Application of Betty

Neumann's Systems
Model IN NURSING
PRACTICE

Presented By: Atiqa Ishtiaq

Case study
Kiran is a 30 years old lady, a wife of bus driver. She was admitted
in the hospital 2 days ago with sever hypertension above 200/110
mm Hg accompanied by chest pain, shortness of breadth. And
insomnia. Patient tells the nurse that her husband met with the
accident 3 days ago and he was severely injured with other
passengers, She is worried about him as passengers are blaming her
husband for tragedy
Patient is looking anxious and irritable.

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Stressors in the Kirans Case are:

Psychological
Stressors

Financial
stressors

Physical Stressors

1. Anxiety which stemmed from the uncertainty about the fate of her
husband.
2. A sense of guilt because relatives of the passengers are blaming her
husband for the tragedy.
3. Ambivalence in the sense that she would be happy if her husband
survived and at the same time worried too that if he did survive he
would be subjected to court litigation.
Her husband is the breadwinner of the family and in a brood of 5 children,
only one is employed; the rest are still in school.

1. Insomnia
2. Elevated blood pressure unresponsive to maintenance medications
3. Persistent chest pains

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Assessment data suggest that:

The clients flexible line of defence is compromised here; she
had a hard time in life, irritable and constantly taking the
stress, her nutritional level is also not good and quantity of
stress increases.
Her normal line of defence is also unstable, she is not well
and we can assess she is not as she has blood pressure of
above 200/110 associated with chest pain and shortness of
breath.
And her line of resistance is severely debilitated; as she can
develop heart attack if not properly managed with her
hypertension and stress. Her environment full of talking
relatives also worsen the condition.

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As Betty Neumann's model focuses on Levels of Prevention for

stability of patients line of defence in Kirans case levels of
prevention are applied as:
Primary Prevention would not be applicable because the
accident causing the stressors has already occurred and the
patient has already developed the reactions/symptoms of stress.
Secondary Prevention: In this case secondary preventions will be
used for nursing interventions. Secondary level of prevention is
aimed at reducing the further complexity of Problem
Nursing intervention centered initially on the round the clock
monitoring of the blood pressure and giving of the ordered antihypertensive drugs. Since the EKG showed myocardial ischemia,
the patient was closely watched for worsening of the pain because
of the possibility of a myocardial infarction.

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Nursing Diagnosis

Desired Outcomes Outcomes

At the time of discharge Client will:

Decreased Cardiac output related to
myocardial ischemia as evidenced by
tachycardia, shortness of breadth and
elevated blood pressure i.e. 200/110
mmHg

1.Maintain blood pressure within

individually acceptable range.
2.Demonstrate stable cardiac rhythm and
rate within patients normal range.
3.Participate in activities that reduce blood
pressure/cardiac workload.

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Nursing Interventions

Rational

Monitor BP Measure in both arms/thighs three

times, 35 min apart while patient is at rest,
then sitting, then standing for initial evaluation.
Use correct cuff size and accurate technique.

Comparison of pressures provides a more

complete picture of vascular involvement/scope
of problem.

Note presence, quality of central and peripheral

pulses.

Observe skin color, moisture, temperature,

and capillary refill time.

Bounding carotid, jugular, radial, and femoral

pulses may be observed/palpated. Pulses in the
legs/feet may be diminished, reflecting effects of
vasoconstriction increased systemic vascular
resistance and venous congestion.

Presence of pallor; cool, moist skin; and

delayed capillary refill time may be due to
peripheral vasoconstriction or reflect
cardiac decreased output.

Provide calm, restful surroundings,

Helps reduce sympathetic stimulation;
minimize environmental activity/noise. Limit promotes relaxation.
the number of visitors and length of stay.
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Nursing Interventions

Diagnosis

Maintain activity restrictions, e.g.,

bedrest/chair rest; schedule periods of
uninterrupted rest; assist patient with selfcare activities as needed.

Reduces physical stress and tension that

affect blood pressure and the course of
hypertension.

Instruct in relaxation techniques, guided

imagery, distractions.

Can reduce stressful stimuli, produce

calming effect, thereby reducing bp.

Instruct and implement to patient dietary

restrictions in sodium, fat and cholesterol
food.

This restrictions helpmanage fluidretention

and decreasemyocardial workload

Administer medications anxiolytics drugs

also as indicated

Medications will help to control the blood

pressure
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Evaluation
Goals are achieved:
1) Patient has maintained blood pressure within individual
acceptable range.
2) Demonstrate stable cardiac rhythm and rate within
patients normal range.

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Tertiary Prevention:
If possible to stay in a relatives house for a few weeks because
they were being hounded by media who were camped outside
their home.
Regular monitoring of the patients blood pressure by a
daughter who is a student-nurse who should also monitor her
intake of medications as prescribed by the physician.
Avoid watching TV shows that mention about the tragedy.
Avoid answering the phone.
She should have a close relative with her aside from the
children who will manage their affairs in the meantime.

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Thank You

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