Question

Answer this question:

Using Dorothea Orem's Self-care deficit theory, what are some following caregiver and patient goals for this scenario? List caregiving and patient goals after reading the scenario.

The Scenario:

• Patient is a 25-yr old construction worker, lives with his fiancé who is 8 months pregnant with their first child. He has a younger brother who lives with their parents.
• Motorcycle head-on collision, was wearing his helmet
• Treated at local ER Trauma Hospital
• Taken to surgery for emergent surgical procedure to repair lacerated liver, kidneys and pancreas, with massive internal bleeding.
• Fractured right leg, pins placed on R leg, on orthopedic leg traction
• Extensive surgery done to save right foot
• Taken to Surgical ICU (SICU) post operatively, sedated, on mechanical ventilator (respirator), with multiple IV drips to maintain blood pressure, on dialysis for acute kidney failure, on a special orthopedic bed with traction.

Patient Timeline:

• April 2: Motor Vehicle Accident (MVA) ; taken to ER Trauma Hospital
• April 3: Emergency surgery, taken to Surgical ICU (SICU), intubated, mechanical ventilation (respirator), sedated most of the time, IV medication for Bp, unstable VS, multiple blood transfusions, kidney failure, dialysis 3x a week. On ortho bed with R leg traction. Parents and fiance’s family visit.
• April 25: SICU, Off sedation, weaned off respirator. Regained consciousness, does not remember a lot. Asks “what happened”? Still on hemodialysis 3x a week. Complains of pain from abdominal incision. Refuses to get out of bed. Does not do his breathing exercises. Does not want to eat. Parents and brother visits. Fiancé’s family visits.
• May 4: Stepdown unit surgical floor, withdrawn, does not talk much. Fiancee delivers to an 8.2-lb. baby boy. Fiance’ mad because “he missed everything…” Still on hemodialysis 3x a week, R leg and R foot on cast, Physical Therapy sees patient 2x a day, experiences mod.-severe pain of abdominal incision when walking. Cooperative and works with Physical Therapists. Wants to go home.
• May 15: Rehabilitation facility, continues to progress. Verbalized different perspective in life. Noted to keep to himself on some days. Ambulates with crutches, still with right leg and foot cast. Taken to outpatient dialysis 2x a week. Fiance’ much better, visits more frequently with baby.
• June 1: Discharged to home with RN visits. Walks with crutches, with right leg/ foot cast. Abdominal incision with mild – moderate pain. Takes pain medicine when reminded by fiancé. Has sacral (tailbone area) bedsore measuring 3cm. x 4 cm., being treated and followed by RN. Needs assistance with ADL’s. On disability.

Answer 1

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'”

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories:

(1) the theory of self-care,

(2) the self-care deficit theory,

(3) the theory of nursing systems, which is further classified into wholly compensatory, partial compensatory and supportive-educative.

Assumptions :

(1) In order to stay alive and remain functional, humans engage in constant communication and connect among themselves and their

. (2) The power to act deliberately is exercised to identify needs and to make needed judgments.

(3) Mature human beings experience privations in the form of action in care of self and others involving making life-sustaining and function-regulating actions.

(4) Human agency is exercised in discovering, developing, and transmitting to others ways and means to identify needs for, and make inputs into, self and others.

(5) Groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members.

Patient goals :

*) The maintenance of a sufficient intake of air

*) The maintenance of a sufficient intake of water

*) The maintenance of a sufficient intake of food

*) The provision of care associated with elimination process and excrements

*) The maintenance of a balance between activity and rest

*) The maintenance of a balance between solitude and social interaction

*) The prevention of hazards to human life, human functioning, and human well-being

*) The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal

*) Seeking and securing appropriate medical assistance

*) Being aware of and attending to the effects and results of pathologic conditions and states

*) Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures

*) Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures

*) Modifying the self-concept (and self-image) in accepting oneself as being in a particular state of health and in need of specific forms of health care

*) Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a lifestyle that promotes continued personal development

Care - giving :

*) Monitor the blood pressure, breathing, temperature, and pulse.

*) Check the surgical site for signs of bleeding or infection.

*) Fluid intake and urine output should be monitored every one to two hours. If the patient does not have a urinary catheter, the bladder should be assessed for distension, and the patient monitored for inability to urinate

*) Watch for signs of an allergic reaction.

*) Give pain relievers or other medications through IV, by injection, or orally.

*) Ask patient to get up and walk around. They may need assistance to do this.

*) Ask patient to do Deep breathing exercises or forced coughing to prevent respiratory complications.

*) Body temperature must be monitored, since patients are often hypothermic after surgery, and may need a warming blanket or warmed IV fluids

*) Ensure patient Takes medications as prescribed, watch out for potential complications, and he keeps his follow-up appointments.

*) Bowel sounds are monitored, and the patient's diet gradually increased as tolerated, depending on the type of surgery and the physician's orders.

*) Monitor for any evidence of potential complications, such as leg edema, redness, and pain (deep vein thrombosis), shortness of breath (pulmonary embolism), dehiscence (separation) of the incision, or ileus (intestinal obstruction)

*) Ensure whether patients are comfortable, either in bed or chair, and that they have their call lights accessible. After dressing changes, blood-soaked dressings should be properly disposed of in a bio-hazard container