Professional Documents
Culture Documents
illness. I will use the Marjory Gordon’s health assessment tool for the
discharge plan will also be develop for the client needs and a discussion
I will also list the clients medication regime and identify six medications in
detail regarding the dosage, side effects and rationale. Two of these six
tool.
the client’s details to ensure his privacy and protection. I will refer to him
left hip. Mr Jack is well known to the medical services as he has had
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Student ID: 20600910
Mr Jack presented as fatigue, with shortness of breath (SOB). His balance
was notably poor due to his recent surgical hemiarthroplasty on his left hip
two nurses. Mr Jack complains of dizziness and pain on his left hip due to
with graft and a vascular ulcer on the left shin. Mr Jack has had previous
multiple infarcts in the posterior circulation of the brain, had cervical spine
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Student ID: 20600910
Marjory Gordon Health Assessment
has prescribed this to him. He states throughout his life he has always
taken Samoan herbal medicines as he feels this helps with ‘cleansing his
system’ and makes his body feel stronger. Mr Jack started smoking at the
age of 15 years and has recently stopped smoking in the last three months.
although in the but he was a regular consume of this substance perhaps 3-4
times a fortnight. He visits his local GP for follow-up of his blood pressure
has had 4-5 colds in the last year. up. Mr Jack feels his current admission
to over exert himself but tends to forget about his medical condition stating
“the mind is willing but the body is weak”. He would like to leave the
rehabilitation ward and gain his independence around his mobility again.
Nutritional/Metabolic Pattern:
Mr Jack enjoys his traditional Samoan meals such as taro, green bananas,
vegetables, fruit. He eats at least three main meals a day, breakfast, lunch
and dinner, and would usually have a snack in between if feeling hungry.
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Student ID: 20600910
He enjoys drinking 4-5 hot beverages during the day. Mr Jack prefers to
drink water rather then fizzy drinks. His fluid intake is approximately
thin fluids. Mr Jack usually has no problems with skin integrity, however
reported a shin ulcer which was slow to heal a few years ago. He has no
Elimination Pattern:
Mr Jack would pass urine at least five times daily, in the morning,
throughout the day and before he goes to bed. He would usually have at
Activity/Exercise Plan:
Mr Jack exercises at home in his garage. He has a set of weights and bike
machine which he utilises for a period of 15-20 min three to four times a
he has not used these machines. Mr Jack tries to stay as active as possible
by doing chores around the house whether it be gardening, fixing the car or
hanging the washing. He is quite aware of his health status and tries to
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Student ID: 20600910
feed, dress, shower, groom, toilet himself with the assistance of a mobility
Sleep/Rest Pattern:
Mr Jack gets at least seven to eight hours of sleep at night and would
occasionally have two naps in the day depending on how tired he feels
during the day or if the weather is too hot. Sometimes Mr Jack would rest
Cognitive/Perceptual Pattern.
this area. Mr Jack understood the reason for his admission and was
Prior to admission Mr Jack felt well and healthy, there were times he
right’ but tries hard to gather his strength back in order to go home and be
with his fanau (family). Mr Jack states at times he is aware that his
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Student ID: 20600910
medical condition and his health tends to ‘get him down’ but when his
family arrive to visit him in hospital he suppresses his feelings and assures
them ‘he’s okay’. Mr Jack tries to give his family the impression that
grandchildren. His wife and children visit him once or twice daily at the
comes from a supportive family who all have an input and try to manage
his health, from his diet to his daily exercises. Mr Jack is very comfortable
with his supportive family but till worries about his health condition.
Sexuality/Reproductive Pattern:
He has a strong loving supportive relationship with his wife and is seen as
the role model to the whole fanau. He enjoys spending time with his
family and grandchildren and quality time alone with his wife at home.
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Student ID: 20600910
Mr Jack will often take ‘time out’ and have some quiet time by himself
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Student ID: 20600910
Nursing Care Plan
Date Nursing Diagnosis Client Centred Nursing Intervention Rationale Evaluation
Client Problem and Objective
Cause
07/03/08 Impaired Gas Mr Jack will state he Monitor respiratory rate/depth Indicators of adequacy of Mr Jack did not experience
exchange related to has not experienced use of accessory muscles and respiratory function or degree of shortness of breath and
transient ischemic difficulty in breathing areas of cyanosis. compromise and therapy stated there were no
attacks and each 8 hourly shift. needs/effectiveness (Carpenito- difficulties in his breathing.
myocardial infarction Moyett, 2005).
07/03/08 Pain related to Mr Jack will verbalize Monitor signs and symptoms Some people deny the experience Mr Jack did not experience
hemiarthroplasty adequate relief of pain associated with pain, eg BP, of pain when it is present. any pain and was able to
surgical placement or ability to cope with heart rate, temperature, colour Attention to associated signs may manage moderate pain
on left hip pain each 8 hourly and moisture of skin, help the nurse in evaluating the through non-medical
shift. restlessness, and ability to focus. pain (Gulanick & Myers, 2006) alternatives eg massage..
