to evaluate the extent to which
the process was fruitful.
INTRODUCTION
SYSTEM MODEL- BETTY
NEUMAN
A theory is a group of
related concepts that propose action that guide
practice. A nursing theory is a set of concepts,
definitions, relationships, and assumptions or
propositions derived from nursing models or from
other disciplines and project a purposive,
systematic view of phenomena by designing
specific inter-relationships among concepts for
the purposes of describing, explaining,
predicting, and /or prescribing.
The Neuman’s system model has two major
components i.e. stress and reaction to stress.
The client in the Neuman’s system model is
viewed as an open system in which repeated
cycles of input, process, out put and feed back
constitute a dynamic organizational pattern. The
client may be an individual, a group, a family,
a community or an aggregate. In the development
towards growth and development open system
continuously become more differentiated and
elaborate or complex. As they become more
complex, the internal conditions of regulation
become more complex. Exchange with the
environment are reciprocal, both the client and
the environment may be affected either
positively or negatively by the other.
The system may adjust
to the environment to itself.
The ideal is to
achieve optimal stability. As an open system the
client, the client system has propensity to seek
or maintain a balance among the various factors,
both with in and out side the system, that seek
to disrupt it. Neuman seeks these forces as
stressors and views them as capable of having
either positive or negative effects. Reaction to
the stressors may be possible or actual with
identifiable responses and symptom.
MAJOR CONCEPTS
I. PERSON VARIABLES-
Each layer, or concentric circle, of the Neuman
model is made up of the five person variables.
Ideally, each of the person variables should be
considered simultaneously and comprehensively.
1.
Physiological - refers of the
physicochemical structure and function of the
body.
2.
Psychological - refers to mental
processes and emotions.
3.
Sociocultural - refers to relationships;
and social/cultural expectations and activities.
4.
Spiritual - refers to the influence of
spiritual beliefs.
5.
Developmental - refers to those processes
related to development over the lifespan.
II. CENTRAL CORE-
The basic structure, or central core, is made up
of the basic survival factors that are common to
the species (Neuman, 1995, in George, 1996).
These factors include: system variables, genetic
features, and the strengths and weaknesses of
the system parts. Examples of these may include:
hair color, body temperature regulation ability,
functioning of body systems homeostatically,
cognitive ability, physical strength, and value
systems. The person's system is an open system
and therefore is dynamic and constantly changing
and evolving. Stability, or homeostasis, occurs
when the amount of energy that is available
exceeds that being used by the system. A
homeostatic body system is constantly in a
dynamic process of input, output, feedback, and
compensation, which leads to a state of balance.
III. FLEXIBLE LINES OF DEFENSE-
The flexible
line of defense is the outer barrier or cushion
to the normal line of defense, the line of
resistance, and the core structure. If the
flexible line of defense fails to provide
adequate protection to the normal line of
defense, the lines of resistance become
activated. The flexible line of defense acts as a
cushion and is described as accordion-like as it
expands away from or contracts closer to the
normal line of defense. The flexible line of
defense is dynamic and can be changed/altered in
a relatively short period of time.
IV. NORMAL LINE OF DEFENSE-
The normal line of defense represents system
stability over time. It is considered to be the
usual level of stability in the system. The
normal line of defense can change over time in
response to coping or responding to the
environment. An example is skin, which is stable
and fairly constant, but can thicken into a
callus over time.
V. LINES OF RESISTANCE-
The lines of resistance protect the basic
structure and become activated when
environmental stressors invade the normal line
of defense. Example: activation of the immune
response after invasion of microorganisms. If
the lines of resistance are effective, the
system can reconstitute and if the lines of
resistance are not effective, the resulting
energy loss can result in death.
VI. RECONSTITUTION-
Reconstitution
is the increase in energy that occurs in
relation to the degree of reaction to the
stressor. Reconstitution begins at any point
following initiation of treatment for invasion
of stressors. Reconstitution may expand the
normal line of defense beyond its previous
level, stabilize the system at a lower level, or
return it to the level that existed before the
illness.
