Paper 1

Case Study: Cardiac patients who undergoes Coronary by Pass Graft was admitted first at ward the after some preparations will then be pick up by Operating Room personnels prior to the said procedure. After the operating room the patient will then proceed to the Recovery Room for stabilization of vital signs and other health parameters. When the patient is stable he/she will then proceed to the Surgical ICU for further monitoring. After the Intensive Care unit stay, he/she will then be brought up to the ward for rehabilitation and preparation for his/her discharges after a few days. As a ward nurse our main purpose to make sure that the patient recovers faster and be able do activities of daily living as soon as possible. I am the one who gives medications to the patient to be sure that complications will be prevented. We clean the surgical site every day to prevent infections and most of all we encourage him/her to ambulate, which a good way to recover faster and be able to do activities of daily living earlier.

Environmental theory: This theory is defined with the following factors present in the patients environment like pure or fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness, light, adequate ventilation and provision of a quiet or noise free and warm environment. In this theory by Nightingale she believes that the environment was the major component creating illness in a patient. In accordance with my case study, environmental theory of Florence Nightingale reflects the need of the patient who is stay in at the hospital for recovery. For a postoperative patient to recover fast he/she needs to attain the following environmental factors. Fresh air is needed for a patient to recover faster from effects of anesthesia and also to bring back normal function of the lungs. Pure water, in the ward we provide purified water for every patient

for them to avoid any diseases coming from water contamination. Our dietary provides foods that are necessary for their diet, usually for postoperative patients who undergoes Bypass, diet such as low salt and low fat are strictly implemented. Another would be cleanliness, our nursing orderlies make sure that surrounding are well cleaned specially the toilets to be able to prevent spread of diseases coming from different human secretions, also disposal of garbage are divided to infectious, biodegradable and non biodegradable to prevent contaminations. For a patient a quiet and noise free environment is a necessity, it helps them to relax and avoid stressors. It gives them a sense of security as well as comfort ability. LIMITATIONS A limitation that I have notice which is relevant to the Environmental theory is that it focuses on basic needs of the patient when it comes to health care setting. It does not tackle medical approaches like medications and nursing care for the patient.

System theories This theory is incorporated the concept of a whole person and an open system approach. The concept is aimed toward the development of a person in a state of wellness having the capacity to function optimally. In coordination with my chosen study, system theories of Betty Neuman states that Health is a in which all parts and subparts are in harmony with the whole of the client. For a patient who just undergone a heart surgery system theories is very much applicable. The main role of the nurse is to help a person to adapt with environmental stimuli causing illness back to state of wellness. In terms correlated with Newmans theory which is the Lines of resistance, as a nurse we need to decrease the stressors of the postoperative patient for his/her recovery to be continuous. We provide a quiet and comfortable environment and we usually limit visitors to provide comfort and rest. We remove means of stressors like noise for them to have periods of rest. We teach the

patient diversional activities like reading, watching TV or doing deep breathing exercises for them to divert problems and stressful situations. Patient is inform regarding outcomes or produce results of certain stressors and actions of the lines resistance of a client. According to Neuman there are two specified reactions which is negentropy or entropy. For a post-operative patient we encourage negentropy which is set towards stability or wellness unlike Egentropy which is set towards disorganization of the system producing illness.

LIMITATIONS Limitations that I have encounter is that sometimes relatives are hard headed, even if ask to lessen the visits they always insist to stay with the patient and spend their time talking to them. Also patient is unable to manage stress due to over thinking, like hospital bills and how they will recover after the surgery.

