sleep deprivation AEB feeding regime for the youngest child of feeding every 2 to 3
hours
Readiness for enhanced sleep Mother and father wish they could find a way to get more
sleep
Disturbed sleep pattern AEB getting up every 2 to 3 hours a night to feed baby.

COGNITIVE-PERCEPTUAL PATTERN
The family all seem to be well educated. The mother has a general associates and father a
bachelors in business. The mother mentioned that her kids do very well in school making As
and Bs. When I asked conceptual questions they had no trouble understanding the question and
giving me a straightforward answer. They only speak English so therefore that is what is spoken
in the home. None but the father wear glasses and everyones hearing is fully intact.
Potential nursing diagnoses:
Risk for compromised human dignity Familys lack of time to clean home for when
visitors might come and see it.
Risk for Disturbed body image Naturally larger genes in family, 14 (carrier) year old
girl is already worried about how she is gaining unwanted weight.

NURSING PROCESS PAPER

16

Stress overload AEB families inability to manage much else but their medical problems
therefore a lot of other things are neglected and create stress on the family.
Deficient knowledge AEB the lack of information on GSDVI we have. Very rare disease.
Readiness for enhanced knowledge Mother and childrens many questions about how
the body works and how better to manage their disease. I, of-course, didnt know the
answer because I am so unfamiliar with the disease and how to manage it.
Risk for depression Life long disease. Being different than everyone else. Lack of
attention from parents due to other siblings needing their attention more.
SELF-PERCEPTION--SELF-CONCEPT PATTERN/ROLE RELATIONSHIP PATTERN
When I asked Mrs. S about the general atmosphere in their home and if it was positive or
negative she hesitated a little bit. She then asked if I was talking about everyone or just her. She
said the general atmosphere of their home is a positive and family oriented one. As for herself,
she often times feels so overwhelmed that she gets pretty negative. She proceeded to say how
this is probably how it is in most homes and how she usually gets over it in a few hours. She said
for the most part everyone is happy including herself but at times she just needs time to collect
herself before she feels happy again.
She continued to explain that their never is any one thing that gets her in a bad mood but
just the build up of several days of little things that she has to fix. For example she mentioned
how her kids and even her husband will not put things back where they go, or when she finally
does get around to clean something it is quickly back to its original cluttered dirty state. In other
words, she does not get much help around the house, if anything those in the house are almost
playing against her. She feels that she cannot really complain to her husband because he works
so hard to keep them afloat and she feels her kids are too young to really make a difference. At
this point I interceded with my experience with doing specific chores every weekend around the
house before I could go play and I started around 8 years old. She took this to heart and said she
will try to start something like that with her older kids.

NURSING PROCESS PAPER

17

As mentioned, the father works a lot to keep things running in their home. She said that
he often times goes to work at 7am and comes home at 9 or 10pm. More often than not he just
goes strait to bed after eating something to start again the next day. They do get time on the
weekends though to spend time with each other and do family activities. It is something that Mr.
S looks forward to every week. He loves his children.
When I finally asked her to rate the general mood state of the family (nervous (5) or
relaxed (1)) she said that in the mornings it is a 4 and the rest of the day is a 2. This is due to all
the things that everyone needs to do in the mornings before school. The rest of the day is a 2
because she is still taking care of two children at the same time while trying to get things done
around the house. The general assertiveness of the family ((5) assertive (1) passive) is at about a
2 she said, which she thought as being healthy.
Through observation I found that Mrs. S is the one that really runs the house. She
mentioned that if the children get out of hand she is the one to discipline, but if that doesnt do
the trick Mr. S will put the kids in place. They dont believe in always exercising physical
discipline but at times it is called for and seems to be the only way to get through to her children.
She said this is a rare occasion when it happens but is does happen every once in a while.
Potential nursing diagnoses:
Caregiver role strain AEB mother and father never getting a moment to themselves and
from their testimony of having a lot of stress.
Risk for impaired parenting Due to the many things have to be managed like diet there
is a higher chance for the parents to either mess up or neglect something or someone
because of the many other things they have to do.
Risk for ineffective relationship - Lack of personal time spent together between husband
and wife and even between parent and child due to there being so many with issues.