VII. STRESSORS--
The Neuman Systems
Model looks at the impact of stressors on health
and addresses stress and the reduction of stress
(in the form of stressors). Stressors are
capable of having either a positive or negative
effect on the client system. A stressor is any
environmental force which can potentially affect
the stability of the system: they may be:
-
Intrapersonal
- occur within person, e.g. emotions and
feelings
-
Interpersonal
- occur between individuals, e.g. role
expectations
-
Extra
personal - occur outside the individual,
e.g. job or finance pressures
The person has a
certain degree of reaction to any given stressor
at any given time. The nature of the reaction
depends in part on the strength of the lines of
resistance and defense. By means of primary,
secondary and tertiary interventions, the person
(or the nurse) attempts to restore or maintain
the stability of the system.
VII. PREVENTION-
As defined by Neuman's
model, prevention is the primary nursing
intervention. Prevention focuses on keeping
stressors and the stress response from having a
detrimental effect on the body.
-
Primary -Primary prevention
occurs before the system reacts to a stressor.
On the one hand, it strengthens the person
(primarily the flexible line of defense) to
enable him to better deal with stressors, and on
the other hand manipulates the environment to
reduce or weaken stressors. Primary prevention
includes health promotion and maintenance of
wellness.
-
Secondary-Secondary
prevention occurs after the system reacts to a
stressor and is provided in terms of existing
systems. Secondary prevention focuses on
preventing damage to the central core by
strengthening the internal lines of resistance
and/or removing the stressor.
-
Tertiary -Tertiary
prevention occurs after the system has been
treated through secondary prevention strategies.
Tertiary prevention offers support to the client
and attempts to add energy to the system or
reduce energy needed in order to facilitate
reconstitution.
NURSING METAPARADIGM
A. PERSON-
The person is a
layered multidimensional being. Each layer
consists of five person variables or subsystems:
-
Physical/Physiological
-
Psychological
-
Socio-cultural
-
Developmental
-
Spiritual
The layers,
usually represented by concentric circle,
consist of the central core, lines of
resistance, lines of normal defense, and lines
of flexible defense. The basic core structure is
comprised of survival mechanisms including:
organ function, temperature control, genetic
structure, response patterns, ego, and what
Neuman terms 'knowns and commonalities'. Lines
of resistance and two lines of defense protect
this core. The person may in fact be an
individual, a family, a group, or a community in
Neuman's model. The person, with a core of basic
structures, is seen as being in constant,
dynamic interaction with the environment. Around
the basic core structures are lines of defense
and resistance (shown diagrammatically as
concentric circles, with the lines of resistance
nearer to the core. The person is seen as being
in a state of constant change and-as an open
system-in reciprocal interaction with the
environment (i.e. affecting, and being affected
by it).
B. THE ENVIRONMENT-
The environment is
seen to be the totality of the internal and
external forces which surround a person and with
which they interact at any given time. These
forces include the intrapersonal, interpersonal
and extra personal stressors which can affect
the person's normal line of defense and so can
affect the stability of the system.
-
The
internal environment exists within the
client system.
-
The
external environment exists outside
the client system.
-
Neuman
also identified a created environment
which is an environment that is created and
developed unconsciously by the client and is
symbolic of system wholeness.
C. HEALTH-
Neuman sees health
as being equated with wellness. She defines
health/wellness as "the condition in which all
parts and subparts (variables) are in harmony
with the whole of the client (Neuman, 1995)". As
the person is in a constant interaction with the
environment, the state of wellness (and by
implication any other state) is in dynamic
equilibrium, rather than in any kind of steady
state. Neuman proposes a wellness-illness
continuum, with the person's position on that
continuum being influenced by their interaction
with the variables and the stressors they
encounter. The client system moves toward
illness and death when more energy is needed
than is available. The client system moves
toward wellness when more energyis available
than is needed.
