Agunday, Jessica Ella H.

January 15, 2011

Master of Arts in Nursing
Major in Nursing Administration
Theoretical Foundations in Nursing

Preliminary Examination

”Nurses work in life situations with others to bring about the conditions that are
beneficial to persons nursed. Nursing demands the exercise of both the speculative and
practical intelligence of nurses. In nursing practice situations, nurses must have
accurate information and be knowing about existent conditions and circumstances of
patients and about emerging changes in them. This knowledge is the concrete base for
nurses’ development of creative practical insights of what can be done to bring about
beneficial relationships or conditions that do not presently exist. Asking and answering
the questions, ‘what is?’ and ‘what can be?’ are nurse’s point of departure in nursing
practice situation.” (Orem, 1995, p. 155)

Application of Dorothea Orem’s Self Care Deficit Nursing Theory (SCDNT)

Case History of Mrs. Trinidad Villarama

Mrs. Trinidad Villarama, a 76 year old female came to the hospital with complaints of
pain over all joints, stiffness which is more in the morning and reduces ability on performing
activities. She had these complaints since 6 years ago and has taken treatment from a private
physician’s clinic and herbolario. Sometimes she self-medicates. The symptoms were not
reducing and came to Briones General Hospital for further management. The patient was able
to do the activities of daily living (ADL) by herself but the way she performed and the posture
she used was making her at risk to develop the complications of the disease, She was also
malnourished and was not having awareness about the deficiencies and effects. Medical
diagnosis: Rheumatoid Arthritis.

Nurse Jane Salazar was assigned to care for the patient. She decided to use Orem’s
SCDNT for the patient.

Data Collection for Mrs. Villarama According to Orem’s Self-Care Deficit Nursing Theory

1. Basic Conditioning Factors

Age 76 years old

Gender Female
Health State Disability due to joint pains, needs nursing therapeutics
Developmental State Ego Integrity vs Despair
Sociocultural Orientation Elementary Graduate, Ilocano
Health Care System Combination of Institutional and alternative health care
Family System Married, Husband retired teacher
Patterns of Living At home with husband, daughter and her family
Environment Urban Area, 2-Storey Home, sleeps in bedroom upstairs,
bathroom downstairs, items for ADL not easy reach, no
precautions to prevent injuries.
Resources Husband’s pension, daughter, and son in the US.

2. Universal Self Care Requisites

Air Breathes without difficulty, no pallor.

Water Drinks 6 to 8 glasses of fluid per day.
Edema present over ankles.
Turgor normal for age.
Food Food intake is not adequate, diet is not nutritious (mostly
carbohydrates)
Hemoglobin: 9.6 gm%. BMI = 14%
Elimination Ocassional urinary incontinence, wears pull-up diapers when
going out of home.
Frequent constipation. Takes laxatives occasionally.
Activity / Rest Frequent rest is required due to pain.
Pain not completely relieved.
Activity level is low.
Deformity of the joints (especially in the fingers secondary to
the disease process)
Social Interaction Communicates well with husband, daughter and family,
neighbors, friends; calls son in the US by phone.
Need for medical care is communicated to the husband and
daughter.
Prevention of Hazards Needs instructions on care of joints and prevention of falls.
Needs instruction or improvement of nutritional status.
Prefers to walk bare foot inside the home.
Needs shower chair and safety bars in bathroom.
Promotion of Normalcy Has good relationship with husband, daughter and her family.

3. Developmental Self-Care Requisites

Maintenance of Able to feed self.

Developmental Environment Difficulty in dressing, bathing, toileting, and ambulating.

Prevention/ Management of Feels that the problems are due to her own behaviors and
the conditions threatening discusses the problems with husband and daughter.
the normal development Feels bad for not being able to cook for the family anymore.

4. Health Deviation Self-Care Requisites

Reports the problem to the physician during clinic visits and

hospitalization.
Adherence to Medical Cooperates with the medication.
Regimen Inadequate knowledge on the use and side effects of
medicines.
Has difficulty in performing prescribed exercises.

Not aware about the actual disease process.