NURSING PROCESS PAPER

18

SEXUALITY-REPRODUCTIVE PATTERN
The only thing that I felt was worth discussing and was appropriate in this section was
that of having more children or not. She was curtain that they are not going to have anymore
children but that is what they said before their youngest was conceived. She said that was not
planned but they are very happy she is with them. They do use birth control but she often times
forgets to take her pill which is how she thinks she got pregnant with her youngest. She claims to
be more thorough now about taking her pill.
Potential nursing diagnoses:
Risk for ineffective childbearing process Parents accidentally got pregnant with 6th
child and they havent really changed all that much to prevent getting pregnant again
other than mother will be more religious about taking birth control pills.

COPING-STRESS-TOLERANCE PATTERN/VALUE-BELIEF PATTERN

I live on Pepsi said Mrs. S when I asked her about her means of keeping up with
everything and managing her stress. She continued to say that the rest of the family is generally
relaxed. The children are always playing outside which is there way of getting the energy/stress
out. As for Mr. S, his time on the weekends with his family is his time to de-stress and relax. If a
problem ever arises they are quick to evaluate their options and also include prayer in their
decision. She said that their religion is a huge source of stress management in their home. They
are practicing LDS members. She did mention that at times this is also a stressor since she is the
chorister for the Primary, which just adds more to her workload, but she said it is well worth it in
the end. She said, I have excepted that my life as a mother of 6 children is going to be stressful.
My next step is to continuously figure out better and better ways to manage it. I agreed with her
that there will always be a better way to do something. Its just finding it and managing your
own stress whilst doing so that is hard.

NURSING PROCESS PAPER

19

Potential nursing diagnoses:

Risk for Anxiety Due to the overload or responsibility on the parents
Readiness for enhanced coping They are always looking for a better way to do
something.
Fear AEB mother expressing it about her children not receiving what they need and
potentially going to the hospital for it.
Risk for impaired religiosity Due to the difficulty of getting family to church and also
due to the added strain of having a calling in the church on top of the already stressful
life.
Risk for spiritual distress Mother said Why God thought it a good idea to do this to her
and her family with the GSDVI

OTHER CONCERNS (INDIVIDUAL OR FAMILY)

There was nothing else that she or her family members felt they needed to mention that
was not addressed in the previous sections.
FIVE NURSING DIAGNOSES AND WHY
The five nursing diagnoses that I felt were most important for the family to address and
work on are: risk for imbalanced nutrition, deficient knowledge, stress overload, risk for
poisoning, and impaired home maintenance. I chose these because I felt these where what needed
fixing the fastest. There are plenty of other diagnoses that need goals and interventions as well
but these were urgent. Risk for imbalanced nutrition interventions and goals are critical because
the main issue in the home is the care of those with GSDVI, which all has to do with diet.
Deficient knowledge interventions and goals are critical as well due to the severity of doing
something wrong with these GSDVI kids and their diets. Knowing more never hurt too. Stress
overload, due to the effects that stress can have on the people doing the caring and those being
taken care of. If you have an overly stressed caregiver the risk of that person making mistakes
are much higher and their personal health is also suffering. Just as important, those that are being
cared for that are severely stress wont progress and might even regress due to it. Risk for

NURSING PROCESS PAPER

20

poisoning might not be the most apparent diagnosis if this family was assessed on paper, but it is
definitely urgent for this family. Things like cleaning supplies need to be put in locations
inaccessible to the children in the home, but also due to the GSDVI children in the home having
high carbohydrate and high sugar foods out everywhere is just as dangerous. Lastly, the
diagnosis of impaired home maintenance needs attention too. If the home was clean, a lot of
these other issue they have, both on this list and not, would be solved. You need a safe
environment to raise a happy health family and I believe if these diagnoses where eliminated
they would have just that

Running Head: NURSING PROCESS PAPER

21

Subjective and
objective data that is
pertinent to the
nursing diagnosis.

Nursing Diagnosis
R/T & AEB or
AMB if applicable

Short and long term

measurable and realistic
patient goals & outcomes

Nursing interventions
Independent (Including all
assessments, treatments,
medications)

Subjective The
family saying that
they basically
walk a fine line
between eating
too much sugar
for their livers to
handle or not
eating enough and
running the risk
of hypoglycemia
(vomiting results
in hypoglycemia
too)

Risk for
Imbalanced
nutrition R/T
Excessive
intake in
relationship to
metabolic need
and Inability to
ingest or digest
food or absorb
nutrients
because of
biological,
psychological,
or economical
factors

Long term - Display

normalization of
laboratory values
and be free of signs
of malnutrition as
reflected in Defining
Characteristics by
the end of the
month.

