Nursing Care Planning
Introduction The model of Nursing that is most familiar to nurses was originally developed by Roper in 1976 and was updated and added to in 1980, 1981 and 1983 by Roper, Logan and Tierney. The model has been used in a wide variety of nursing settings. The model of nursing specifies 12 activities of daily living which are related to basic human needs. They are maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal hygiene, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying.
In this essay I am going to look at how the nurse would establish a care plan in relation to the 12 activities of daily living, with controlling body temperature as its main aim. Controlling a persons body temperature is an important activity of daily living and is vital in everyday routines. The patient involved in the care plan is Mr Turner, a patient who has been living in a nursing home for the past year and has presently been unconscious for the past 3 weeks.
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The fact that Mr Turner is unconscious it is therefore vital that his body temperature is regulated and monitored at frequent intervals as Mr Turner is unable to inform nursing staff if he is feeling any changes in his temperature. The Roper, Logan and Tierney model of nursing suggests that the activities of living can be used as a guide when an assessment of needs is being carried out. The assessment process would most likely involve the nurse and the patient discussing each activity and identifying previous routines. However in Mr Turners case this may involve the nurse collaborating with relatives and close friends.
Main body When the primary nurse is establishing the care plan she must always have her main aim in mind. In Mr Turner’s situation it is controlling his body temperature. The nurse has to ensure that the balance between heat loss and heat production is equal. The nurse should observe regularly for any changes in the colour and feel of the patient’s skin and also for any changes in temperature, as this could be a sign of infection. If the patient is too hot the skin could become damp with perspiration and look flushed, if on the other hand he is too cold then the skin could have a bluish tinge too it.
The surroundings of the patient should be given careful consideration. The room should neither be too hot or cold. If Mr Turner is showing signs of being too hot then a fan should be installed to cool the air above him, as if he is cooled down too quickly his temperature could drop suddenly. If on the other hand he is too cold then an extra blanket could be provided allowing him to slowly warm up. If there is any sudden change in temperature then specimens of Mr Turners respiratory and urinary tracts should be collected to aid the diagnosis and rule out any possible chest and urinary tract infections.
A urinary tract infection is when germs enter the tract possibly when Mr Turner is being cathertised. A chest infection could occur when the patient inhales germs or bacteria, which multiply in the lining of the bronchi. However she must also take into consideration any other activities of daily living that apply to Mr Turner. As Mr Turner is unconscious Respiration would play a vital part in the care plan. The nurse should carry out neurological observations every 4 hours. This would involve the use of the Glasgow Coma Scale, which enables the nurse to measure the level of consciousness.
The nurse should also ensure that the environment that Mr Turner is in is safe and secure and that he is comfortable. The nurse should ensure that Mr Turner is lying in the recovery position as this prevents the tongue from slipping back and maintains a clear airway. Nutrition would also feature in the care plan, ensuring that Mr Turner has adequate fluid and food intake to prevent dehydration or pyrexia. Mr Turners input and output should be recorded. The nurse should also be aware of Mr Turners body image especially when carrying out any aspects of personal hygiene ensuring that he has privacy and his dignity is maintained at all times.
The nurse should also aim to move or turn Mr Turner every 2 hours to prevent pressure sores and should also take this opportunity to mobilise his limbs. Communication also plays an important part in the care plan. The nurse should always assume the Mr Turner can hear what is being said to him and should therefore explain everything that is happening to him, she should also talk to him the way she would to a conscious patient as he may be feeling frightened or confused. There should also be communication with the other health care professionals so that the care plan can be updated to the eeds of the patient. There should also be communication with Mr Turners relatives so that they understand his condition what is happening to him and what care he is receiving. Conclusion When the nurse is establishing the care plan she must always have a specific aim in mind and also consider all aspects of daily living and how they apply to the individual patient. This ensures that the patient is being cared for as a whole based on his/hers individual needs. This nurse must also ensure that as the patient progresses that an evaluation of the care plan takes place and is updated on a regular basis.