D. NURSING-
Neuman sees nursing as a
unique profession that is concerned with all of
the variables which influence the response a
person might have to a stressor. The person is
seen as a whole, and it is the task of nursing
to address the whole person. Neuman defines
nursing as actions which assist individuals,
families and groups to maintain a maximum level
of wellness, and the primary aim is stability of
the patient/client system, through nursing
interventions to reduce stressors. Neuman states
that, because the nurse's perception will
influence the care given, then not only must the
patient/client's perceptions be assessed, but so
must those of the caregiver (nurse). The role of
the nurse is seen in terms of degrees of
reaction to stressors, and the use of primary,
secondary and tertiary interventions.
Neuman envisions a 3-stage
nursing process:
1. Nursing Diagnosis
- based of necessity in a thorough assessment,
and with consideration given to five variables
in three stressor areas.
2. Nursing Goals -
these must be negotiated with the patient, and
take account of patient's and nurse's
perceptions of variance from wellness
3. Nursing Outcomes
- considered in relation to five variables, and
achieved through primary, secondary and tertiary
interventions.
NURSING PROCESS BASED
ON SYSTEM MODEL
Assessment:
Neuman’s first
step of nursing process parallels the assessment
and nursing diagnosis of the six phase nursing
process. Using system model in the assessment
phase of nursing process the nurse focuses on
obtaining a comprehensive client data base to
determine the existing state of wellness and
actual or potential reaction to environmental
stressors.
Nursing diagnosis- the
synthesis of data with theory also provides the
basis for nursing diagnosis. The nursing
diagnostic statement should reflect the entire
client condition.
Outcome identification and planning-
it involves negotiation between the care giver
and the client or recipient of care. The overall
goal of the care giver is to guide the client to
conserve energy and to use energy as a force to
move beyond the present.
Implementation – nursing
action are based on the synthesis of a
comprehensive data base about the client and the
theory that are appropriate to the client’s and
caregiver’s perception and possibilities for
functional competence in the environment.
According to this step the evaluation confirms
that the anticipated or prescribed change has
occurred. Immediate and long range goals are
structured in relation to the short term goals.
Evaluation
–
evaluation is the anticipated or prescribed
change has occurred. If it is not met the goals
are reformed.
-------------------------------------------------------------------
ASSESSMENT
PATIENT PROFILE
1. Name- Mr. AM
2. Age- 66 years
3. Sex-Male
4. Marital status-married
5. Referral source- Referred from -------
Medical College, -------
STRESSORS AS PERCEIVED BY CLIENT
(Information collected from the patient and his
wife)
-
Major stress area, or areas of health concern
-
Patient was suffering from severe abdominal pain
, nausea, vomiting, yellowish discolorations of
eye, palm, and urine, reduced appetite and gross
weight loss(8kg with in 4 months)
-
Patient is been diagnosed to have Periampullary
carcinoma one week back.
-
Patient underwent operative procedure i.e.
WHIPPLE’S PROCEDURE- Pancreato duodenectomy on
27/3/08.
-
Psychologically disturbed about his disease
condition- anticipating it as a life threatening
condition. Patient is in depressive mood and
does not interacting.
-
Patient is disturbed by the thoughts that he
became a burden to his children with so many
serious illnesses which made them to stay with
him at hospital.
-
Patient has pitting type of edema over the ankle
region, and it is more during the evening and
will not be relieved by elevation of the
affected extremities.
-
He had developed BPH few months back (2008
January) and underwent surgery TURP on January
17. Still he has mild difficulty in initiating
the stream of urine.
-
Patient is a known case of Diabetes since last
28 years and for the last 4 years he is on Inj.
H.Insulin (4U-0-0). It is adding up his distress
regarding his health.
-
Life style patterns
-
patient is a retired school teacher
-
cares for wife and other family members
-
living with his son and his family
-
active in church
-
participates in community group meeting i.e.
local politics
-
has a supportive spouse and family
-
taking mixed diet
-
no habits of smoking or drinking
-
spends leisure time by reading news paper,
watching TV, spending time with family members
and relatives
-
Have you experienced a similar problem?
-
The fatigue is similar to that of previous
hospitalization (after the surgery of the BPH)
-
Severity of pain was some what similar in the
previous time of surgery i.e. TURP.