1. Perform a nutritional
assessment.
2. Assess ability to read
food labels.
3. Assess ability to plan a
menu, making
appropriate food
selections.
4. Determine healthy body
weight for age and
height. Refer to dietitian
for complete nutrition
assessment if 10% under
healthy body weight or if
rapidly losing weight.
5. Discuss with the client
those aspects of their diet
that will remain
unchanged.
6. Negotiate with the client
regarding the aspects of
his or her diet that will
need to be modified.
7. Validate the client's
feelings regarding the
impact of current
lifestyle, finances, and
transportation on ability
to obtain nutritious food.
8. activity level/exercise
patterns of each family
member.

Objective
Seeing lollypops,
candy and other
forms of food that
would spike
blood sugar levels
all over the house
in unorthodox
locations.

Short term Verbalize

understanding of
causative factors
when known and
necessary
interventions by the
end of assessment.
Long term Demonstrate
behaviors, lifestyle
changes to regain
and/or maintain
appropriate blood
sugar levels by the
end of the month.

Documented rationale for your

interventions and references

Evaluation of goals:
achieved or
measurable changes

1. This should include types and

amount of foods eaten, how food
is prepared, the pattern of intake
(time of day, frequency, other
activities patient is engaged in
while eating)
(www1.us.elsevierhealth.com).
2. Food labels contain information
necessary in making appropriate
selections, but can be misleading
(www1.us.elsevierhealth.com).
3. Cultural or ethnic influences need
to be identified and addresse
(www1.us.elsevierhealth.com).
4. Establishing those that are at risk
will better help care taker develop
a plan to better to suit them
(www1.us.elsevierhealth.com).
5. Aspects of the client's life that are
meaningful and valuable to them
should be understood and
preserved without change
(Leininger, 1996).
6. Give and take with the client will
lead to culturally congruent care
(Leininger, 1996).
7. Validation lets the client know
that the nurse has heard and
understands what was said, and it
promotes the nurse-client
relationship (Leininger, 1996).

Long term goal

evaluation: Unable
to assess at this
time.
Short term goal
evaluation:
Achieved most
of the conversation
had between me
and the family was
about
understanding
causative factors
and interventions
of the risk for
imbalanced
nutrition.
Long term goal
evaluation: Unable
to assess at this
time.

NURSING PROCESS PAPER

22

Subjective and
objective data that is
pertinent to the nursing
diagnosis.

Nursing
Diagnosis R/T
& AEB or
AMB if
applicable

Short and long term

measurable and realistic
patient goals & outcomes

Nursing interventions
Independent (Including all
assessments, treatments,
medications)

Objective - Family not

only has dish detergent
and cleaning supplies
out everywhere but
also food that could
potentially do serious
damage if to much was
eaten by one of the
GSDVI patients.

Risk for
Poisoning
R/T
improper
storage of
household
hazardous
materials and
food.

Short term Put all

household hazardous
materials in a
designated and safe
place within 2 hours

1. Purchase baby proof

locks or knobs to
prevent access to
storage locations.
2. Designate specific
locations for hazardous
materials preferably to
locations higher than
what a child could get
to.
3. Get down on your
hands and knees and
crawl around your
house, noticing things
from your childs
vantage point.
4. Install emergency
phone numbers, such
as police, fire, poison
control, etc., at every
phone around the
house.
5. Note family members
age, gender,
socioeconomic status,
each persons
developmental,
decision making
abilities, level of
cognition and
competence.

Subjective none
A poison is any
substance that impairs
health or destroys life
when ingested,
inhaled, or absorbed
by the body. Any
substance can be
poisonous if too much
is taken. Sources in a
persons home include
drugs, medicines,
other solid and liquid
substances and gases
and vapors. Poisons
can impair the function
of every major organ
system. (Wilkinson &
Treas)

Short term Remove

food that would be
tempting for your
GSDVI children to eat
and potentially suffer
from within 2 hours.
Long term Baby
proof storage locations
for hazardous
materials with locks or
baby proof knobs by
the end of this week.
Long term Do not
place anything that is
not suppose to be
eaten anywhere for
more than 20 min
without putting it back
in a secure location for
the next month.