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Student ID: 20600910
Respond immediately to In the midst of painful
complaint of pain. experiences a patient’s perception
of time may become distorted.
Prompt responses to complaints
may result in decreased anxiety in
the patient. Demonstrated concern
for patient’s welfare and comfort
fosters the development of a
trusting relationship. nurse in
evaluating pain (Gulanick &
Myers, 2006).
07/03/08 Potential for Mr Jack’s surgical Utilize good hand washing Friction and running water Mr Jack’s wound has
infection related to wound on left hip will technique. effectively remove remained free from
surgical remain infection free microorganisms from hands. infection each 8 hourly shift.
hemiarthroplasty each 8 hourly shift. Washing between procedures Nil evidence of sluff, pus,
procedure on left hip reduces the risk of transmitting foul smell, swelling of skin
pathogens from one area of the observed.
body to another (e.g., perineal
care or central line care). Use of
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Student ID: 20600910
disposable gloves does not reduce
the need for hand washing (Ralph
& Taylor, 2006).
07/03/08 Risk for falls related Mr Jack will remain Keep bedside rails up in bed in This prevents patient from falling Mr Jack has remained injury
to lower impaired fall and injury free low position. out of the bed when resting free each 8 hourly shift. He
balance. each 8 hourly shift. (Comer, 2005). has not had any falls or
sustained injuries.
Ensure client uses a transfer Staff member will be able to assist
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Student ID: 20600910
safety belt and a nurse present at the client if he/she is feeling dizzy
all times when ambulating with or unsteady at any time during
walking frame. ambulation. Thus providing and
promoting a safe environment and
making the client feel safe too
(Comer, 2005).
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Student ID: 20600910
Discharge Plan:
Mobility:
hand reacher to mobilise with. Mr Jack has been encouraged and taught
how to use these devices and displays the confidence and determination to
Current Supports
Mr Jack lives at home with his wife, one independent son and one
dependent daughter who attends college. They are all aware of his current
condition and have all been involved with his current care whilst in
hospital. A meeting was held with the Multi Disciplinary Team (MDT) and
the family prior to Mr Jack’s discharge and the family will continue to
his mobility. The family are aware of their father’s needs and have been
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Student ID: 20600910
informed that a referral has been made to the Orthopaedics Department and
Personal Cares
Mr Jack with a shower stool to assist him in the shower, he has been
advised to use the hand reacher in the shower to assist him when bending.
He also uses this device when putting on shoes and socks to prevent him
from bending and falling. Mr Jack appears very confident when using the
Mr Jack and his family have been informed about conserving his energy
related to his TIA condition. Mr Jack and his family have been encouraged
to reinforce the use of the devices he has been given to make daily
activities easier for him. His wife has stated she will assist with domestic
tasks and all meals. However declined ALL assistance with regards to
management of daily tasks and this was to ensure Mr Jack would maintain
expressed to his family he will only need their assistance when requested
Mrs Jack has stated she will drive him to the necessary venues in regards to
He speaks in both Samoan and English and does not need an interpreter in
this area. Mr Jack wears spectacles when reading however, states he has
difficulty in reading now and finds it hard to concentrate for a long period..
Cognition
Mr Jack is orientated to date, time, place and person. He has insight into
remembers what happened prior to admission and stated he “felt dizzy and
Jack had eye surgery for a bilateral cataracts several years ago. A referral
has been made by the eye specialist to the Outpatients Eye Department for
Management of Health:
Medications on discharge:
Ischemic strokes)
Prior to discharge Mr and Mrs Jack were spoken to by the House Surgeon
in regards to the medication regime and the complications that would occur
stressed to him and his wife that he remain compliant with his medication.
medications.
Mr Jack’s surgical wound on his left leg remains infection free. Surges
Jack has been prescribed with codeine, paracetamol and aspirin to assist
with management of pain. Laxsol and Lactulose have also been prescribed
A referral has been made to the dietician for management of his dietary
his retains an adequate healthy diet for his wellbeing. Mr Jack needs to
know that fatty foods found in traditional meals can contribute to his
A urinal has been provided for Mr Jack for night time purposes.
rehabilitation of the client’s surgical fracture on the left hip. This method is
known for its therapeutic healing, not only for the physical being of the
individual, but also for the spiritual being (A. Fanueli. Personal
fofo vai (massage with traditional herbs/leaves), fofo itu (massage used
for people who are spiritually possessed) and fofo gau (massage for the
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Student ID: 20600910
During the assessment of Mr Jack he stated he preferred using Samoan
traditional methods rather than Western medical treatment for his health.
symptoms he was exhibiting, such as dizzy spells, feeling tired and at times
most of these symptoms after being informed about the side effects from
Rationale
In this instance I would advocate the fofo gau to Mr Jack and his fanau.
