Nursing Theory Plan of Care Project

Nursing Theory Plan of Care Project

Sandra Jaynes, RN

Catherine Jordan, RN

Martha Lyons, RN

Lisa McDonough, RN

Elany Sayson, RN

NUR 513

November 7, 2011

Antonella Marchionna, MSN, RN

Nursing Theory Plan of Care Project

The goal for this care plan was to use Dorthea Orem's self -care theory to design a care plan to address the nursing problems of our assigned client, Mr. Issler.

Case Scenario of Mr. Isser

Mr. Issler is a 71-year-old male escorted to Schroder's Family Practice Emergency Room via his ex-daughter-in-law that indicated, "The patient was pale and diaphoretic today after exiting from an airplane flight of two and a half hours."

Vital Signs: Pulse rate of 58, BP 176/84, and a Respiratory Rate of 22 per minute. Pulse oximetry, 88% (on Room air). Height 72 inches and Weighs 147 pounds. Laboratory report showed: Na+ 143, K + 4.2, CO2 25, Chloride 101, Glucose, 130, Calcium 8.9, BUN 29, Creatinine 2.0, H, and an INR of 2.5.

Physical Examination: Head- within normal limits. Eyes- Pupils equal, round, and reactive to light accommodation (PERRLA). Ears- 3mm and Brisk. Nose- Within normal limits. Throat/Oral- Within normal limits. Cardiovascular-Sinus Bradycardia. Abdomen- Soft, with slight abdominal distention. Urine- Light Amber and clear.

Musculoskeletal- Generalized weakness. Skin- Intact, cool, pale, and diaphoretic. Neurological Examination: Alert and Oriented to person, place, and time. Speech was clear.

Past Medical History: CHF, DVT, and Thyroid. Note. Mr. Issler is uncertain if he has hyperthyroid or hypothyroid.

Current Medications: Synthroid, Lasix, Coumadin, and Metoprolol. Note. Patient has a large bag of medications.

Social History: Lives with his exdaugher-in-law after wife died two months ago.

Seen via ER cardiologist and referred for follow-up with this primary care physician to have his thyroid checked.

Theoretical statement:

Dorothea Orem's concept of provision of self- care, hence when a person can care for himself or herself, or when a person is cannot care for himself or herself, nursing assistance is needed.

Statement development is necessary and useful for theory development. In this case study, Orem's theoretical statements is based on relational statements. According to Walker and Avant (2011), relational statement is either association or causality. Associational statements are concepts that occur together. Causal statements are cause and effect relationship. Orem's theory is based on her experience, empirical generalizations, observations, inferences, and conceptualizations. Orem's theory is focused on the concept of self-care. Orem's statement described that a person will need nursing only under certain self-care limitations (Rosenbaum, 1986). Nursing care and interventions are necessary to reduce the self-care deficit.

Based on the case study, Orem's theory statement is related to causality and association. Mr. Issler is requiring nursing assistance because of his circumstances. Orem's theories: Theory of self-care, Theory of self-care deficit, and Theory of Nursing system are applied to Mr. Issler situation. The theory of self-care includes balance between solitude and social interaction and seeking appropriate medical assistance (George, 2011). Therefore, Orem's theory of self- care applied to Mr. Issler's living condition with his daughter-in-law, recent loss of his wife, seeking primary provider, and cardiologist.

The theory of self-care deficit includes maintaining nurse-patient relationship, providing support, and coordinating nursing care (George, 2011). Orem's theory applied in relation to Mr. Issler clinical manifestations e.g., pale, diaphoretic, vital signs and labs result; medical history, and follow up appointment.

The theory of Nursing Systems includes the assessment of the ability of a patient to perform self-care activities. Orem theory is applied in relation to maintain optimum functioning of Mr. Issler.

Orem's self-care theory predicts the nursing requirements and assistance. It helps nurses focus on helping patients to anticipate or meet self- care demands. Nurses are guiding, supporting a person and providing an environment that promotes personal development and teaching to meet self-care demands.

Congruence with Nursing Theory

One of the major assumptions in Orem's theory is that the patient being well educated in his or her actual and potential health problems is essential to promoting self-care behaviors (Dorthea Orem's Self Care Theory, 2011). To be consistent with this part of Orem's theory, teaching has been included into each aspect of the care plan. Mr. Issler will receive teaching on ways to conserve energy to help avoid fatigue, appropriate nutrition to maintain proper weight, and health maintenance techniques to cope with chronic disease.

A second component from Orem's theory that has been incorporated is her assertion that each client must be treated as a unique individual (Dorthea Orem's Self Care Theory, 2011). The care plan has been designed with his individual needs in mind; keeping in mind his recent family loss, medical history, and current symptoms. Customization includes assessing for fatigue, depression, and monitoring his BMI.

Orem also taught that each person should be responsible for his or her own activities of daily living. Her theory is designed around assisting patients to reach their highest self-care potential. In concert with this, Mr. Issley will be encouraged to take initiative in his care by independently performing ADLs (taking breaks as needed) and participating in teaching and asking questions.

In addressing the metaparadigms, Orem defined the purpose of nursing as to control or minimize the effects chronic conditions (Dorthea Orem's Self Care Theory, 2011). This care plan seeks to alleviate the effects of his chronic conditions and prevent some of his acute issues from becoming chronic. She also defined health as "being structurally and functionally whole or sound." (Dorthea Orem's Self Care Theory, 2011). The goal of the interventions in this