Running Head: NURSING PROCESS PAPER

Nursing Process Paper

Clayton Jensen
Professor Carrie Huntsman-Jones
NURS*408*01 East Midvale Elementary Clinical Site
October 3, 2014

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Abstract

For a physician to be able to see into someones life in a matter of fifteen minutes or less
and be able to diagnosis them is not as easy at it seems. Often times we see this diagnosis as
enough in our society and we do what we can to resolve it, but in reality, there is much more
going on than that which is brought to the physicians attention. As much as this diagnosis is
needed from them, what is happening in their home setting is just as important and in just as
much need of care. This is where a nursing home health assessment is able to meet the many
needs of a family managing and possibly suffering from the care and management of a sick or
injured member.
The focus of this assessment is on the S family as a whole and more specifically how
five of the six children have Glycogen Storage Disease and the effect that has had on all of them.
As you can imagine this weighs heavily on the familys ability to not only provide but also create
an environment where everyone is safe and equally attended too.
The Functional health patterns will be used to conduct the assessment of the S family.
The Functional health pattern assessment provides the database for forming nursing diagnoses
and care plans to best help this family in their future endeavors and life management.

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Pathophysiology:
Glycogen Storage Disease Type 6 (GSDVI)
According to the National Library of Medicine, Glycogen storage disease type VI (also
known as GSDVI or Hers disease) is an inherited disorder caused by an inability to break down a
complex sugar called glycogen in liver cells. A lack of glycogen breakdown interferes with the
normal function of the liver.
The signs and symptoms of GSDVI typically begin in infancy to early childhood. The
first sign is usually an enlarged liver (hepatomegaly). Affected individuals may also have low
blood sugar (hypoglycemia) or a buildup of lactic acid in the body (lactic acidosis) during
prolonged periods without food. The signs and symptoms of GSDVI tend to improve with age.
This condition is inherited in an autosomal recessive pattern, which means both copies of
the gene in each cell have mutations. The parents of an individual with an autosomal recessive
condition each carry one copy of the mutated gene. Although, they typically do not show signs
and symptoms of the condition but can.

HEALTH-PERCEPTION--HEALTH MANAGEMENT PATTERN

In the last few years the S family has gone through a lot, which is to be expected said
Mrs.S, living with and taking care of a family with 5 Glycogen Storage Disease type 6 (GSDVI)
children comes with the expectation of a number of hospital visits a year. Within just this
previous year she has taken her eight year old son to the hospital, for a few nights stay, a total of
9 times. They have also taken their eighteen-month-old daughter to the emergency room 3 times
within the past ten months. When I asked her about the previous years before this last year she
couldnt give me a definite answer because they visit the hospital so often with their children. In

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asking her why her children visit the hospital so much she said the main reason for most of the
hospital visits is because of diet issues. As one can imagine managing one childs diet with
GSDVI would be difficult, let alone 5 children. She said the visits are usually due to the fact that
one of her children is vomiting and because of that he or shes blood sugar will drop and drop
fast until they are extremely hypoglycemic. This can also occur when a child acquires a stomach
virus or flu and maintenance of blood sugar is miscalculated. She said that does not happen often
anymore, due to her experience, but can happen very easily. I asked her how this affects not only
the child being taken to the hospital but also her and the rest of her family. She proceeded to tell
me how it is very difficult for the rest of the family just due to the stress of having a sibling so
sick that they need hospitalization. This also weighs heavily on Mr. S to be able to not only
provide financially but also manage the other children left at home.
The best way for them to avoid these situations is to avoid it all together with diet and
hygiene. In order to do so the children have a strict diet of little to no sugar and practice good
hand hygiene. As recommended by University of Florida Health Glycogen Storage Disease
Program:
In GSD types III, VI and IX, galactose and fructose can be converted in the body
to glucose. In small quantities, these sugars do not cause harm, but foods high in
sucrose and/or fructose should be avoided since it will lead to over storage of
glycogen. The increased glycogen formation can worsen hepatomegaly, and it
may contribute to increased damage of the muscles in the glycogen storage
diseases that also affect the muscle. In addition, simple sugars increase insulin
production which, in turn can cause a rapid fall in glucose concentrations and
hypoglycemia.
While management of ones sugars with GSDVI is important, it is also important to
combine that management with the right amounts of carbohydrates, proteins, calcium and
multivitamins for the maximum dietary benefit. Mrs. S has been told to provide 2 grams of

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protein per kilo per day for each infant and roughly 1 gram of protein per kilo per day for each
child or to follow this graph:
University of Florida Health Glycogen Storage Disease Program
Category

Age (yrs)

Grams of protein per kg body weight per day

Infants

0.0-0.5

2.2

0.5-1.0

1.6

1-3

1.2

4-6

1.1

7-10

1.0

11-14

1.0

15-18

0.9

>20

0.8

11-14

1.0

15-19

0.8

>20

0.8

Children

Males

Females

(https://ufhealth.org)
She also provides a daily multivitamin and the correct amount of calcium recommended by her
physicians show in the graph below:
University of Florida Health Glycogen Storage Disease Program
Age

Amount (mg)/day

0-6 months

210

7-12 months

270

1-3 years

500

4-8 years

800

9-18 years

1300

19-50 years

1000

51 and older

1200

Pregnant/Lactating Women <18

1300

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Pregnant/Lactating Women >18

