Nursing Care Plan Template

In the care plan template provided, identify 4-6 actual or potential physiological patient problems.

Identify all objective and subjective patient assessment data which supports your clinical reasoning in selecting these issues (i.e. how do you know that this is a problem for this patient?).

• This should be specific assessment data e.g. SBP 88mmHg instead of just saying ‘hypotensive’

Identify the optimal outcome that your patient should achieve before they are discharged.

• This should be a specific target that is appropriate for your specific patient e.g. SBP 110-130mm/Hg, urine output > .5mls/kg/hr, GCS 15/15, etc.

Do not include nursing interventions in the template.

Problems may be:

•   actual health problems: a health problem that is currently present or occurring and needs intervention to either end or reverses its effects. There will be patient signs and/or symptoms that support the manifestation of the problem.

Examples:     Dehydration due to ……..

Wound infection related to ……

Acute pain related to ….

Impaired skin integrity due to ….

Inadequate tissue perfusion related to……..

•  potential health problems: a health problem which has not yet occurred, however based on assessment items there is a risk that the patient may develop this problem if no interventions or prevention measures are initiated.

                                The patient is ‘at risk of’ falls due to …

                                The patient is ‘at risk of’ developing a  DVT due to….

The patient is at risk of infection due to………

For potential health problems, please consider that you are identifying the risk based on evaluation of the data you have been given in the case study. As such, the assessment data will be what puts the patient at risk rather than the assessment data the patient would have if they had this problem as an actual problem. For example, the assessment data for an actual DVT will be redness, swelling, pain, heat while the assessment data for a potential DVT might be reduced mobility, low BP, activation of inflammatory response.

Focus on those problems and nursing/patient outcomes that nursing interventions could contribute to or could be completed during one standard nursing shift.

Actual or potential problem     

Assessment data                         

Nursing outcome

Actual problem: the patient is dehydrated related to decreased fluid intake

• Low blood pressure (or ↓BP) – SBP 88mmHg
• Tachycardia – HR 125bpm
• Patient states he is thirsty
• Dry mucous membranes
• Low urine output – 100mls in 6 hours
• Patient will return to a normotensive state with a systolic BP between xx and xxmmHg
• HR will be between x and x
• Lack of reported thirst
• Moist mucous membranes evident.
• Urine output will be at least xmls/hr

The patient is ‘at risk of’ infection due to compromised host defences

• Low neutrophil count
• Receiving radiation therapy for cancer
• Pt will remain free from any nosocomial infection
• WCC will remain between x and x
• Pt will verbalise how to prevent acquiring infections
• Pt’s family, friends, and hospital staff will use appropriate infection control include PPE and HH

Note: you can use commonly used abbreviations or symbols, e.g. BP for blood pressure.

No marks are allocated to the template, however it is required to be submitted in order to receive a pass grade for this assessment.

Nursing Care Plan Report – 2000 words

From your nursing care plan template select 2 (two) physiological problems. These may be actual problems, potential problems or one of each.  Do not select psychosocial problems as you will not be able to discuss the pathophysiology of these and they will not be marked.

For each of your chosen problems:

• Explain the pathophysiology and how this relates to the patients clinical presentation. I.e. What is happening in the body to cause the signs and symptoms that the patient has?
• Identify the key nursing interventions required specifically to treat or prevent the problem you have chosen. These interventions should be supported by contemporary clinical guidelines, policies and high quality best-practice evidence. Nursing interventions should include a rationale supported by evidence. Nursing interventions may be
• Independent interventions – nurse led, nurse initiated
• Collaborative interventions – with other members of the multidisciplinary team
• Dependant interventions  – for example dependent on a doctors order
• These interventions should focus just on interventions which will specifically treat or prevent your chosen problems. Please do not include general nursing care which would be applicable here, or interventions which are required for all care (i.e. there is no need to identify obtaining consent, hand hygiene, etc. as this is required for all nursing interventions always). You do not need to describe the intervention, just state what you would do and why (not how you would do it). 
• Identify the intended goals of care and patient outcomes for your problem, considering how you would evaluate this. I.e. what do you want to achieve for your patient specifically, how will you measure the patient’s progression towards this goal and how often will you take these measurements?
• Include specific outcomes here appropriate for your patient. The idea is that if someone were to read your plan of care without knowing the patient they would still be able to achieve patient specific goals. For example, your patient might have a history of COPD with CO2 retention and the target oxygen requirements would be 88-92%. Instead of your outcome being ‘satisfactory oxygen saturations’ you should specify ‘oxygen saturations of 88-92%’. Instead of saying “acceptable BP” as an outcome, identify what range you want the BP to be in for your patient.