Self- care theory Orem defined Nursing as The act of assisting others in the provision and management of self care to maintain / improve human functioning at home level of effectiveness. This theory focuses in activities that adult individuals perform on their own behalf to maintain life, health and well being. It has a strong health promotion and maintenance focus. For this theory, as a nurse we start to teach patient how to do self care. We encourage them to do their normal activities with minimal help. We do this step by step and not putting patient in a rush. Activities such as ambulating and eating are assigned to them while we do the cleaning of the surgical site and giving them a sponge bath. Through the periods of recovery we encourage them to take a shower and clean the wound but of course with the nurse assistance. In coordination with my case study I applied the twenty one nursing problems (Faye Glen Abdellah). First is to maintain good hygiene. At their first admission to the ward, we are the first

one to clean the patient. We prepare their bed, change their clothes do oral and bedside care until they are able to do them by themselves. Second would be to promote optimal activity; exercise, rest and sleep. As a nurse we encourage and assist patient in every activity he/she does. We transfer them to the wheelchair, help the patient in changing positions to avoid pressure sores and assist them in ambulating. Then after days of recovery we encourage them to start from minimal activity until they are able to ambulate and regain their balance. Third is to promote safety, as a nurse we ensure patient that he/she is in a safe environment, free from threats and other security concerns. At night we even make sure that their siderails are up to prevent incidence of fall. Fourth is to maintain body mechanics. Giving Assistance to the patient whenever he/she does an activity, until he is able to regain equilibrium without any assistance. Fifth is to facilitate the maintenance of a supply of oxygen. We make sure that the patient gets enough oxygen by proving every room with wall oxygen and making sure that the environment is well ventilated. Sixth is to facilitate maintenance of nutrition. As a nurse we inform the patient that only food that are provided by the hospital should be taken, this will ensure that they get the right nutrition they need and avoiding the foods that may cause harm to his/her condition. Seventh would be to facilitate maintenance of elimination. Our ward provides own comfort room to every patient so that when they feel the call of nature they will be able to eliminate it quickly. Eight is to facilitate the maintenance of fluid and electrolyte balance. In the ward we make sure that patients are drinking purified water by providing a water dispenser. Ninth is to recognize the physiologic response of the body to disease condition. In handling a postoperative patient, we always assess the from head to toe, we ask if he/she felt any pain and check the surgical site from time to time to see if there is any infection happening. Tenth would be to facilitate the maintenance of regulatory mechanisms of function. We make sure that patient condition is stable inside and outside of his/her body. Eleventh is to facilitate the maintenance of sensory functions. Checking the patients visual capacities through Snellen chart. Twelve would be to identify and accept

positive and negative expressions, feelings and reactions. For a patient who is postoperative, lot feelings come up. They feel a bit frustrated because of their present condition as well as feeling sad due to payments they have to make when they got discharge. As a nurse we need to cope up with different feelings that are patient shows. We need to understand that it is normal to have those expressions when undergone a major surgical procedure. Thirteenth is to identify and accept the interrelatedness of emotions and illness. In the ward we deal with different emotions especially the postoperative ones. We help them cope up with the situation and encourage them think on positive things for their fast recovery. Fourth teen is to facilitate maintenance of effective verbal and non-verbal communication. As a nurse taking care of postoperative patients we always listen to patients concern, and be on the look out for any means of body language like pain. Fifteenth is to promote the development of productive interpersonal relationship. In post surgical patient as a nurse we need to build a good interpersonal relationship with the patient to for us to be able to help them in coping up with the recovery. Sixteenth is to progress toward achievement of personal spiritual goals. The hospital provides chaplain for every patient upon request and every Sundays for them to help in their spiritual needs. Seventeenth is to create and maintain a therapeutic environment. In every patient a therapeutic environment is a must. This will help patient to avoid stress and aid in fast recovery. Eighteenth would be to facilitate awareness of self as an individual with varying needs. As one of the function of the nurse, we encourage post op patient to try and do their usual daily activities for feel that they are recovering and soon enough be able to be back at their normal state. Nineteeth would be to accept the optimum possible goals. Goals should be set for patient care to be able to see if the care being given to the patient is working. Twenty is to use community resources as an aid in resolving problems arising from illness. This is applicable when patient is discharge and staying at home for continuous recovery. Last would understand the role of social problems as influencing factors. For postoperative patients, social

problems are one of the causes of stress; it may be problem in the family or at work. The purpose of the nurse is to inform the patient regarding the possible problems that may arise during recovery if those stressful factors are tolerated.

Limitations: Limitations that I have encounter in connection with my chosen case study is that Self-care theory are some patients are hesistant to do self care. Some are afraid that it might be difficult for them to bring to their normal state some wants to have some time until they are fully recovered.