6
1000

(https://ufhealth.org)
Adequate complex carbohydrate consumption is extremely important in all GSD patients
diets. A lack of sufficient carbohydrates can result in an increase in occurrences of
hypoglycemia. A lack of carbohydrates will also increase glycogen and/or fat breakdown leading
to increased ketone formation in the body.
Uncooked cornstarch serves as the best way to provide a carbohydrate for people who
suffer from GSDVI. This is because cornstarch is digested at a slower rate than other complex
carbohydrates and provides a slow steady amount of glucose that the body can handle without
the livers help. This creates a kind of pseudo-liver for these people since their livers can not
handle storing any excess sugar. For example:
A candy bar will provide the body with a boost of sugar obviously, but if the sugar
metabolism rate is exceeded the body will therefore store the precious excess
sugar in the liver for later use as glycogen. Well, this is not good for those with
GSDVI because they cant get rid of the sugars in their liver once they are stored.
By providing the cornstarch, the sugar acquired from its metabolism is at a slow
enough rate that the body can handle the sugar amount without ever needing to
store excess in the liver for later. This in turn prevents fatty liver and liver damage
in GSDVI suffers
The ratio that the S family uses for the cornstarch is 1 gram per kilo per dose. So in the case of
the 8 year old (A.S.) in the family who weighs 38 lbs. he would get around 17 grams per dose
per day 3 times a day. They would put that in about 6 oz. of water. They have also found that the
best brand of cornstarch to use is ARGO because it tends to have the most consistent breakdown
in comparison with all other brands. The way they take it is by mixing the ARGO cornstarch

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with water and adding MIO drink-mix (no sugar added sweetener) for taste three times a day. As
you might have assumed when cornstarch mixes with water it thickens with time. So knowing
this they have to drink the mixture fast enough so that the mixture doesnt become a solid but
also slow enough so they dont get sick. Mrs. S mentioned that if her children do drink the
mixture too fast they will end up with a grainy diarrhea, which puts them in danger again for
hypoglycemia. So in the end they need the cornstarch to prevent hypoglycemia and fatty liver but
also they can get hypoglycemia from the cornstarch by drinking it to fast and causing vomiting
or diarrhea. Also it helps to drink the cornstarch mixture 30 minutes after eating, too soon will
also cause vomiting and ultimately hypoglycemia.
Now, you might ask, what about a baby? Are they going to drink the cornstarch too in
order to get that longer lasting, slower release of sugar in their system? No, they are not. In the
case of infants who are breastfeeding and are too young to eat the cornstarch, they have to be fed
every 2 to 3 hours no matter what. This is to keep them from getting hypoglycemic but also
preventing them from eating too much and damaging their liver. In other words, the life of a
parent with a GSDVI infant is not all that pleasant and is lacking in sleep and time for anything.
Another practice they have is to stay physically activity and healthy. Although there isnt
any research Mrs. S and her doctors know that it is theorized that exercise is beneficial, she still
makes sure her family gets it. She said that it seemed to help her kids feel better for the long run.
Of-course the right amount of sugars, carbs, proteins, etc. are calculated to provide the correct
amount needed for such activities.
No one in this family uses any tobacco products or alcohol. This is highly recommended
simply because if the children with GSDVI where to obtain the habit of drinking alcohol they
would no doubt go into liver failure and potentially die. Backing up these practices in their home

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is that of their beliefs. Due to being a practicing LDS family they have not only health reasons to
not drink alcohol but also religious beliefs supporting that choice.
They participate in their recommended yearly vaccinations and screenings and have yet
to find any type of negative effect from this. If anything this is significantly helping them
because when one of the children that has GSDVI gets sick it isnt just something they will get
over without hospitalization and/or professional care.
Their insurance provider is Blue Cross Blue Shield and they feel quite satisfied with it
and the care they receive through it. In the past it was hard for them and their insurance to
identify if their insurance covered the management and treatment of their childrens GSDVI.
This is because of the rarity of this disease and due to that, their insurance company had to look
deeper into the policy to see if it was covered, which it was.
This is also another issue they ran into with the care of their children. All the doctors in
the state never heard of GSDVI or they had no idea how to treat it. She spoke of most of the
treatment recommended by her doctors was acquired from the Internet. This was extremely
difficult for the family and their first child. She said, not knowing what was wrong was terrible
but for the doctors to not know anything either was extremely disconcerting. They did end up
being able to put a finger on what type of disease their child had (GSD) but that also left them
with another dilemma, which type of GSD did their child have because each type is significantly
different as well as its treatment. When they had their first-born scanned for the first time they
found that his liver was the size of an adults at 7 months. When they really looked at his liver
they found that it appear to have little tumors inside it, but in fact that was actually the only
health part of the liver left. The rest of the liver was fat. Due to a lot of personal research and the
help of her doctors she was able to find a specialist on GSD that lives in Florida. This helped