Documented rationale for your

interventions and references

(1,2) - Remember that when it

comes to childproofing a
home, more is better. Keeping
dangerous things up high is
good, but keeping dangerous
things up high inside a closet
with a childproof knob is
better.
(www.keepyourchildsafe.org).
3. It may help tip you off to
potential hazards that you
might not have otherwise
noted
(www.keepyourchildsafe.org).
4. By having fast access to
emergency numbers you will
reduce the time period
between accidents and help
arriving
(www.keepyourchildsafe.org).
5. These factors affect the
persons ability to protect
self/others and influence
choice of
interventions/teaching.
(Doenges, 2010, p.637)

Evaluation of goals:
achieved or
measurable changes

Short term goal

evaluation: Not
achieved As much as
I would have liked to
touch on this more
with the family during
our assessment we did
not tackle this goal in
the allotted time they
provided. If another
opportunity arises, this
will be a #1 priority.
Short term goal
evaluation: Not
achieved - As much as
I would have liked to
touch on this more
with the family during
our assessment we did
not tackle this goal in
the allotted time they
provided. If another
opportunity arises, this
will be a #1 priority.
Long term goal
evaluation: Unable to
assess at this time.
Long term goal
evaluation: Unable to
assess at this time.

NURSING PROCESS PAPER

Subjective and objective

data that is pertinent to
the nursing diagnosis.

Nursing Diagnosis
R/T & AEB or
AMB if applicable

Subjective - Me and my
husband have no time for
anything about our kids
and everything else that
needs to be done,

Stress overload RT work, family,

and personal
responsibilities
(multiple coexisting stressors)
AEB pt statements
We never get time
to relax, and We
are always worried
about our blood
sugar levels.

Objective - The stress on

the children to keep true
to their diets for fear of
damaging their liver or
becoming hypoglycemic
and having to visit the
hospital again.

23

Short and long

term measurable
and realistic patient
goals & outcomes
Short Term Family will review
the amounts and
types of stressors in
daily living in three
days and tell me
them via telephone.
Long term - Client
will reduce stress
levels through use
of relaxation
techniques and
other strategies by
the end of next
month (Halloween
- 10-31-14)
Short term - Report
negative effects
from stressors by
the end of
assessment.

Nursing interventions
Independent (Including
all assessments,
treatments, medications)

Documented rationale for your interventions

and references

1. Listen actively to 1. Having an opportunity to speak about

stressors is helpful in dealing with stress
descriptions of
overload. Listening engenders trust and
stressors and the
trust is the first step in the process of
stress response.
helping clients to reduce the psychological
2. Categorize
distress of stress overload (Ackley &
Ladwig, 2012, www.pterrywave.com).
stressors as
2.
Removing
or minimizing some stressors,
modifiable or
changing responses to stressors, and
nonmodifiable
modifying the long-term effects of stress are
3. Encourage social
all actions that can assist those with diabetes
support.
and stress (Ackley & Ladwig, 2012,
www.pterrywave.com).
4. Explore possible
3.
Stressors in highly valued roles affect
therapeutic
physical health only when there is
approaches such
insufficient emotional support from social
as cognitive
networks (Ackley & Ladwig, 2012,
behavior therapy,
www.pterrywave.com).
4. These types of therapies decrease the
biofeedback,
sympathetic nervous system response to
neurofeedback,
stress. Neurofeedback promotes optimum
pharmacologic
functioning of the central nervous system,
agents, and
induces relaxation, and supports healthy
complimentary
balance, flexibility, and resilience. Adults
who had experienced hospitalizations of at
and alternative
least 5 days said that spirituality
therapies.
strengthened their coping ability (Ackley &
5. Note each family
Ladwig, 2012, www.pterrywave.com).
members gender, 5. Women, children, young adults, and
age, and
divorced and separated persons tend to have
higher stress levels. Multiple stressors can
developmental
weaken the immune system and tax physical
level of
and emotional coming mechanisms in
functioning.
persons of any age, but particularly the very
young and elderly. (Doenges, 2010, p.805)

Evaluation of goals:
achieved or measurable
changes
Short term goal
evaluation: Achieved - I
was able to have each of
those there to talk about
what stressors are
present in their lives.
Those people that were
not there I have been
unable to assess.
Long term goal
evaluation: Unable to
assess at this time
Short term goal
evaluation: Achieved Along with the
description of each
stressor they have they
also explained the
negative effects those
stressors have on them.

