Running head: PLAN OF CARE 1

Plan of Care

Brean Simms

Delaware Tech Community College

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Plan of Care

Deborah is a 66-year-old African American female residing in Smyrna, DE. She is

retired and lives at home with her husband, Lionel, who is 71 years of age. Deborah was forced

into early retirement with an arthritis laden body which limited her mobility, and eventually

caused her to be wheelchair bound. She reluctantly underwent back surgery in 2013, which led

to her obtaining a DVT in her left leg which resulted in lymphedema of her bilateral lower

extremities. For years, she visited a rheumatologist that would give her cortisone injections in

her hips, but one day it just wasn’t enough. The following year she had bilateral total hip

replacements, and once she healed from that surgery, she had bilateral total knee replacements.

Deborah’s mobility and strength were extremely impaired after undergoing these surgeries and

from being wheelchair bound for a few years. Today she can ambulate with a walker or cane but

continues to have chronic pain and limited ROM in her bilateral lower extremities.

During Deborah’s holistic assessment, she was asked what her sources of strength were.

She replied that her husband and her religious beliefs were her major sources. Deborah is a

Jehovah’s Witness and believes that one day God will wipe away all the pain and suffering from

the earth. Her convictions give her strength to cope with her ailments and unexpected life

changes. “Many older adults frequently use and highly value religious coping strategies such as

prayer. Evidence shows spiritual well-being to be directly correlated with mental health and less

medical illness among older adults” (Trakalo, Horowitz, & McCulloch, 2015, p. 1874). Risk for

Spiritual Distress is an applicable diagnosis since her spiritual health may be challenged by her

unexpected life changes. Her ailments prevented her from going to the Kingdom Hall of

Jehovah’s Witnesses weekly and associating with her brothers and sisters in the congregation.
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The goal in the care plan is for her to maintain a dynamic, personal relationship with a supreme

being in the face of unpleasant circumstances. Interventions include being physically present

and actively listen to Deborah with open discussions about suffering and dying using open ended

questions. “Presencing is often the best and sometimes the only intervention to support a client

who suffers under circumstances that medication interventions cannot address. When a client is

helpless, powerless, and vulnerable, a nurse’s presencing can be most beneficial” (Trakalo,

Horowitz, & McCulloch, 2015, p. 1891). The projected evaluation is that Deborah participates

in religious observance and articulates a sense of hope about the future, faith in a higher power,

how to access spiritual resources. With referrals to the local Kingdom Hall in Smyrna, DE, to

reach out to the elders and fellow brothers and sisters of the congregation, the projected

evaluation is that Deborah will find meaning and existence in the present situation.

Deborah’s chronic back and joint pain from her arthritis and past surgical procedures

limits her endurance, impairs her gait, affects her completion of activities of daily living, and

requires her to take narcotic medication one to two times daily for pain management. Thus,

applicable nursing diagnosis for her include: Impaired Walking, Chronic Pain, and Activity

Intolerance. Her goals for these diagnoses include to demonstrate increased tolerance to

activity, demonstrate optimal independence and safety in walking, to choose methods of

nonpharmacological pain relief to implement, to report decreased pain because of these

nonpharmacological therapies, and to report that the pain management regiment achieves

comfort-function goal with the occurrence of side effects.

A nursing intervention for impaired walking and activity intolerance is to allow Deborah

extra time to carry out physical activities. Her impaired walking may not only be from her pain

but also can be attributed to “fear of falling, decreased strength in muscles, reduced balance, or
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visual acuity” (Ackley & Ladwig, 2014, p. 123). To prevent falls in the home, an important

nursing intervention is to assess and modify any barriers to walking in the home environment.

Effective precautions include removing small rugs or mats that may slip or slide, making sure

handrails are strong and secure, postmining furniture to create a unobstructed pathway and

remove electrical cord and loose objects from walking paths (Ackley & Ladwig, 2014). In

addition, it would be in Deborah’s best interest to make referrals for home health services for PT

home visits, support, and assistance with ADL’s. “Research shows that the use of simple

stretching program for geriatric clients counteracts age related decline in gait function” (Ackley

& Ladwig, 2014).

Deborah is prescribed Vicodin and takes it daily to manage her chronic back and joint

pain. Therefore, an appropriate nursing intervention for activity intolerance is to assess and treat

her pain before activity. “Pain restricts the client from achieving a maximal activity level and is

often exacerbated by movement” (Ackley & Ladwig, 2014, p. 122). It would be beneficial to

refer Deborah to physical therapy for functional training and for strength training because

functional decline is common amongst older adults and intensive functional training improves

balance and coordination. Strength training improves function (Ackley & Ladwig, 2014).

Because of her narcotics use, a necessary nursing intervention for chronic pain diagnosis

is to educate Deborah and her family about proper medication administration, medication side

effects, and non-pharmacologic methods of pain relief. Pharmacological interventions are the

first-line approaches to the management of pain. Use of nonpharmacological interventions are to

supplement, not replace pharmacological interventions, and may play a significant role in holistic

pain management. “Combining nonpharmacologic and pharmacologic techniques provides

enhanced pain control and increased quality of life” (Ackley & Ladwig, 2014) (Trakalo,
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Horowitz, & McCulloch, 2015, p. 172). The expected outcome is that Deborah will experience

pain relief within her acceptable level of pain.

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References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based guide to

planning care (10th ed.). Maryland Heights, MO: Mosby Elsevier.

Trakalo, K., Horowitz, L. S., & McCulloch, A. R. (Eds.). (2015). Spirituality. Nursing: A

concept-based approach to learning (2nd ed., pp. 1871-1894). Boston, MA: Pearson

Education, Inc.

Trakalo, K., Horowitz, L. S., & McCulloch, A. R. (Eds.). (2015). Comfort. Nursing: A concept-

based approach to learning (2nd ed., pp. 141-174). Boston, MA: Pearson Education, Inc.