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tremendously to correctly diagnose the child but also relieve some of the stress of being in the
dark. He was also the first to mention the use of cornstarch and which kind is most effective.
With the extra insight from the specialist they were able to get their sons liver back to normal
through a special diet and its management.
Even with all the help they have gotten thus far there are still things that the family needs
more knowledge on and clarification. For one, the doctor they are working with mentioned that
they need to pay scrupulous attention to dental hygiene with these types of diseases. She didnt
know why but continued to do as they were told just in case. I said I would find out and let her
know. I have since called and confirmed that the dental hygiene is a means of preventing
infection. First and for most, it is very important that GSDVI patients can eat. If they cannot, due
to an oral infection, they will become hypoglycemic fast. Also once we get an infection the body
needs to utilize sugar for energy to fight the infection off which in turn could sends them into a
further hypoglycemic state than just not eating would.
At first glance you would not take this family for being a family that is dealing with
serious disease. Although, you also would not consider them the healthiest group of people
either. Both parents are severely over weight and their living situation is very cluttered and
messy. I dont know if I would use the description of a lack of sanitation but I would not like to
live or eat there. Despite this, the parents are the only two on prescription medication and
minimal amounts at that. The Mrs. S is taking Lisinopril for her high blood pressure and Mr. S is
taking Simvastatin for his cholesterol.

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Family Genogram: Keep in mind the father does not have a strong relationship with his parents
so therefore he doesnt know much about them.

- Deceased
- Unknown

- Deceased
- Emphysema
- Breast caner

- HTN

- Breast
Cancer

- 65 yrs

- 64 yrs

- High
Cholesterol
- 41 yrs

- GSDVI
- 15 yrs

- GSDVI
Carrier
- 14 yrs

- GSDVI
-10 yrs

- HTN

-Rheumatoid
Arthritis
- HTN

39 yrs

- 41 yrs

- GSDVI

- GSDVI

- 8 yrs

- 3 yrs

- GSDVI
- 1 yrs

*Aunt is suspected to having GSD as

well because Rheumatoid Arthritis is considered a symptom of not treating GSD for a long
period of time. *

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Upon examination of their home I found that it was not a place that I would recommend a
person to raise children. It wasnt that the integrity of the home was falling apart but rather there
was so much clutter and trash everywhere that it was hard to find a place to sit, let alone live.
Also they did not appear to have a location where they could eat at a table because the table was
being used to hold things. As for their trash disposal and other waste disposal, they said that they
have no problem with that and their trash is picked up every Thursday. I asked the question to see
if I could get anyone to mention the trash throughout the house and why it wasnt in the trash,
but the topic was quickly changed as if they were ashamed by their living arrangements. The
children themselves look clean and well taken care of but the rest of the house was in shambles.
It was apparent that the parents of the home have a difficult time finding time outside of taking
care of their children to clean house. I asked her about this due to her embarrassment and my
curiosity and it was just that, she said she just doesnt have the time to do any one thing without
having to regulate something with her kids.
Potential nursing diagnoses:
Risk for Ineffective Relationship - Lack of personal time spent together between husband
and wife and even between parent and child due to there being so many with issues.
Risks for Chronic Low Self-Esteem Children have a life long disease.
Sedentary lifestyle AEB extremely messy home.
Risk-prone health behavior - Mothers diet consists of Pepsi and not much else.
Risk for Ineffective health maintenance Due to many health regulations that need to be
followed.
Risk for infection - During potential hypoglycemic states the immune system is
weakened.
Risk for sudden infant death syndrome Baby can go into hypoglycemia state very easily
and die from it.
Risk for contamination Due to filthy home.
Risk for poisoning Due to high carb high sugar foods being out for kids to eat and also
having dish detergent and cleaning supplies not put away in a safe locations.
Impaired comfort AEB the lack of places to sit and even walk.
Inadequate finances AEB mother saying they are always struggling to make ends meat.
NUTRITIONAL-METABOLIC PATTERN

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Most of what is mentioned above will descriptively explain the familys nutritional
patterns due to the fact that the main issue of the family is that of the children and their GSDVI. I
did see that they had food in unusual places amongst the clutter through out the house. For
example: I saw a loaf of bread on top of the clutter all over the table, gummy snacks for the kids
on the fireplace mantel, and some kind of bread in the living room on the piano amongst other
things here and there.
On the flipside, she was very proud of the fact that her kids go through an average of six
to seven glasses a day of water. She spoke of its importance to their diet. Despite that, she knows
how good it is for them to be well hydrated. They didnt report any dental, skin, or healing
problems as well.
Potential nursing diagnoses:
Risk for Imbalanced nutrition: less than body requirements Not enough sugar consumed
results in hypoglycemia.
Risk for Imbalanced nutrition: more than body requirements Too much sugar consumed
results in fatty liver and death.
Unstable blood glucose level AEB livers inability to release glycogen when stored (aka:
hypoglycemia.
Impaired liver function AEB abnormal accumulation of sugar and fat in the liver
Readiness for enhanced fluid balance Mother knows the effect of staying hydrated for
her and her family especially those with GSDVI and wants to make sure everyone
benefits from it.
ELIMINATION PATTER
The family did not report any use of laxatives. They said if those with GSDVI really
needed to have a bowel movement all they would have to do would be to change one of the
many things in their already strict diet and that would mimic a laxative. They did not report any
constipation issues but diarrhea is something they look out for if one of the GSDVI kids does not
manage their diet properly as mentioned before.