NURSING PROCESS PAPER

24

Subjective and
objective data that
is pertinent to the
nursing diagnosis.

Nursing
Diagnosis R/T
& AEB or
AMB if
applicable

Short and long term

measurable and realistic
patient goals & outcomes

Objective
house was very
cluttered and
dirty. No where
to sit or place
anything

Impaired
home
maintenance
R/T family
with
medically
impaired
individuals
that need
management

Short term - The

family will identify
factors that restrict
self-care and home
management by the
end of the
assessment.

Subjective
Mother saying,
my house is
suck a mess. It
is so
embarrassing.

Short term - The

family will
demonstrate the
AEB
ability to perform
Outward
skills necessary for
expressions
the care of their
by individual home by the end of
or family of the week.
difficulty in
maintaining Long Term the home or Express satisfaction
in caring for with home by the
self or
end of the month.
family
members

Nursing interventions
Independent (Including all
assessments, treatments,
medications)

1. Assess home
environment, financial
resources, patients
knowledge about selfcare; and communication
patterns in the family
2. List obstacles to effective
home maintenance
management with patient
and family to develop
understanding of
potential and actual
health and safety hazards.
Being discussion at
patients level of comfort.
3. Discuss home
environment
4. Assist family members to
assign daily and weekly
responsibility for home
maintenance activities.
5. Assist family members to
contact community
agencies that can assist
them in their efforts to
improve home
maintenance
management.

Documented rationale for your

interventions and references

1. Assessment information will

assist in identifying
appropriate interventions there
after
(http://nandanursingdiagnosis.
org).
2. People, especially adults, learn
best where they have specific
needs to fulfill
(http://nandanursingdiagnosis.
org).
3. To determine ability to care
for self and to identify
potential health and safety
hazards. (Doenges, 2006,
p.294)
4. Having a schedule will
promote consistency in
following the plan of care
(http://nandanursingdiagnosis.
org).
5. Community resources can
lessen familys burden while
members learn to function
independently for the unit
(http://nandanursingdiagnosis.
org).

Evaluation of
goals: achieved or
measurable
changes
Short term goal
evaluation:
Achieved The
main factor that
restricted self-care
and home
management is the
care of those with
GSDVI.
Short term goal
evaluation:
Unable to assess
at this time.
Long term goal
evaluation:
Unable to assess
at this time.

NURSING PROCESS PAPER

25

Subjective and
objective data that is
pertinent to the
nursing diagnosis.

Nursing Diagnosis
R/T & AEB or
AMB if applicable

Short and long

term measurable
and realistic patient
goals & outcomes

Objective Lots of
facial expressions of
doubt in what was
being told to us by
family members.
Looking to one
another for
conformation that
what they said was
right. Lots of secondguessing.

Deficient
knowledge R/T
Unfamiliarity with
information
resources, rarity of
the disease, and
lack of time to
acquire it

Short term - All

1. Assess motivation and
family members
willingness of patient
will participate in
and caregivers to
learning process
learn.
during our
2. Assess ability to learn
assessment/teaching
or perform desired
opportunity.
health-related care.
3. Identify priority of
Short term learning needs within
Identify
the overall plan of
interferences to
care.
learning and
4. Question patient
specific action(s) to
regarding previous
deal with them
experience and health
during our
teaching.
assessment/teaching 5. Identify any existing
meeting.
misconceptions
regarding material to
be taught.
Short term 6. Determine familys
Verbalize
self-efficacy to learn
understanding of
and apply new
pathophysiological
knowledge.
condition/disease
7. Provide physical
process.
comfort for the
learner.
Long term - Initiate
8. Provide a quiet
necessary lifestyle
atmosphere without
changes and
interruption.
participate in self
9. Establish objectives
education about
and goals for learning
GSDVI by the end
at the beginning of the
of the month.
session.

Subjective Family
saying that they are
not sure or dont
know about some
things that have to do
with what the GSDVI
disease truly is on a
pathophysiological
level amongst other
levels of its
understanding.

