Question

Rosa was a 78-year-old woman who lived alone in a large city. She had been widowed for 10 years. Her children were grown, and all were successful. She was very proud of them because she and her husband had immigrated to the United States when the children were small and had worked very hard to establish and maintain a home. She had only a few years of primary education and still clung to many of her “old country” ways. She spoke a mixture of English and her native language, and her children were somewhat embarrassed by her. They thought she was somewhat of a hypochondriac because she constantly complained to them about various aches and pains, her knees that “gave out,” her “sugar” and “water” problems, and her heart palpitations. She had been diagnosed with mild diabetes and heart failure. She was a devout Catholic and attended mass each morning. Her treks to church events, to the senior center at church, and to her various physicians (internist; orthopedic, cardiac, and ophthalmic specialists) constituted her social life. One day the recreation director at the senior center noticed her pulling a paper bag of medication bottles from her purse. She sat down to talk with Rosa about them and soon realized that Rosa had only a vague idea of what most of them were for and tended to take them whenever she felt she needed them.

a. What is your primary nursing diagnosis for this patient? Utilize the PES format (problem, etiology, S&S)

b. What would be the top three assessment you would do and why?

c. What would be your top three interventions and why?

d. What is your goal for this patient? Goal must be S.M.A.R.T (Specific, Measurable, Attainable, Realistic, and Timely)

Answer 1

a..Ineffective coping

Definition

Inability to form a valid appraisal of the stressors, inadeqaute choices of practiced responses and/or inability to use available resources

Possible etiologies (related to)

• Severe level of anxiety, repressed
• Low self-esteem
• Unmet dependency needs
• Regression to or fixation in an earlier stage of development
• Retarded ego
• Inadequate coping skills
• Possible child abuse or neglect

Defining characteristics ("evidenced by")

• Numerous physical complaints verbalized, in the absence of any pathophysiological evidence
• Total focus on self and physical symptoms
• History of doctor shopping
• Demanding behaviors
• Refuses to attend therapeutic activities
• Does not correlate physical symptoms with psychological problems
• Feigning of physical or psychological symptoms to gain attention
• Inability to meet basic needs
• Inability to meet role expectations
• Inadequate problem solving
• Sleep pattern disturbance

b.Subjective and Objective assessment

Any physical symptoms for which ther is no organic basis but for which evidence exists for the implication of psychological factors

Monitor physician's ongoing assessment, laboratory reports and other data to maintain assurance that possibilty of organic pathology is clearly ruled out. Review findings with the client.

Rationale: Accurate medical assessment is vital for the provision of appropriate and adequate care. Honest explanation may help the psychological implications

Mood /affect assessment

Depresses mood is often common

Loss or alteration in physical functioning with no organic basis:

Paralysis, aphonia, anosmia, seizures,coordination disturbances, psudopregnancy

Excessive anxiety of having a serious illness

Answer to question no: C

• Recognize and accept that the physical complaint is indeed real to the individual, even though no organic etiology can be identified. Rationale: Denial of the client's feelings is nontherapeutic and interferes with establishment of trusting relationship
• Provide pain medications as prescribed by the physician. Rationale: client comfort and safety are nursing priorities
• Gradually withdraw attention to physical symptoms. Minimize time given in response to physical complaints. Rationale: Lack of positive response will discourage repetition of mal adaptive behaviors

d.Short-term goal

Within( specified time) client will verbalize understanding of correlation between physical symptoms and psychological symptoms

Long-term goal

By time of discharge from treatment, client will demonstrate ability to cope with stress by means other than pre-occupation with physical symptoms