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Even though the family said there is not a problem with waste disposal I would beg to
differ. Yes, they might have all the resources to do so, but based off of the cluttered living
arrangements I would say they need to adopt a new practice in hygiene and cleanliness around
the home. They do have two dogs that live in the house as well (Chiwawas) and I would guess it
would be easy for those dogs to find a location to urinate or defecate without the family ever
knowing in that home. I am not trying to say that the dogs arent potty trained but that it would
be easily overlooked if one would have an accident in the home due to the present mess.
When I asked about potential insect or rodent problems they did mention ants and
roaches here and there but that was it. I would wager though that there is a lot more than they
think going on under all the clutter. If I were a pest, that would not only be an optimal location
for me to live but also the fact that food seemed to be everywhere it wasnt suppose to be would
provide me easy access to food as well.
Potential nursing diagnoses:
Risk for Diarrhea Drink Cornstarch too fast or too soon.
Risk for dysfunctional gastrointestinal motility High chance of diarrhea due to diet ill
management.
ACTIVITY-EXERCISE PATTERN
Like mentioned previously, the mother mentioned the importance of exercise in their
family. They said they all love to hike in the mountains and play sports. The sports of choice for
her and her children are soccer, softball, baseball, and swimming. She said her kids spend most
of their time outside playing while it is light out. Upon examination on her children, each showed
no sign of obesity our lack of nutrition. They looked as fit as children their age should be. As for
the mother she definitely falls into the obese category but from her description of what a day is
like for her she is by no means sitting around doing nothing. She is constantly on the move doing

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something productive. So, if I had to say, her obesity probably is due to not only genetics but
also due to a high stress lifestyle, which would be hard to avoid in her scenario.
When they are not outside playing and have a moment to sit down, they enjoy watching
movies together or playing cards or a board game. Mrs. S said that usually the kids get a little
time at night to do just that before they have to go to bed for the next day but she rarely gets
around to taking a moment for herself. This posed an interest in getting her a chance to talk about
how she manages her stress and when she gets time for herself, if ever. (Discussed further in
COPING-STRESS-TOLERANCE PATTERN/VALUE-BELIEF PATTERN)
For their transportation they have a van and a sedan. Mr. S usually is driving the sedan
from work and back so that leaves the van for Mrs. S and her children. She said it recently has be
a great car as well for the sedan. In the past they have had to make repairs here and there for both
cars but noting extremely expensive. Like their home though, theirs cars were very cluttered and
messy and trying to talk about this with them was quickly avoided. As mentioned before it
seemed as though Mrs. S was quite embarrassed about her house and its cleanliness so
apparently there are some issues and sensitivity in the area. According to her houses integrity is
in good shape.
Potential nursing diagnoses:
Fatigue AEB mothers testimony of always needing Pepsi to keep her running.
Impaired home maintenance AEB filthy home
Readiness for enhanced self-care Mother wants to be able to find a way to take time for
herself while still adequately taking care of her family.
Self-neglect AEB mothers account of how her and her husband never have time for
anything else but their children.
SLEEP-REST PATTERN

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This is an area that really needs some work in the family, especially for the mother. This
obviously will improve with time because the one year old will eventually be able to take the
cornstarch. So, currently the baby needs to be fed every two to three hours in order to keep
satiated as well as prevent any GSDVI issues that can occur due to too much food at a time. So,
since this is the job of the mother of the family you might guess that she is always lacking in
sleep. She said she might get something like four hours of sleep a night, more or less. This is not
only due to the feeding regime of her youngest but also get up in time to get her other children
off to school with a proper breakfast that is all calculated and a lunch that has the same values
met. This would include not only counting carbs and sugars but also measuring out the
cornstarch for each child for their morning does and lunchtime doses. They also test each childs
ketone levels with ketone strips and put together a calculated snack for school. She said
mornings are probably the most difficult time of day just because of the organized chaos
combined with her lack of sleep. She mentioned hoping she would get used to the lack of sleep
but she has yet to do so. The family does seem to find time to rest here and there but for the most
part there is always something to do.
Potential nursing diagnoses:
Sleep deprivation AEB feeding regime for the youngest child of feeding every 2 to 3
hours
Readiness for enhanced sleep Mother and father wish they could find a way to get more
sleep
Disturbed sleep pattern AEB getting up every 2 to 3 hours a night to feed baby.
COGNITIVE-PERCEPTUAL PATTERN
The family all seem to be well educated. The mother has a general associates and father a
bachelors in business. The mother mentioned that her kids do very well in school making As and
Bs. When I asked conceptual questions they had no trouble understanding the question and

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giving me a straightforward answer. They only speak English so therefore that is what is spoken
in the home. None but the father wear glasses and everyones hearing is fully intact.
Potential nursing diagnoses:
Risk for compromised human dignity Familys lack of time to clean home for when
visitors might come and see it.
Risk for Disturbed body image Naturally larger genes in family, 14 (carrier) year old
girl is already worried about how she is gaining unwanted weight.
Stress overload AEB families inability to manage much else but their medical problems
therefore a lot of other things are neglected and create stress on the family.
Deficient knowledge AEB the lack of information on GSDVI we have. Very rare disease.
Readiness for enhanced knowledge Mother and childrens many questions about how
the body works and how better to manage their disease. I, of-course, didnt know the
answer because I am so unfamiliar with the disease and how to manage it.
Risk for depression Life long disease. Being different than everyone else. Lack of
attention from parents due to other siblings needing their attention more.
SELF-PERCEPTION--SELF-CONCEPT PATTERN/ROLE RELATIONSHIP PATTERN
When I asked Mrs. S about the general atmosphere in their home and if it was positive or
negative she hesitated a little bit. She then asked if I was talking about everyone or just her. She
said the general atmosphere of their home is a positive and family oriented one. As for herself,
she often times feels so overwhelmed that she gets pretty negative. She proceeded to say how
this is probably how it is in most homes and how she usually gets over it in a few hours. She said
for the most part everyone is happy including herself but at times she just needs time to collect
herself before she feels happy again.
She continued to explain that their never is any one thing that gets her in a bad mood but
just the build up of several days of little things that she has to fix. For example she mentioned
how her kids and even her husband will not put things back where they go, or when she finally
does get around to clean something it is quickly back to its original cluttered dirty state. In other
words, she does not get much help around the house, if anything those in the house are almost
playing against her. She feels that she cannot really complain to her husband because he works