-
Was psychologically disturbed during the
previous surgery i.e. TURP.
-
What helped then- family members psychological
support helped him to over come the crisis
situation
-
Anticipation of the future
-
Concerns about the healthy and speedy recovery.
-
Anticipation of changes in the lifestyle and
food habits
-
Anticipating about the demands of modified life
style
-
Anticipating the needs of future follow up
-
What doing to help himself?
-
Talking to his friends and relatives
-
Reading the religious materials i.e. reading the
Bible
-
Instillation of positive thoughts i.e. planning
about the activities to be resume after
discharge, spending time with grand children,
going to the church, return back to the social
interactions etc
-
Avoiding the negative thoughts i.e.
diverts the attentions from the pain or
difficulties, try to eliminate the disturbing
thoughts about the disease and surgery etc
-
Trying to accept the reality etc..
-
What is expected of others?
-
Family members visiting the patient and spending
some time with him will help to a great extent
to relieve his tension.
-
Convey a warm and accepting behaviour towards
him.
-
Family members will help him to meet his own
personal needs as much as possible.
-
Involve the patient also in taking decisions
about his own care, treatment, follow up etc
STRESSORS AS PERCEIVED BY THE CARE GIVER.
-
Major stress areas
-
Persistent fatigue
-
Massive weight loss i.e.( 8 kg of body weight
with in 4 months)
-
History of BPH and its surgery
-
Persistence of urinary symptoms (difficulty in
initiating the stream of urine) and edema of the
lower extremities
-
Persistent disease- chronic hypertensive since
last 28 years
-
Depressive ideations and negative thoughts
-
Present circumstances differing from the usual
pattern of living
-
Hospitalization
-
acute pain ( before the surgery patient had pain
because of the underlying pathology and after
the surgery pain is present at the surgical
site)
-
nausea and vomiting which was present before the
surgery and is still persisting after the
surgery also
-
anticipatory anxiety concerns the recovery and
prognosis of the disease
-
negative thoughts that he has become a burden to
his children
-
Anticipatory anxiety concerning the restrictions
after the surgery and the life style
modifications which are to be followed.
-
Clients past experience with the similar
situations
-
Patient verbalized that the severity of pain,
nausea, fatigue etc was similar to that of
patient’s previous surgery. Counter checked with
the family members that what they observed.
-
Psychologically disturbed previously also before
the surgery. (collected from the patient and
counter checked with the relatives)
-
Client perceived that the present disease
condition is much more severe than the previous
condition. He thinks it is a serious form of
cancer and the recovery is very poor. So patient
is psychologically depressed.
-
Future anticipations
-
Client is capable of handling the situation-
will need support and encouragement to do so.
-
He has the plans to go back home and to resume
the activities which he was doing prior to the
hospitalization.
-
He also planned in his mind about the future
follow up ie continuation of chemotherapy
-
What client can do to help himself?
-
Patient is using his own coping strategies
to adjust to the situations.
-
He is spending time to read religious books and
also spends time in talking with others
-
He is trying to clarify his own doubts in an
attempt to eliminate doubts and to instill hope.
-
He sets his major goal i.e. a healthy and
speedy recovery.
-
Client's expectations of family, friends and
caregivers
-
he sees the health care providers as a source pf
information.
-
He tries to consider them as a significant
members who can help to over come the stress
-
He seeks both psychological and physical support
from the care givers, friends and family members
-
He sees the family members as helping hands and feels
relaxed when they are with him.
Evaluation/ summary of impressions-
There is no apparent discrepancies identified
between patients perception and the care givers
perceptions.
INTRAPERSONAL FACTORS
1. Physical examination and investigations
Height- 162 cm
Weight
– 42 kg
TPR-
37o C, 74 b/m, 14 breaths per min
BP
-
130/78 mm of Hg
-
Eye- vision is normal, on examination the
appearance of eye is normal. Conjunctiva is pale
in appearance. Pupils reacting to the light.
