Question

You are taking care of a newly admitted 78 year old resident, Ms. Wong, in the low care wing of an Aged Care unit. She suffered a stroke last year resulting in right sided weakness of both her right arm and right leg. She now walks with the help of a 4 wheel frame and needs assistance with her ADLs due to the weakness of her right arm. She is a retired Registered Nurse. She has a past medical history of Type 2 diabetes mellitus, hypertension and osteoporosis. She is currently on multiple drugs for all these conditions and is worried about forgetting to take her medications on time. When her medication was checked, it appeared that she had missed her doses on several occasions. She lives alone and has always been single. Her mother passed away 2 years ago and Ms. Wong, who was much attached to her, deteriorated both mentally and physically after the incident.

question 1 Determine the steps you would need to take in making a Nursing Care Plan (NCP) for Ms. Wong and the tools that you would use for her preventive health assessment (in 50-70 words).

Answer 1

The steps which has to be taken in making a nursing care plan

• Complete history collection regarding the illness and assessing the client for the illness
• Making an analysis
• Framing the appropriate evidence based nursing diagnosis
• Setting goals for the desired nursing diagnosis
• Nursing interventions and implementation of the plan
• Finally evaluating the outcome of the interventions provided

Here the nursing care plan will be

Assessment

Subjective data

• Weakness in the right side of body
• Walking with assistive aides
• K/c/o Diabetes ,osteoporosis

Objective data

• Weakness if upper arm and lower limb
• Loss of loved one
• Inability to do ADL
• Poor coping

Nursing diagnosis

Ineffective coping mechanism related to loss of mother as evidenced by difficulty to do ADL ,forgetting to take medication, physical and psychological changes

Goal

Will be able to cope up and lead a quality life

Nursing interventions and rationale

• Assess the coping strategies ,to plan for care
• Provide psychological support ,to let her speak her needs
• Encourage her to participate in social support group, online interaction with similar patient ,use of mass media to quit loneliness
• Practice yoga ,meditation ,relaxation therapy to enhance memory functions

Evaluation

The patient is able to cope with the situation and able to do ADL, take medication on time without skipping.