 As this is a formal academic report you should include

– an introduction: identify which patient case study you are using and the purpose/direction of your report e.g. “… This report will discuss compartment syndrome and surgical wound breakdown as two actual problems experienced by Mr. Smith. The pathophysiology of these conditions will be outlined along with nursing interventions required to treat these problems…”

– a conclusion: 1 or 2 sentences only which sum up your work. The conclusion should not include references as it is a summary of your ideas only. 

– at a third year BN level, for a 2000 word report you should have at least 20 high quality sources of evidence

List down known health benefits from each listed ingredient. How does each of the listed ingredients benefit sleeping?

Ingredients: 

· L-Tryptophan

· Valerian, Goji (Wolfberry)

· Chamomile

· Lemon Balm

· Passion Flower

· L-Taurine

· Hops

· St.John’s Wort

· Gaba

· Skullcap

· L-Theanine

· Ashwagandha

· Inositol

· 5-HTP

· Melatonin

Assignment:

For this assignment, the student will create a Power Point Presentation on a cultural group.

Pick a cultural or religious group (different from yours) that you commonly encounter at workplace. You can select a group discussed in Chapter 1 of Pozgar or a different group. Research the answers to the following…

1. Title Slide with your name (1 slide)
2. Health beliefs and practices (1-2 slides)
3. Family patterns (1 slide)
4. Communication style (1-2 slides)
5. Space orientation (1-2 slides)
6. Time orientation (1-2 slides)
7. Nutritional Patterns (1-2 slides)
8. Pain Responses (1-2 slides)
9. Childbirth and perinatal care (1-2 slides)
10. Death and Dying (1-3 slides)
11. Spirituality, religion, and faith (include holy days) (1-2 slides)
12. Prayer and meditation (1-2 slides)
13. What knowledge did you gain about this group that you were not aware of? (2-3 slides)
14. Identify at least two ethical healthcare issues might arise when caring for this cultural group? (2-3 slides)
15. Reference slides (1-2 slides)

For this section, insure information is referenced and cited in your slides. The presentation should start with a title slide and end with a reference slides. At least 2 references are required for this assignment. If you include pictures, your pictures should also be referenced and cited.

Assignment Expectations:

• Length:
  • At least 17 slides
  • Use the tips at http://www.garrreynolds.com/preso-tips/design/ to create the slideshow.  Because good PowerPoints have very few words, submit a script that describes the content of each slide – about 50 words per slide.  Place this script in a separate Word document that shows each slide number and the text for each slide as shown in the provided PowerPoint Slide Notes.docx.
• Structure:
  • Include a title page and reference page in APA style
• References:
  • References are required. You should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions

 Respond to  your colleagues who were  assigned a different disorder than you. Compare the differential  diagnostic features of the disorder you were assigned to the diagnostic  features of the disorder your colleagues were assigned. What are their  similarities and differences? How might you differentiate the two  diagnoses? 

                                                            Main Post

Opioid Use Disorder 

Substance  use disorder is a major public health problem in the United States.  This is a problem that is associated with increased morbidity,  mortality, and cost of care. It suffices to say that the health care  delivery system is significantly burdened by issues that are associated  with substance use disorder. Data from 1995 to 2018 shows that there has  been an increase in the prevalence rate the use of cannabis as well as  other illegal drugs and analgesics (Seitz et al., 2019). This shows how  substance abuse presents a serious problem for the health care system.  when discussing substance abuse and related disorders, it is very hard  to ignore the opioid epidemic in the country. The opioid epidemic is a  crisis that has taken millions of lives over the last few decades. This  crisis was initially worsened by an augmented use of pharmaceutical  opioids. Currently, most deaths due to opioid are caused by overdosing  on heroin as well as the illegally manufactured synthetic opioid that is  referred to as fentanyl (Lyden & Binswanger, 2019). Death is not  the only negative outcome of the crisis. Opioid use is also associated  with disorders. Opioid use disorder shall form the description of this  paper where the diagnostic criteria shall be presented first. The paper  shall then discuss the treatment of opioid use disorder using  psychotherapy and psychopharmacologic interventions. Finally, the  clinical features of the disorder shall be discussed with reference to  the DSM-5 criteria.

