Question

Case Scenario Peter is a 50-year-old truck driver working at a transportation company since he was 30 years old. He lives with his wife and his son aged 16 who is a form- four student.

He has had hypertension for 15 years. He is taking Lasix and Zestril.

However, due to his working schedule, Peter is not able to strictly follow the medication regimen.

Two years ago, he was diagnosed with heart failure and had been repeatedly admitted due to acute pulmonary edema (APO).

Since then , he also needs to take Digoxin and use home oxygen every day.

He was admitted to your medical ward due to APO.

He had severe shortness of breath.

He appeared very frightened and asked if he would die this time.

The doctor prescribed IV Lasix stat.

(Problem1: Breathing difficult)----patient has heart failure

(Problem2: Fear)

What are the objective and subjective data, goals, nursing care plan, evaluation of problem1, and problem 2?

Answer 1

Answer:Nursing care plan for ineffective pattern breathing pattern and fear of death is tabulated in the table format and the objective and subjective data, goals, nursing care plan, evaluation of problem1, and problem 2 is described below:

assessment	diagnosis	goals	interventions	rationale	evaluation

  Nursing care plan-ineffective breathing pattern (a)Table part 1

Assessment objective data: 50 year old truck driver male includes vitals(not provided in the case study) Subjective data: severe shortness of breath, history of hypertension,treatment with lasix and zestril history of heart failure taking digoxin and home oxygen treatment

Nursing diagnosis ineffective breathing pattern related to poor cardiac function secondary to hypertension as evidenced by severe shortness of breath and associated fear of death.

Goals: Short term: 1.Patient will have a normal breathing pattern within 6 to 8 hours of admission and will not experience any shortness of breath. 2.The patient will be having a relaxed breathing with rates equal to 12-16 breaths per minute and will be comfortable to breathe 6-8 hours; 3.The patient will breathe effectively and no longer have fear of death due to recovery from shortness of breath. long term The patient will not have episodes of severe shortness of breath in future.

Nursing care plan-ineffective breathing pattern (b)continued

interventions	rationale	evaluation
1.The respiratory rate and effort every 2 hourly 2Auscultation of the chest every 4 hourly 3Patient support and monitoring during the phase of severe shortness of breath 4.pulse oximetry and ABG as per policy and hospital facility	1Change in the pattern of breathing to severe tachypnea, highly efforted breathing or shallow breath indicates respiratory compromise and must be picked up early and treated 2.Auscultation of the chest may reveal abnormal breath sounds(basal crackles in heart failure).Normal breath sounds will be heard on recovery. 3 Patient support and the presence of the medical staff reduces patient anxiety and helps to pick up respiratory deterioration at the earliest 4.Monitoring of the patient oxygen status is imperative to know his baseline levels,response to therapy and take timely action for oxygen supplementation and supporting ventilation.	Goal met: The patient was able to have normal effective breathing pattern with respirations of 12 to 16 breaths per minute,was comfortable and was to breathe without any complaints and had no fear of death due to severe shortness of breath

Answer:  Nursing care plan-fear of death.

assessment	diagnosis	goals	interventions	rationale	evaluation
objective data: 50 year old truck driver male subjective data: patient appeared very frightened. Patient asked if he would die this time,patient experiences severe shortness of breath.	fear of death related to severe shortness of breath due to poor cardiac function as evidenced by the patient appearing frightened and asking if he would die this time.	1.The patient will be relieved of his fear of death,will not appear frightened and will cope normally with his disease. 2.The patient will be educated about the disease process, its treatment and the recovery course so as to get a realistic idea about his condition and avoid anxiety	1.Encourage patient to verbalize his thoughts and listen to the patient about his fear of death.using active listening and affirmation skills 2.maintaining a relaxed and calm atmosphere while communicating with the patient 3.Empathize with the patient and provide reassurance of the ongoing treatment to cure his condition 4. Educate the patient about the disease and its treatment and the normal recovery course. 5.relaxation therapy to calm fear, counselling and use of pharmacotherapy.[physician guided-dependent intervention]	1.listening to the patient gives vent to his feelings and provides emotional support which is therapeutic and allays anxiety. 2.The patients feeling of positivity increases and fear  decreases in a relaxed and calm atmosphere 3.Empathizing with the patient and reassuring him helps and to cope up with his fears 4.Knowledge about the disease process and its treatment and the normal recovery course helps patient get a realistic overview of his conditions and decreases anxiety and fear. 5.Fear and anxiety affect oxygenation and treatment process,so relaxation theapy must be provided	Goals met: The patient is relaxed,comfortable, effectively coping up with his medical condition and no longer fearful of death