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so hard to keep them afloat and she feels her kids are too young to really make a difference. At
this point I interceded with my experience with doing specific chores every weekend around the
house before I could go play and I started around 8 years old. She took this to heart and said she
will try to start something like that with her older kids.
As mentioned, the father works a lot to keep things running in their home. She said that
he often times goes to work at 7am and comes home at 9 or 10pm. More often than not he just
goes strait to bed after eating something to start again the next day. They do get time on the
weekends though to spend time with each other and do family activities. It is something that Mr.
S looks forward to every week. He loves his children.
When I finally asked her to rate the general mood state of the family (nervous (5) or
relaxed (1)) she said that in the mornings it is a 4 and the rest of the day is a 2. This is due to all
the things that everyone needs to do in the mornings before school. The rest of the day is a 2
because she is still taking care of two children at the same time while trying to get things done
around the house. The general assertiveness of the family ((5) assertive (1) passive) is at about a
2 she said, which she thought as being healthy.
Through observation I found that Mrs. S is the one that really runs the house. She
mentioned that if the children get out of hand she is the one to discipline, but if that doesnt do
the trick Mr. S will put the kids in place. They dont believe in always exercising physical
discipline but at times it is called for and seems to be the only way to get through to her children.
She said this is a rare occasion when it happens but is does happen every once in a while.
Potential nursing diagnoses:
Caregiver role strain AEB mother and father never getting a moment to themselves and
from their testimony of having a lot of stress.

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Risk for impaired parenting Due to the many things have to be managed like diet there
is a higher chance for the parents to either mess up or neglect something or someone
because of the many other things they have to do.
Risk for ineffective relationship - Lack of personal time spent together between husband
and wife and even between parent and child due to there being so many with issues.

SEXUALITY-REPRODUCTIVE PATTERN
The only thing that I felt was worth discussing and was appropriate in this section was
that of having more children or not. She was curtain that they are not going to have anymore
children but that is what they said before their youngest was conceived. She said that was not
planned but they are very happy she is with them. They do use birth control but she often times
forgets to take her pill which is how she thinks she got pregnant with her youngest. She claims to
be more thorough now about taking her pill.
Potential nursing diagnoses:
Risk for ineffective childbearing process Parents accidentally got pregnant with 6th
child and they havent really changed all that much to prevent getting pregnant again
other than mother will be more religious about taking birth control pills.
COPING-STRESS-TOLERANCE PATTERN/VALUE-BELIEF PATTERN
I live on Pepsi said Mrs. S when I asked her about her means of keeping up with
everything and managing her stress. She continued to say that the rest of the family is generally
relaxed. The children are always playing outside which is there way of getting the energy/stress
out. As for Mr. S, his time on the weekends with his family is his time to de-stress and relax. If a
problem ever arises they are quick to evaluate their options and also include prayer in their
decision. She said that their religion is a huge source of stress management in their home. They
are practicing LDS members. She did mention that at times this is also a stressor since she is the

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chorister for the Primary, which just adds more to her workload, but she said it is well worth it in
the end. She said, I have excepted that my life as a mother of 6 children is going to be stressful.
My next step is to continuously figure out better and better ways to manage it. I agreed with her
that there will always be a better way to do something. Its just finding it and managing your own
stress whilst doing so that is hard.
Potential nursing diagnoses:
Risk for Anxiety Due to the overload or responsibility on the parents
Readiness for enhanced coping They are always looking for a better way to do
something.
Fear AEB mother expressing it about her children not receiving what they need and
potentially going to the hospital for it.
Risk for impaired religiosity Due to the difficulty of getting family to church and also
due to the added strain of having a calling in the church on top of the already stressful
life.
Risk for spiritual distress Mother said Why God thought it a good idea to do this to her
and her family with the GSDVI
OTHER CONCERNS (INDIVIDUAL OR FAMILY)
There was nothing else that she or her family members felt they needed to mention that
was not addressed in the previous sections.
FIVE NURSING DIAGNOSES AND WHY

The five nursing diagnoses that I felt were most important for the family to address
and work on are: risk for imbalanced nutrition, deficient knowledge, stress overload, risk for
poisoning, and impaired home maintenance. I chose these because I felt these where what
needed fixing the fastest. There are plenty of other diagnoses that need goals and
interventions as well but these were urgent. Risk for imbalanced nutrition interventions and
goals are critical because the main issue in the home is the care of those with GSDVI, which