Awareness of potential Not compliant with the diet, claims she has to no appetite to
problem associated with the eat.
regimen Not aware of prevention of hazards.
Not aware of side effects of medicines.

Modification of self-image to Has adapted to limitation in mobility.

incorporate change in health The adoption of new ways for activities leads to deformities
status and progression of the disease.

Adjustment of lifestyle to Adjusted with the deformities.

accommodate changes in Pain tolerance not achieved, needs frequent medication to
the health status and relieve pain.
medical regimen.

Nursing System Design for Mrs. Villarama: Supportive-Educative

Diagnostic Operations Prescriptive

Operations
 Therapeutic Self-Care Adequacy Nursing Diagnosis Methods of Helping
Demand Of
Self-Care Agent

Air Adequate

Water Adequate

Food Actual nutritional Guiding

-Increase adherence to taking Inadequate deficit related to Supporting
sufficient food. inadequate intake and Teaching
knowledge deficit

Elimination Actual eliminative Teaching

-Establish regular pattern of Inadequate disturbance related to
elimination urinary incontinence
(Bowel and Bladder) and constipation.

Activity and Rest Inadequate Actual self-care Guiding

-Cope with/manage pain on deficit: Dressing, Supporting
ambulation. toileting, ambulating Teaching
-Improve ability to peform ADL related to restricted Promoting a
including dressing and toileting joint movement developmental
secondary to the environment
inflammatory process
in the joints.

Solitude/Social Interaction Adequate Potential for social Guiding

-Continue to maintain family, isolation related to Supporting
friends, health care contacts ineffective pain Teaching
control. Promoting a
developmental
environment

Prevention of Hazards Inadequate Potential for fall and Guiding

-Maintain safe ambulation fracture related to: Supporting
-Prevents falls and injury a. Joint pain Teaching
-Improve living environment b. Joint Promoting a
and lifestyle. deformities developmental
c. Inability to environment
maintain good
body
mechanics

Potential for injury

related to:

a. Deficit safety
home devices
b. Knowledge
deficit on
safety
practices.
Maintain developmental
environment
-Support increased normalcy
in the environment
Prevent/manage
developmental threats
-manage/decrease threats by
receiving appropriate therapy
-keep communication lines
open and clear with health
care providers
Maintenance of health status
-Promotion health and well
being
Awareness/management of
disease process
-increase understanding of
interrelationships of disease
process, activity and hazards
Adherence to medical regimen
-increase adherence to to
having sufficient diet
-regulate use of analgesic
-develop understanding of side
effects of medications
Awareness of potential
problems
-gain better understanding of
cause and prevention of injury
Inadequate Actual deterioration Guiding
in health status Supporting
related to difficulty in Providing physical and
dressing, bathing, psychological support.
toileting and
ambulating.
Actual developmental Providing physical and
Inadequate deficit related to psychological support.
decreased ability to
perform ADL
independently.
Potential for Teaching
Inadequate continued alterations Guiding and directing.
in health status
related to inadequate
health-seeking
behaviors, financial
status and
knowledge deficit
Potential for joint Guiding and directing,
Inadequate deformities, falls, and Providing physical
decreased mobility support.
related to disease Providing/maintaining
process in joints. environment that
supports person’s
development.
Non-adherence to Teaching
Inadequate prescribed medical Guiding and directing
treatment related to Providing psychological
lifestyle, and support
knowledge deficit.
Inadequate pain relief
related to timing of
analgesics.
Potential for
Inadequate exacerbations and Teaching, guiding and
increased disability directing
related to knowledge
-understand treatment plan
Modify self-image to
incorporate changed health
status
-adapt practice of good body
mechanics to prevent
deformities and progression of
the disease.
Adjust lifestyle to
accommodate health status
changes and medical regimen
-adjust performing if ADL
-achieve pain relief and
tolerance
-develop recreational activities
deficits concerning
problems.
Actual threats to self- Providing psychological
Inadequate image related to support.
disease, treatment,
and inability to do
ADL independently.
Actual deficit in ability Guiding and directing
to self-care related to Providing/ maintaining
Inadequate inadequate environment that
resources, supports persons
knowledge deficit and development.
lack of recreational
activities.