Diagnostic Criteria 

Opioid  use disorder is described as a pattern of opioid use that is  problematic, leading to clinically significant distress or impairment.  The distress or impairment should be manifested by at least two symptoms  from a list that is provided in the DSM-5. This manifestation should  last at least 12 months to make a correct diagnosis (APA, 2013).  Notably, if a person exhibits 2-3 symptoms, this is considered a mild  case. If there are 4-5 symptoms, this is considered moderate, and 6 or  more symptoms demonstrate a severe case. The symptoms as provided in the  DSM-5  list include taking opioids in larger amounts or longer period  than intended, persistent desire or uncontrolled effort to moderate or  stop using opioids, spending so much time using, acquiring and  recovering from the use, craving for opioids, failing to fulfill  important obligations in life due to opioid use, continued use  regardless of social and interpersonal problems that are worsened by the  use of opioids, giving up social, occupational and recreational  activities due to opioid use, using opioids in situations that are  hazardous, and continued use of opioids with the knowledge that it is  causing or exacerbating physical or psychological problems. Notably,  having a high tolerance for opioids in order to achieve the desire to  consume as well as suffering from withdrawals are also symptoms to  include in the list but do not apply in cases where opioids are used  solely for medication purposes (APA, 2013).  

Psychotherapy 

The  most effective psychotherapeutic approach in the treatment of opioid  use disorder is cognitive behavioral therapy. In one study, the  accessibility, feasibility, and efficacy of cognitive behavioral therapy  in the treatment of opioid use disorder was confirmed (Barry et al.,  2019). This approach is effective in preventing relapse and it is also  known to work in preventing those that are taking opioid medications for  pain from starting to use other illicit opioid substances. The use of  psychotherapy as discussed entails rehabilitation as well as  maintenance. While rehabilitation focuses on the use of cognitive  behavioral therapy, maintenance includes psychological support and  patients are always encouraged to join support groups such as an  anonymous program. Education and reward cooperation can be the benefits  of these support groups (Dydyk, Jain & Gupta, 2020). In addition,  when group approaches are used, patients get to benefit from therapeutic  factors such as universality and guidance. The maintenance phase may  also require the use of medications. 

Psychopharmacologic Treatment 

When  cognitive behavioral therapy is used in combination with medication, it  is said to be most effective in the treatment of opioid use disorder  (Dydyk, Jain & Gupta, 2020). Drugs are used for opioid replacement,  maintenance, and substitution therapy. Thus, the drugs that are commonly  used include Methadone and Buprenorphine. They are always provided  under supervision. These drugs are longer acting though they are not as  addictive and euphoric as the illicit opioid drugs. The mentioned drugs  are mu opioid receptor agonists, and they are used as opioid  substitutions even though they have dissimilar pharmacodynamic and  pharmacokinetic properties (Noble & Marie, 2019). Other medications  that are used include Naltrexone that helps in reducing the urge to use,  hence maintaining abstinence and Lofexidine which may be used to treat  side effects associated with withdrawal.

Clinical Features 

 In  a person that presents to the clinic and is diagnosed with opioid use  disorder, they may have slurred speech, pinpoint pupils as well as  sedation. On of the criterion for the disorder is tolerance. This is  requiring high amounts to quench the desire. In such cases, patients may  not present with acute symptoms. This may also be true in cases where  the patient has used a dose that is typical for them. Most acute cases  are emergencies due to overdosing (Strain, Saxon & Hermann, 2015).  It is therefore very important for any health worker to be keen in  identifying the acute symptoms, especially emergency cases in order to  prevent deaths due to overdosing of opioids, something that is very  common.

References

Barry,  D. T., Beitel, M., Cutter, C. J., Fiellin, D. A., Kerns, R. D., Moore,  B. A., … & Schottenfeld, R. S. (2019). An evaluation of the  feasibility, acceptability, and preliminary efficacy of  cognitive-behavioral therapy for opioid use disorder and chronic pain. Drug and alcohol dependence, 194, 460-467

Dydyk, A. M., Jain, N. K., & Gupta, M. (2020). Opioid Use Disorder. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK553166/#article-42233.s6

Lyden, J., & Binswanger, I. A. (2019, April). The United States opioid epidemic. In Seminars in perinatology (Vol. 43, No. 3, pp. 123-131). WB Saunders

Noble,  F., & Marie, N. (2019). Management of opioid addiction with opioid  substitution treatments: beyond methadone and buprenorphine. Frontiers in Psychiatry, 9, 742

Seitz,  N. N., Lochbühler, K., Atzendorf, J., Rauschert, C., Pfeiffer-Gerschel,  T., & Kraus, L. (2019). Trends in substance use and related  disorders: Analysis of the epidemiological survey of substance abuse 1995 to 2018. Deutsches Ärzteblatt International, 116(35-36), 585.

Strain,  E., Saxon, A. J., & Hermann, R. (2015). Opioid use disorder:  Epidemiology, pharmacology, clinical manifestations, course, screening,  assessment, and diagnosis. UpToDate, Post, TW, editor. UpToDate. Waltham, MA [cited 2018 Apr 1]