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20

all has to do with diet. Deficient knowledge interventions and goals are critical as well due to
the severity of doing something wrong with these GSDVI kids and their diets. Knowing more
never hurt too. Stress overload, due to the effects that stress can have on the people doing the
caring and those being taken care of. If you have an overly stressed caregiver the risk of that
person making mistakes are much higher and their personal health is also suffering. Just as
important, those that are being cared for that are severely stress wont progress and might
even regress due to it. Risk for poisoning might not be the most apparent diagnosis if this
family was assessed on paper, but it is definitely urgent for this family. Things like cleaning
supplies need to be put in locations inaccessible to the children in the home, but also due to
the GSDVI children in the home having high carbohydrate and high sugar foods out
everywhere is just as dangerous. Lastly, the diagnosis of impaired home maintenance needs
attention too. If the home was clean, a lot of these other issue they have, both on this list and
not, would be solved. You need a safe environment to raise a happy health family and I
believe if these diagnoses where eliminated they would have just that

Subjective and
objective data that is
pertinent to the
nursing diagnosis.

Nursing Diagnosis
R/T & AEB or
AMB if applicable

Short and long term

measurable and realistic
patient goals & outcomes

Subjective The
family saying that
they basically
walk a fine line
between eating
too much sugar
for their livers to
handle or not
eating enough
and running the
risk of
hypoglycemia
(vomiting results

Risk for
Imbalanced
nutrition R/T
Excessive
intake in
relationship to
metabolic need
and Inability to
ingest or digest
food or absorb
nutrients
because of
biological,

Long term - Display

normalization of
laboratory values
and be free of signs
of malnutrition as
reflected in Defining
Characteristics by
the end of the
month.
Short term Verbalize
understanding of

Nursing interventions
Independent (Including all
assessments, treatments,
medications)

Documented rationale for your

interventions and references

1. Perform a nutritional
1. This should include types an
assessment.
amount of foods eaten, how
2. Assess ability to read
is prepared, the pattern of in
food labels.
(time of day, frequency, othe
3. Assess ability to plan a
activities patient is engaged
menu, making
while eating)
appropriate food
(www1.us.elsevierhealth.co
selections.
2. Food labels contain informa
4. Determine healthy body
necessary in making approp
weight for age and
selections, but can be mislea
height. Refer to dietitian
(www1.us.elsevierhealth.co
for complete nutrition
3. Cultural or ethnic influences
assessment if 10% under
to be identified and addresse
healthy body weight or if
(www1.us.elsevierhealth.co

NURSING PROCESS PAPER

in hypoglycemia
too)

psychological,
or economical
factors

Objective
Seeing lollypops,
candy and other
forms of food that
would spike
blood sugar levels
all over the house
in unorthodox
locations.

21

rapidly losing weight.

4. Establishing those that are a
causative factors
5.
Discuss
with
the
client
will better help care taker de
when known and
those aspects of their diet
a plan to better to suit them
necessary
that
will
remain
(www1.us.elsevierhealth.co
interventions by the
unchanged.
5.
Aspects of the client's life th
end of assessment.

Long term Demonstrate

behaviors, lifestyle
changes to regain
and/or maintain
appropriate blood
sugar levels by the
end of the month.

6. Negotiate with the client

meaningful and valuable to
regarding the aspects of
should be understood and
his or her diet that will
preserved without change
need to be modified.
(Leininger, 1996).
7. Validate the client's
6. Give and take with the clien
feelings regarding the
lead to culturally congruent
impact of current
(Leininger, 1996).
lifestyle, finances, and
7. Validation lets the client kno
transportation on ability
that the nurse has heard and
to obtain nutritious food.
understands what was said,
8. activity level/exercise
promotes the nurse-client
patterns of each family
relationship (Leininger, 199
member.

Subjective and
objective data that is
pertinent to the
nursing diagnosis.

Nursing
Diagnosis R/T
& AEB or
AMB if
applicable

Short and long term

measurable and realistic
patient goals & outcomes

Objective - Family not

only has dish detergent
and cleaning supplies
out everywhere but
also food that could
potentially do serious
damage if to much was
eaten by one of the
GSDVI patients.

Risk for
Poisoning
R/T
improper
storage of
household
hazardous
materials
and food.

Short term Put all

household hazardous
materials in a
designated and safe
place within 2 hours

Subjective none
A poison is any
substance that impairs
health or destroys life
when ingested,
inhaled, or absorbed
by the body. Any
substance can be
poisonous if too much
is taken. Sources in a
persons home include
drugs, medicines,
other solid and liquid
substances and gases
and vapors. Poisons
can impair the
function of every
major organ system.
(Wilkinson & Treas)

Nursing interventions
Independent (Including all
assessments, treatments,
medications)

Documented rationale for your

interventions and references

1. Purchase baby proof (1,2) - Remember that when

locks or knobs to
comes to childproofing a
prevent access to
home, more is better. Kee
storage locations.
dangerous things up high
2. Designate specific
good, but keeping danger
locations for hazardous
things up high inside a cl
materials preferably to
Short term Remove
with a childproof knob is
locations higher than
food that would be
better.
what a child could get
tempting for your
(www.keepyourchildsafe
to.
GSDVI children to eat 3. Get down on your
3.It may help tip you off to
and potentially suffer
potential hazards that yo
hands and knees and
crawl
around
your
from within 2 hours.
might not have otherwise
house, noticing things
noted
from your childs
Long term Baby
(www.keepyourchildsafe
vantage
point.
proof storage locations
4.By having fast access to
4. Install emergency
for hazardous
emergency numbers you
phone numbers, such
materials with locks or
reduce the time period
as police, fire, poison
baby proof knobs by
between accidents and he
control, etc., at every
the end of this week.
arriving
phone around the
(www.keepyourchildsafe
house.
Long term Do not
5. Note family members 5.These factors affect the pe
place anything that is
ability to protect self/oth
age, gender,
not suppose to be
and influence choice of
socioeconomic status,
each persons
eaten anywhere for
interventions/teaching.
developmental,
more than 20 min
(Doenges, 2010, p.637)

NURSING PROCESS PAPER

22
without putting it back
in a secure location for
the next month.