Nursing interventions
Independent (Including
all assessments,
treatments, medications)

Documented rationale for your interventions and

references

1. People must see a need or purpose for learning.

Some people are ready to learn soon after they are
diagnosed; others cope better by denying or
delaying the need for instruction. Learning also
requires energy, which people may not be ready to
use. Persons also have a right to refuse educational
services (www1.us.elsevierhealth.com).
2. Cognitive impairments need to be identified so an
appropriate teaching plan can be designed.
3. People learn material that is important to them
(www1.us.elsevierhealth.com).
4. A whole family can bring many life experiences to
each learning session. Families learn best when
teaching builds on previous knowledge or
experience (www1.us.elsevierhealth.com).
5. This provides an important starting point in
education (www1.us.elsevierhealth.com).
6. Self-efficacy refers to one's confidence in their
ability to perform a behavior. A first step in
teaching may be to foster increased self-efficacy in
the learner's ability to learn the desired information
or skills (www1.us.elsevierhealth.com).
7. This allows patient to concentrate on what is being
discussed or demonstrated. According to Maslow's
theory, basic physiological needs must be
addressed before patient education
(www1.us.elsevierhealth.com).
8. This allows patient to concentrate more
completely (www1.us.elsevierhealth.com).
9. This allows learner to know what will be discussed
and expected during the session. Adults tend to
focus on here-and-now, problem-centered
education (www1.us.elsevierhealth.com).

Evaluation of goals:
achieved or
measurable changes

Short term goal

evaluation: Unable to
assess at this time.
This would be one of
the focuses of a
second encounter with
the whole family
present.
Short term goal
evaluation: Unable to
assess at this time.
This would be one of
the focuses of a
second encounter with
the whole family
present.
Short term goal
evaluation: Achieved
As we discussed the
disease in depth I was
able to explain a little
more than what they
already knew to help
clarify some
pathophysiology
processes of the
disease.
Long term goal
evaluations: Unable to
assess at this time.

Running Head: NURSING PROCESS PAPER

26

Work Cited
Ackley, B.J., & Ladwig, G.B. (2008). Nursing Diagnoses handbook: An evidence-based guide to
planning care (8th ed.). St. Louis, MI: Mosby Elsevier (www.pterrywave.com)
childproofing your home: safety tips and childproofing checklist. (n.d.). childproofing your
home: safety tips and childproofing checklist. Retrieved September 30, 2014, from
http://www.keepyourchildsafe.org/child-safety-book/home-childproofing-tips.html
Deglin, J. H., & Vallerand, A. H. (2009). Davis's drug guide for nurses (11th ed.). Philadelphia,
Penn.: F.A. Davis.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales. Philadelphia: F.A. Davis.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales. Philadelphia: F.A. Davis.
EHS: Nursing Diagnosis Care Plans, 4/e - Knowledge Deficit - Patient Teaching; Health
Education. (n.d.). <i>EHS: Nursing Diagnosis Care Plans, 4/e - Knowledge Deficit Patient Teaching; Health Education</i>. Retrieved September 29, 2014, from
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick34.ht
ml
Glycogen storage disease type VI. (n.d.). Genetics Home Reference. Retrieved September 28,
2014, from http://ghr.nlm.nih.gov/condition/glycogen-storage-disease-type-vi
Herdman, T. H. (2012). NANDA International nursing diagnoses: definitions & classification
2012-2014 ([Rev. ed.). Chichester, UK.: Wiley-Blackwell.
Leininger, M., & McFarland, M. (2002). <i>Transcultural nursing in the new millennium:
concepts, theories, research & practice</i> (3rd ed.). New York: McGraw-Hill.
LeMone, P. (2013). Medical-surgical nursing: critical thinking in patient care. (5th ed., Pearson
new international ed.). Upper Saddle River, N.J.: Pearson
Nursing diagnosis IMPAIRED HOME MAINTENANCE. (n.d.). Nursing Diagnosis for
Nurses and BSN students. Retrieved October 2, 2014, from
http://nandanursingdiagnosis.org/nursing-diagnosis-impaired-home-maintenance/
Nutrition Corner. (n.d.). UF Health, University of Florida Health. Retrieved September 28,
2014, from https://ufhealth.org/glycogen-storage-disease-program/nutritioncorner#carbohydrates
Taber's cyclopedic medical dictionary (Ed. 21 ed.). (2005). Philadelphia: F.A. Davis.

NURSING PROCESS PAPER

27

Stanhope, M., & Lancaster, J. (2011). Foundations of nursing in the community: communityoriented practice (eighth ed.). Maryland Heights, Missouri: Mosby.
Wilkinson, J. M., & Treas, L. A. (2011). Fundamentals of nursing (2nd ed.). Philadelphia: F.A.
Davis Co..