-
Ear- appearance of ears normal. No wax
deposition. Pinna is normal in appearance and
hearing ability is also normal.
-
Respiratory system- respiratory rate is
normal, no abnormal sounds on auscultation.
Respiratory rate is 16 breaths per min.
-
Cardiovascular system- heart rate is 76
per min. on auscultation no abnormalities
detected. Edema is present over the left ankle
which is non pitting in nature.
-
GIT- patient has the complaints of
reduced appetite, nausea; vomiting etc. food
intake is very less. Mouth- on examination is
normal. Bowel sounds are reduced. Abdomen could
not be palpated because of the presence of the
surgical incision. Bowel habits are not regular
after the hospitalization
-
Extremities- range of motion of the
extremities are normal. Edema is present over
the left ankle which is non pitting in nature.
Because of weakness and fatigue he is not able
to walk with out support
-
Integumentary system- extremities are
mild yellowish in color. No cyanosis. Capillary
refill is normal.
-
Genitor urinary system- patient has
difficulty in initiating the urine stream. No
complaints of painful micturation or difficulty
in passing urine.
-
Self acre activities- perform some of his
activities, for getting up from the bed he needs
some other person’s support. To walk also he
needs a support. He do his personal care
activities with the support from the others
-
Immunizations- it is been told that he
has taken the immunizations at the specific
periods itself and he also had taken hepatitis
immunization around 8 years back
-
Sleep –. He told that sleep is reduced
because of the pain and other difficulties.
Sleep is reduced after the hospitalization
because of the noisy environment.
-
Diet and nutrition- patient is taking
mixed diet, but the food intake is less when
compared to previous food intake because of the
nausea and vomiting. Usually he takes food three
times a day.
-
Habits- patient does not have the habit
of drinking or smoking.
-
Other complaints- patient has the
complaints of pain fatigue, loss of
appetite, dizziness, difficulty in urination,
etc...
2.
Psycho- socio cultural
-
Anxious about his condition
-
Depressive mood
-
Patient is a retired teacher and he is Christian
by religion.
-
Studied up to BA
-
Married and has 4 children(2sons and 2
daughters)
-
Congenial home environment and good relationship
with wife and children
-
Is active in the social activities at his native
place and also actively involves in the
religious activities too.
-
Good and congenial relationship with the
neighbors
-
Has some good and close friend at his place and
he actively interact with them. They also very
supportive to him
-
Good social support system is present from the family as
well as from the neighborhood
3.
Developmental factors
-
Patient confidently says that he had been worked for 32
years as a teacher and he was a very good teacher for
students and was a good coworker for the friends.
-
He told that he could manage the official and
house hold activities very well
-
He was very active after the retirement and once he go
back also he will resume the activities
4.
Spiritual belief system
He believes in got and used to go to church and
also an active member in the religious
activities.
He has a personal Bible and he used to read it
min of 2 times a day and also whenever he is
worried or tensed he used to pray or read Bible.
He has a good social support system present which helps
him to keep his mind active.
INTERPERSONAL FACTORS
good social interaction with others
good social support system is present
active in the agricultural works at home after
the retirement
active in the religious activities.
Good interpersonal relationship with wife and
the children
Good social adjustment present
EXTRAPERSONAL FACTORS
All communication facilities, travel and
transport facilities etc are present at his own
place.
His house at a village which is not much far
from the city and the facilities are available
at the place.
Financially they are stable and are able to meet
the treatment expenses.
Summary
-
Physiological- thin body built pallor of
extremities, yellowish discoloration of the
mucus membrane and sclera of eye. Nausea,
vomiting, reduced appetite, reduced urinary
out put. Diagnosed to have periampullary
carcinoma.
Psycho socio cultural factors- patient is
anxious abut his condition. Depressive mood.
Not interacting much with others. Good
support system is present.
Developmental –no developmental
abnormalities. Appropriate to the age.
Spiritual- patient’s belief system has a
positive contribution to his recovery and
adjustment.