Subjective and objective

data that is pertinent to
the nursing diagnosis.

Nursing Diagnosis
R/T & AEB or
AMB if applicable

Subjective - Me and my
husband have no time
for anything about our
kids and everything else
that needs to be done,

Stress overload RT work, family,

and personal
responsibilities
(multiple coexisting stressors)
AEB pt statements
We never get time
to relax, and We
are always worried
about our blood
sugar levels.

Objective - The stress on

the children to keep true
to their diets for fear of
damaging their liver or
becoming hypoglycemic
and having to visit the
hospital again.

Short and long

term measurable
and realistic patient
goals & outcomes
Short Term Family will review
the amounts and
types of stressors
in daily living in
three days and tell
me them via
telephone.
Long term - Client
will reduce stress
levels through use
of relaxation
techniques and
other strategies by
the end of next
month (Halloween
- 10-31-14)
Short term - Report
negative effects
from stressors by
the end of
assessment.

decision making
abilities, level of
cognition and
competence.

Nursing interventions
Independent (Including
all assessments,
treatments, medications)

1. Listen actively to
descriptions of
stressors and the
stress response.
2. Categorize
stressors as
modifiable or
nonmodifiable
3. Encourage social
support.
4. Explore possible
therapeutic
approaches such
as cognitive
behavior therapy,
biofeedback,
neurofeedback,
pharmacologic
agents, and
complimentary
and alternative
therapies.
5.Note each family
members gender,
age, and
developmental
level of
functioning.

Documented rationale for your intervent

and references
1.

Having an opportunity to speak about

stressors is helpful in dealing with str
overload. Listening engenders trust a
trust is the first step in the process of
helping clients to reduce the psycholo
distress of stress overload (Ackley &
Ladwig, 2012, www.pterrywave.com
2.Removing or minimizing some stressors
changing responses to stressors, and
modifying the long-term effects of stre
all actions that can assist those with di
and stress (Ackley & Ladwig, 2012,
www.pterrywave.com).
3.Stressors in highly valued roles affect ph
health only when there is insufficient
emotional support from social network
(Ackley & Ladwig, 2012,
www.pterrywave.com).
4.These types of therapies decrease the
sympathetic nervous system response
stress. Neurofeedback promotes optim
functioning of the central nervous syst
induces relaxation, and supports health
balance, flexibility, and resilience. Ad
who had experienced hospitalizations
least 5 days said that spirituality
strengthened their coping ability (Ack
Ladwig, 2012, www.pterrywave.com)
5.Women, children, young adults, and divo
and separated persons tend to have hig
stress levels. Multiple stressors can we
the immune system and tax physical a
emotional coming mechanisms in pers
any age, but particularly the very youn
elderly. (Doenges, 2010, p.805)

Subjective and
objective data that
is pertinent to the
nursing diagnosis.

Nursing
Diagnosis R/T
& AEB or
AMB if
applicable

Short and long term

measurable and realistic
patient goals &
outcomes

Nursing interventions
Independent (Including all
assessments, treatments,
medications)

Objective
house was very

Impaired
home

1. Assess home
Short term - The
environment, financial
family will identify

Documented rationale for your

interventions and references

1. Assessment information w
assist in identifying

NURSING PROCESS PAPER

cluttered and
dirty. No where
to sit or place
anything
Subjective
Mother saying,
my house is
suck a mess. It
is so
embarrassing.

maintenance
R/T family
with
medically
impaired
individuals
that need
management
AEB
Outward
expressions
by individual
or family of
difficulty in
maintaining
the home or
in caring for
self or
family
members

23
resources, patients
knowledge about selfcare; and communication
patterns in the family
List obstacles to effective
home maintenance
management with patient
Short term - The
and family to develop
family will
understanding of
demonstrate the
potential and actual
ability to perform
health and safety hazards.
skills necessary for
Being discussion at
patients level of comfort.
the care of their
3.
Discuss home
home by the end of
environment
the week.
4. Assist family members to
assign daily and weekly
Long Term - Express
responsibility for home
satisfaction with
maintenance activities.
home by the end of 5. Assist family members to
the month.
contact community
agencies that can assist
them in their efforts to
improve home
maintenance
management.

factors that restrict

self-care and home
management by the
end of the
2.
assessment.

Subjective and
objective data that is
pertinent to the
nursing diagnosis.

Nursing Diagnosis
R/T & AEB or
AMB if applicable

Short and long

term measurable
and realistic patient
goals & outcomes

Objective Lots of
facial expressions of
doubt in what was
being told to us by
family members.
Looking to one
another for
conformation that
what they said was
right. Lots of secondguessing.

