Nursing Intervention

Nursing Intervention

After assessing the patient and identifying some of the health problems, the nurse will proceed to care planning to manage these conditions and prevent them from worsening. The nurse will aim to ensure that the patient maintains a normal BP or lower the BP, do some physical exercises such as moving and lifting, have normal/healthy elimination, eat a nutritious diet and drink an adequate amount of water. These interventions will control the effects of both signs of constipation and hypertension and prevent further complications that may result from these symptoms.

Education about BP

The nurse will ensure that understand the disease process and how medication or treatment and lifestyle modifications can control hypertension. The nurse will emphasize on various of controlling hypertension, rather than focusing solely on curing it. The nurse will encourage the patient to embrace proper diet and consult a dietitian to assist in developing a weight loss plan. The program will involve restrictions of fat and sodium intake, implementing regular physical activities, consumption of vegetables and fruits (Carpenito, 2009).

The nurse will explain to the patient that it would take about 2 to 3 months for the taste buds to adapt to changes, especially in salt intake, to allow and encourage the patient to adjust to decreased salt intake. The nurse will also advise the patient to avoid tobacco and limit alcohol intake, mainly because they amplify the risks of hypertension and high blood pressure complication (Carpenito, 2009). Support groups, such as family members and friends, will help the patient reduce stress and engage in physical activities to control weight. The nurse will be responsible for assisting the patient in developing and adhering to an appropriate exercise regimen. Proper and regular physical activities are essential factors to foster weight loss and controlling BP (JNC7, 2003).

Diet-and-exercise intervention

A sedentary lifestyle and immobility mainly cause jean’s constipation and hypertension signs. The primary patient goal in this care plan will be to maintain passage of soft, formed stool at a reasonable, healthy frequency. Another patient’s goal will be relief from discomfort caused by constipation, using various measures that treat or prevent chronic constipation. One of the most critical patient-centred interventions to manage constipation is encouraging Jean to take adequate water or fluid, approximately 2000 to 3000 mL per day, to ease the constipation problem.

Sedentary lifestyle and immobility is a severe cause of constipation in the elderly, mainly because they lack physical exercise to stimulate physical and mental well-being (Ikidde, 2014). According to Ikidde (2014), BSFS must be used by nurses to understand the level of constipation for a patient and understand which physical exercise fits the patient based on their conditions. The patient will be encouraged to participate in physical activities and exercises/workouts. Family members will be advised to help the patient to engage in exercise, especially isometric abdominal and gluteal exercises. According to the Royal College of Nursing (2012), the movement promotes peristalsis, while abdominal exercises are responsible for strengthening the abdominal muscles that typically facilitate defecation.

According to Ikidde (2014), sufficient fluid is required to keep the faecal mass or stool soft. The patient will be advised on how insufficient fluid intake results in drier stool, which is harder and difficult to pass. Family members will be responsible for ensuring that Jean take adequate amount of water or fluid per day. Also, the patient will be assisted by the family members to take at least 20 g of dietary fibre such as fresh vegetables, fruits, and whole grains per day. According to Ikidde (2014), dietary fibre adds bulk to the faecal mass, which makes defecation more easier, primarily because it passes through the intestines virtually unaltered.

Psychosocial Impacts of Jean’s Symptoms

First, Jean is living with hypertension, and this may have severe psychosocial impacts, which could consequently reduce the quality of life. Hypertension and HBP are associated with depression, anxiety and stress (Grimsrud et al., 2009). Kretchy et al. (2009) assessed the relationship between hypertension and anxiety and depression using a cross-sectional, hospital-based study involving 400 hypertensive patients. The study discovered that approximately 56% of hypertensive patients experienced symptoms of anxiety, 20% experienced stress, and 4% had symptoms of depression (Kretchy et al., 2009). Patients with hypertension typically display profound negative emotions which increases the chances of having psychosocial effects such as depression and anxiety.

Constipation symptom presented by Jean may have some psychosocial impacts such as embarrassment, loneliness and low quality of life. The involuntary soiling related to faecal impaction contributes to a great deal of discomfort as well as the loss of dignity for elderly patients (Munch et al., 2016). Patients with reduced or no mobility felt embarrassed about asking for assistance to walk to the toilet, while others reported fear of odour and disturbing noise when in the toilet, which also caused embarrassment (Munch et al., 2016).

Holistic Care Approach

Holistic approach in nursing may be necessary in Jean’s case study. A detailed, comprehensive assessment is crucial in nursing because it informs decisions on nursing planning, diagnosis, evaluation and implementation (Byrne et al., 2013). Psychosocial care is one of the most crucial holistic assessment. It includes identifying the patients significant complaints, the medical history presenting illness, psychiatric history, medication list, surgical/medical history, drugs/alcohol and substance use, social/family history, violence risk assessment, occupational history, coping skills, education history, financial assessment, interests and abilities, cultural assessment, and mental status examination (Byrne et al., 2013).