CLINICAL FEATURES
Discoloration of urine
Complaints of vomiting
Fatigue
Reduced appetite
on and off fever
Yellowish discoloration of eye, palms and nails
Complaints of weight loss
Edema over the left leg
INVESTIGATIONS
|
Investigations |
Values |
|
Hemoglobin(13-19g/dl) |
6.9 |
|
HCT (40-50%) |
21.9 |
|
WBC
(4000-11000 cells/cumm) |
12200 |
|
Neutrophil
(40-75%) |
77.2 |
|
Lymphocyte
(25-45%) |
10.5 |
|
Monocyte
(2-10%) |
4.5 |
|
Eosinophil
(0-10%) |
2.6 |
|
Basophil
(0-2%) |
.2 |
|
Platelet
(150000-400000 cells/cumm) |
345000 |
|
ESR
(0-10mm/hr) |
86 |
|
RBS (60-150
mg/dl) |
148 |
|
Pus C/S |
_ |
|
USG |
USG shows
mild diffuse cell growth at the Ampulla of
Vater which suggests peri ampullary
carcinoma of Grade I with out metastasis
and gross spread.
|
|
Urea
(8-35mg/dl) |
28 |
|
Creatinine
(0.6-1.6 mg/dl) |
1.8 |
|
Sodium
(130-143 mEq/L) |
136 |
|
Potassium
(3.5-5 mEq/L) |
4 |
|
PT
(patient)(11.4-15.6 sec)
|
12.3 |
|
APTT-
patient (24- 32.4 sec) |
26.4 |
|
Blood group |
A+ |
|
HIV |
Negative |
|
HCV |
Negative |
|
HBsAg |
Negative |
|
Urine
Protein (negative) |
Negative |
|
Urine WBC
(0-5 cells/hpf) |
Nil |
|
RBC (nil )
|
Nil
|
|
Epithelial
cell(0-5)
|
4-5
|
|
Cast –
granular cast (absent)
|
Nil
|
THERAPEUTIC MANAGEMENT
|
Initial Treatment:
Patient got admitted to ----
Medical college for 3 days and the symptoms
not relieved. So they asked for discharge
and came to ---this hospital
There treated with
-
Inj Tramazac IV SOS
-
IV fluids – DNS
Treatment at this hospital...
Pre operative period
Surgical management
Patient underwent Whipple’s
procedure (pancreato duodenectomy) |
Post operative period (immediate post op)
-
Inj Pethedine 1mg SOS
-
Inj Phenargan SOS
-
Inj Pantodac 40 mg IV OD
-
Inj Clexane 0.3 ml S/C OD
-
Inj Vorth P 40 mg IM
Q12H
-
Inj calcium Gluconate 10 ml
over 10 min
-
IV fluids – DNS
Late post op period
after 3 days of surgery)
-
Inj H Insulin
S/C 6-0-6U
-
Tab Pantodac 40 mg
1-0-0
-
Cap beneficiale 0-1-0
-
Tab Clovipas 75 mg 0-1-0
-
Tab Monotrate 1-0-1
-
Tab
Metalor XL 1-0-0
Other instructions
-
Incentive
spirometry
-
Steam
inhalation
-
Early
ambulation
-
Diabetic
diet
|
NURSING PROCESS
I. NURSING DIAGNOSIS
Acute pain related to the presence of surgical
wound on abdomen secondary to periampullary
carcinoma
Desired Outcome/goal :
Patient will get relief from pain as evidenced
by a reduction in the pain scale score and
verbalization
|
Nursing action |
|
Primary prevention |
Secondary prevention |
Tertiary prevention |
|
|
-
Teach the patient about the relaxation
techniques and make him to do it
-
Encourage the patient to divert his mind
from pain and to engage in pleasurable
activities like taking with others
-
Do not allow the patient to do strainous
activities. And explain to the patient why
those activities are contraindicated.
-
Involve the patient in making decisions
about his own care and provide a positive
psychological support
-
Provide the primary preventive care when
ever necessary.
|
-
Educate the client about the importance of
cleanliness and encourage him to maintain
good personal hygiene.