Deficient
knowledge R/T
Unfamiliarity with
information
resources, rarity of
the disease, and
lack of time to
acquire it

Short term - All

1.
family members
will participate in
learning process
during our
2.
assessment/teaching
opportunity.
3.
Short term Identify
interferences to
4.
learning and
specific action(s) to
deal with them
during our
5.
assessment/teaching
meeting.

Subjective Family
saying that they are
not sure or dont
know about some
things that have to do
with what the GSDVI
disease truly is on a

Nursing interventions
Independent (Including
all assessments,
treatments, medications)
Assess motivation
and willingness of
patient and caregivers
to learn.
Assess ability to learn
or perform desired
health-related care.
Identify priority of
learning needs within
the overall plan of
care.
Question patient
regarding previous
experience and health
teaching.
Identify any existing
misconceptions
regarding material to
be taught.

2.

3.

4.

5.

appropriate interventions t
after
(http://nandanursingdiagno
org).
People, especially adults, l
best where they have speci
needs to fulfill
(http://nandanursingdiagno
org).
To determine ability to car
for self and to identify
potential health and safety
hazards. (Doenges, 2006,
p.294)
Having a schedule will
promote consistency in
following the plan of care
(http://nandanursingdiagno
org).
Community resources can
lessen familys burden whi
members learn to function
independently for the unit
(http://nandanursingdiagno
org).

Documented rationale for your interventions

references

1. People must see a need or purpose for learni

Some people are ready to learn soon after
diagnosed; others cope better by denying
delaying the need for instruction. Learnin
requires energy, which people may not be
use. Persons also have a right to refuse ed
services (www1.us.elsevierhealth.com).
2. Cognitive impairments need to be identified
appropriate teaching plan can be designed
3. People learn material that is important to the
(www1.us.elsevierhealth.com).
4. A whole family can bring many life experien
each learning session. Families learn best
teaching builds on previous knowledge or
experience (www1.us.elsevierhealth.com)
5. This provides an important starting point in
education (www1.us.elsevierhealth.com).
6. Self-efficacy refers to one's confidence in th
ability to perform a behavior. A first step i

NURSING PROCESS PAPER

pathophysiological
level amongst other
levels of its
understanding.

24
Short term Verbalize
understanding of
pathophysiological
condition/disease
process.

6.

7.

8.
Long term - Initiate
necessary lifestyle
9.
changes and
participate in self
education about
GSDVI by the end
of the month.

Determine familys
teaching may be to foster increased self-e
self-efficacy to learn
the learner's ability to learn the desired
and apply new
information or skills
knowledge.
(www1.us.elsevierhealth.com).
Provide physical
7. This allows patient to concentrate on what is
comfort for the
discussed or demonstrated. According to M
learner.
theory, basic physiological needs must be
Provide a quiet
addressed before patient education
atmosphere without
(www1.us.elsevierhealth.com).
interruption.
8. This allows patient to concentrate more com
Establish objectives
(www1.us.elsevierhealth.com).
and goals for learning 9. This allows learner to know what will be dis
at the beginning of
and expected during the session. Adults te
the session.
focus on here-and-now, problem-centered
education (www1.us.elsevierhealth.com).

Work Cited
Ackley, B.J., & Ladwig, G.B. (2008). Nursing Diagnoses handbook: An evidence-based guide to
planning care (8th ed.). St. Louis, MI: Mosby Elsevier (www.pterrywave.com)
childproofing your home: safety tips and childproofing checklist. (n.d.). childproofing your
home: safety tips and childproofing checklist. Retrieved September 30, 2014, from
http://www.keepyourchildsafe.org/child-safety-book/home-childproofing-tips.html
Deglin, J. H., & Vallerand, A. H. (2009). Davis's drug guide for nurses (11th ed.). Philadelphia,
Penn.: F.A. Davis.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales. Philadelphia: F.A. Davis.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nurse's pocket guide: Diagnoses,
prioritized interventions, and rationales. Philadelphia: F.A. Davis.
EHS: Nursing Diagnosis Care Plans, 4/e - Knowledge Deficit - Patient Teaching; Health
Education. (n.d.). <i>EHS: Nursing Diagnosis Care Plans, 4/e - Knowledge Deficit Patient Teaching; Health Education</i>. Retrieved September 29, 2014, from
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ml
Glycogen storage disease type VI. (n.d.). Genetics Home Reference. Retrieved September 28,
2014, from http://ghr.nlm.nih.gov/condition/glycogen-storage-disease-type-vi
Herdman, T. H. (2012). NANDA International nursing diagnoses: definitions & classification
2012-2014 ([Rev. ed.). Chichester, UK.: Wiley-Blackwell.
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concepts, theories, research & practice</i> (3rd ed.). New York: McGraw-Hill.

NURSING PROCESS PAPER

25

LeMone, P. (2013). Medical-surgical nursing: critical thinking in patient care. (5th ed., Pearson
new international ed.). Upper Saddle River, N.J.: Pearson
Nursing diagnosis IMPAIRED HOME MAINTENANCE. (n.d.). Nursing Diagnosis for
Nurses and BSN students. Retrieved October 2, 2014, from
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Wilkinson, J. M., & Treas, L. A. (2011). Fundamentals of nursing (2nd ed.). Philadelphia: F.A.
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