patients visit him daily for all sorts of conditions related to body pain,
gau (A. Fanueli. Personal Communication, March 30, 2008). The Taulasea
will need to obtain a history from the patient and the patient’s fanau to
determine their mobility before their incident. The Taulasea will ask if the
patient had sought Western therapies such as recent surgery, enquire about
current medications he/she is on, how long they have had their condition
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Student ID: 20600910
and what other traditional methods they have sought. After the assessment,
the Taulasea will decide whether they are able to continue with the fofo
through balance of the three worlds, the natural world, the social world and
I feel this traditional alternative will suit Mr Jack’s needs as his preference
pain on his left hip. The fofo gau soothes tight, tense or overworked
lymphatic fluid, softens skin where scar tissue has formed, prepares healthy
muscle for demanding activity and aids recovery from the activity (A.
for their people. This method is also a treatment Mr Jack and his family
Medication Regime
Medication: Felodipine
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Student ID: 20600910
Rational: Mr Jack has a history of hypertension. Felodipine is used to
Medication: Dipyridamole
Dosage: 150mg PO bd
nausea.
2006)..
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Student ID: 20600910
Medication: Allopurinol
Side effects: Skin rash, pain or bleeding when urinating; fever, sore
Medication: Hydroxyurea
constipation, or drowsiness.
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Student ID: 20600910
may help to control the symptoms when used on a regular
Medication: Aspirin EC
nausea, vomiting.
(Skidmore-Roth, 2006)..
Pharmacokinetics of Felodipine
urine and 10% is secreted in the faeces. Less than 0.5% of a dose is
Pharmacodynamics of Felodipine
increase in heart rate. This reflex increase in heart rate frequently occurs
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Student ID: 20600910
during the first week of therapy and generally attenuates over time. Heart
therapeutic doses has no effect on the intrinsic system of the heart (Burton,
Pharmacokinetics of Codeine
distributed from the intravascular spaces to the various body tissues, with
preferential uptake by the liver, spleen and kidney. Codeine crosses the
blood-brain barrier, and is found in foetal tissue and breast milk. The
of pain; however, codeine is not bound to plasma proteins and does not
Pharmacodynamics of Codeine
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Student ID: 20600910
Codeine binds with stereospecific receptors at many sites within the central
nervous system to alter processes affecting both the perception of pain and
have not been fully determined. It has been proposed that there are
and/or side effects of opioid drugs. Codeine has a very low affinity for
opioid receptors and the analgesic effect of codeine may be due to its
The actions of an opioid analgesic may therefore depend upon its binding
affinity for each type of receptor and whether it acts as a full agonist or a
The role of the nurse is to promote, educate and advocate for the client.
to ensure that not only the client is informed about what to expect from the
medications but also the fanau understand the effects of the medications
(Bastable, 2002).
pacific people are at greater risk with this disease (Shotter, 2004). I will
reassure Mr Jack and his family that Felodipine has neutral effects on the
could allow Mr Jack to take his traditional medicine maybe with his food
Jack and his fanau will need to know he is to avoid concurrent grapefruit
juice and alcohol which may cause hypotension (low blood pressure). The
family and client will also need to know the drugs dosage is not to be
will also advise Mr Jack and family members to report signs or symptoms
difficulty of breathing.
Codeine handouts will be given to the client and fanau for educating
purposes regarding this drug. I will inform the family and client that
emphasise to use the drug exactly as directed and not to increase dosage or
may think codeine is the only way to cope with their pain (Skidmore-Roth,
2006).
The client and fanau will be informed Mr Jack is not to use alcohol or over
standing, or when engaging in tasks. Other side effects which occur with
gum may help with this. Mr Jack and fanau will be informed to report
vision changes.
level.
Reflection-in-Action
undertaking this assignmen was quite simple, My initial goal and approach
care plan then the rest of the work will follow through. However, this was
Reflection-on-Action
solving approach in partnership with the patient and their family. I have
learnt that nursing entails not only just the health or medical problem of
nursing where what the nurse assesses and finds, can affect not only the
patient, but the patient’s family. Being culturally aware of patients needs
the ‘key’ to establishing a rapport with the client. As a student nurse I have
family for the sole purpose of maintaining the patients health and
wellbeing.
Conclusion
situations that may lead to problems. It allows the nurse to consider more
client, obtain a medical history from the client, educate the client and
family in regards to the clients health and ensure essential follow-up was
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Student ID: 20600910
maintained after discharge for the client. On completion of this assignment
I feel privileged to have had participated with a pacific client and their
can make a difference when dealing with Pacific People and their health as
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Student ID: 20600910
Reference List.
Burton, E. M., Shaw, M. L., Schentag, J. J., & Evans, E. W., (2005).
Philadelphia: Lippincott.
Comer, S. (2005). Delmar’s critical care nursing plans (2nd ed). USA:
Thomson.
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Reference List
Missouri: Mosby.
Missouri: Mosby.
Philadelphia: Mosby.
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Reference List
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