-
Involve the family members in the care of
patient
-
Encourage relatives to be with the client in
order provide a psychological well being to
patient .
-
Educate the family
members about the pain management measures.
-
Provide the primary and
secondary preventive measures to the client
whenever necessary.
|
Evaluation
–
patient verbalized that the pain got reduced and
the pain scale score also was zero. His facial
expression also reveals that he got relief from
pain.
II. NURSING DIAGNOSIS
Activity intolerance related to fatigue
secondary to pain at the surgery site, and
dietary restrictions
Outcome/ goals
:
Client will develop appropriate levels of
activity free from excess fatigue, as evidenced
by normal vital signs & verbalized understanding
of the benefits of gradual increase in activity
& exercise.
|
Nursing actions |
|
Primary prevention |
Secondary prevention |
Tertiary prevention |
-
Adequately
oxygenate the client
-
Instruct the
client to avoid the activities which causes
extreme fatigue
-
Provide the
necessary articles near the patients bed
side.
-
Assist the
patient in early ambulation
-
Monitor
client’s response to the activities in order
to reduce discomforts.
-
Provide
nutritious diet to the client.
-
Avoid
psychological distress to the client. Tell
the family members to be with him.
-
Schedule rest
periods because it helps to alleviate
fatigue
|
-
Instruct the
client to avoid the activities which causes
extreme fatigue.
-
Advice the
client to perform exercises to strengthen
the extremities& promote activities
-
Tell the
client to avoid the activities such as
straining at stool etc
-
Teach the
client about the importance of early
ambulation and assist the patient in early
ambulation
-
Teach the
mobility exercises appropriate for the
patient to improve the circulation
|
-
Encourage the
client to do the mobility exercises
-
Tell the
family members to provide nutritious diet in
a frequent intervals
-
Teach the
patient and the family about the
importance of psychological well being in
recovery.
-
Provide the
primary and secondary level care if
necessary.
|
Evaluation
–
patient verbalized that his activity level
improved. He is able to do some of his
activities with assistance. Fatigue relieved and
patient looks much more active and interactive.
NURSING DIAGNOSIS-III
Impaired physical mobility related to presence
of dressing, pain at the site of surgical
incision
Outcomes/goals:
Patient will have improved physical mobility as
evidenced by walking with minimum support and
doing the activities in limit.
|
Nursing action |
|
Primary prevention |
Secondary prevention |
Tertiary prevention |
-
Provide
active and passive exercises to all the
extremities to improve the muscle tone and
strength.
-
Make the
patient to perform the breathing exercises
which will strengthen the respiratory
muscle.
-
Massage the
upper and lower extremities which help to
improve the circulation.
-
Provide
articles near to the patient and encourage
doing activities within limits which
promote a feeling of well being.
|
|
-
Educate and reeducate the
client and family about the patients care
and recovery
-
Support the
patient, and family towards the attainment
of the goals
-
Coordinate the
care activities with the family members and
other disciplines like physiotherapy.
-
Teach the
importance of psychological well being which
influence indirectly the physical recovery
-
Provide primary
preventive measures whenever necessary
|
Evaluation –
patient’s physical activity
improved and he is able to move from bed with
support. Patient started doing the active and
passive exercises and he verbalized improvement.
-----------------------------------------------------------
Conclusion
The Neuman’s
system model when applied in nursing practice
helped in identifying the interpersonal,
intrapersonal and extra personal stressors of
Mr. AM from various aspects. This was helpful to
provide care in a comprehensive manner. The
application of this theory revealed how well the
primary, secondary and tertiary prevention
interventions could be used for solving the
problems in the client.
References
1. Alligood M R, Tomey A M.
Nursing Theory: Utilization &Application .3rd
ed. Missouri: Elsevier Mosby Publications; 2002.
2. Tomey AM, Alligood. MR.
Nursing theorists and their work. (5th ed.).
Mosby, Philadelphia, 2002
3. George JB .Nursing Theories:
The Base for Professional Nursing Practice,5th
ed. New Jersey :Prentice Hall;2002.