Establishing appropriate management systems, educational structure and promoting religiousness and patients encouragement would induce nurses to provide holistic care and also improve their caring quality. Comprehensive nursing strategy can also foster significant integration of self-care and incorporate factors like social support and employment as well as the patient’s medical needs and risks (Zamanzadeh et al., 2015). The appropriate actions that nurse may plan/implement to promote empowerment include offering psychosocial support, educating the patient about Heart Failure, Dietary Counseling, and Healthy lifestyle changes (Lindenfeld et al., 2010; Feltner et al., 2014).

Patient’s Perceptions and Attitudes

Most HF patients consider cough, loss of appetite and vomiting as alarming symptoms, while those with severe CHF record less participation in physical activities or exercises and reduced sexual activity (Plotka et al., 2017). Plotka et al. (2017) discovered that elderly patients exercised less compared to the period before undergoing diagnosis. HF patients do not follow the dietary recommendation, such as eating low-sodium diets. Although some admit receiving a low-sodium diet recommendation, they do not even recall specific instructions (Lennie et al., 2008). The nurses will educate Jean about the nature of heart failure and the benefits of lifestyle modifications.

The nurse will routinely perform reinforcement teaching to patients, even if they say that they understand the instructions to follow a low-sodium diet. Also, to enhance patient’s knowledge regarding the procedures of following a low-sodium diet, the nurse will apply strategies that encourage patients to change their perceptions and attitude towards low-sodium foods, which may significantly improve adherence. Based on Lennie et al. (2008), patients who had a favourable opinion on following a low-sodium diet and considered it to be easy, with benefits and without barriers were more likely to report they consistently followed the recommended intake. However, those who perceive a low-sodium diet as challenging to follow did not adhere to the instructions. The nurse will identify the perception and attitude of Jean on a low-sodium diet and offer to advise and strategies for her to overcome such perception, which would significantly improve the consistency of adherence (Lennie et al., 2008).

One challenge the nurse may face when caring for Jean is her elevated fear, which could make her confused. Effective communication and teamwork play a significant role when it comes to HF patient caring. It enhances and improves patient’s knowledge and ensure a substantial reduction of complications and grievances. It also increases the patient’s and nurses’ confidence (Doorenbos, 2016). Error or poor communication in HF caring could result in severe harm such as prescription of wrong medication to patients when nurses communicate with their patients effectively, the confidence of the patient increases (Doorenbos, 2016). The nurse will apply the Goal-of-Care intervention or strategy to enhance more Goal-of-Care communications as well as high-quality communication with Jean (Doorenbos, 2016). According to Doorenbos et al. (2016), a goal-of-care communication strategy between nurses and patients reduces depression, anxiety and enable self-care.

One strategy of both effective communication and self-care is telehealth. The nurse will implement virtual visits or appointments with Jean. The nurse may also use other electronic services to support and empower Jean with a wide range of remote services like patients education, care and monitoring (Lustig, 2012). Telehealth enhances patient’s self-care and empowers patient to overcome fear, denial, and confusion. It ensures that patients get high-quality care, while at the same time reducing the overall costs of healthcare (Lustig 2012). Based on Christensen et al. (2009), telehealth is a crucial approach because it complements the conventional hospital-based and ambulatory health practices, which are primarily provider-centric, by establishing substantial deliver systems that tend to be more patient-centred and those that usually apply technology to improve health care quality and access, assist nurses in managing large volume of information and relationships and reduce costs.

Also, according to the National High Blood Pressure Education Program, screenings for BP with the sole aim of case finding are not recommended, primarily because about 70% of people with hypertension already know their levels of BP (JNC7, 2003). The patient will be responsible for the therapeutic regimen in collaboration with the nurse. The patient will be educated about HBP and how to manage it. Patients will use various strategies to control the symptoms such as lifestyle modifications, medication, weight control, exercise, assistance with social support and setting goals BP.

Family members will be involved in telehealth education programs so that they learn how to support the patient’s efforts in an attempt to control hypertension (Carpenito, 2009). The patient will be provided with written information regarding the potential effects and some side effects of hypertension medication. Jean will be responsible for reporting to the nurse when the side effects of treatments occur. The patient will be informed that “rebound hypertension” may occur, especially when antihypertensive medications are stopped (Carpenito, 2009). The nurse will teach and encourage the patient on how to measure the BP at home, and emphasize that failure to take medications would result in a notable rise in BP. The patient will understand that BP varies continuously and ranges within which it varies need to be closely monitored (Carpenito, 2009).

Discussion