Question

Roy’s Adaptation Model

Your closest friend has been diagnosed with breast cancer. Following surgery and chemotherapy she learned that the cancer has metastasized. She is single and has a daughter who is 6 years old.

Identify her adaptive needs in the physiological adaptive mode. What interventions would you provide?

Consider her possible adaptive needs in the self-concept mode. What possible interventions would you discuss with her?

What would be her needs in the interdependence adaptive mode? What possible interventions would you discuss with her?

Identify her adaptive needs in the role function adaptive mode. List an intervention you could offer to provide.

Answer 1

Self Concept Mode

Assessment of behavior

Patient claims: the lump in my right breast is removed, the size of the breast is smaller, I'm comfortable with this , I would have been upset if my whole breast had been removed

Visually the loss of hair may upset me and i may be ashamed, I actually prepared myself for everything; still i do not know how I will feel when I lose my hair. I may be very sorry about it even though i know it will grow back. I fear my husband will keep a distance from me once my hair starts to fall. We have seen in newspapers that couples get a divorce after this.

My six years old daughter does not know what is going on .I am worried about what will she think after i go bald.

Assessment of stimuli

Focal stimuli

Brest Cancer

Contextual Stimuli

• Breast conserving surgery ,
• Chemotherapy
• daughter's ideas

Residual Stimuli

• Belief and thoughts on chemotherapy side effects
• newspaper information

Present Nursing diagnosis

• Anxiety ,
• Impairment of body image

Possible nursing diagnosis

• Self respect impairment risk
• Insufficient inindividial coping risk ,
• Sexual life alteration risk

Nursing interventions

• Evaluation of the patient in terms of bosy image during every stage of cancer.
• The loss is accepted , grief and anger are normalized and encouraged to express feelings.
• Trusting and supportive relationship is formed .
• The patient's husband is informed that his attitude towards his spouse's body image alteration are very critical , that he should change any negative opinion he has about the disease, and that he should encourage his wife to express her feelings and help her accept the changes.
• the reason for disturbed body image is defined; coping methods and social support are evaluated.
• Informed that the hair loss will begin 7 to 21 days after the first session of chemotherapy .
• Given the opportunity to express feelings about the expected changes.
• Encouraged to get a haircut before losing hair .
• Use of hair softner during shower is suggested .
• Use of shampoos with nutrients , thorough cleansing and gentle drying are recommmended .
• Electrical hair dryers are not suggested .
• Combing of the hair should not be done too frequently , by using soft brushes .
• Wigs or scarves are recommended before treatment .
• If she prefers a wig it is suggested that she buys one before losing her hair , to match her hair color. Eye pencil , brow pencil , fake eyebrows are recommended .
• Informed that hair will grow back in 1 - 2 onths after the end of chemotherapy , will look like pre treatment form 3 to 5 months .
• Informed that the new hair might appear differently .
• The patient is introduced to other patients who had lived this experince before .
• the patient is encouraged to join support groups and group therapy

Interdependence adaptive mode

Patient Claim:

My husband , family and friends are sorry for me . They have been great support . Theor care made me feel better . I spent more time with my friends since my family lives abroad . I spoke to my family over the phone . I carried on my daily life . My husband is trying to take care of oour daughter more . He was not helping me this much before.

Assessment of stimuli

Possible nursing diagnosis

• Insufficiency in inter-family coping risk .
• Insufficiency i individual coping risk .
• Social relation impairment risk

Focal stimuli

Breast Cancer

Contextual Stimuli

• Spouse
• Family
• friends

Presnt nursing diagnosis

Altered family process

Nursing diagnosis : altered family process : Nursing interventions

• An environment where all family members can enpress their feelings is formed .
• Family members are assissted ato identify their support systems and use these when needed.
• The patient is encouraged to define their relationship with family memebers.
• It is evaluated if the patient's interfamily roles are altered due to the disease and their support and their adaptation to altered roles is defined .
• The patient is encouraged to develop efficient coping methods for problems occuring in family proccess and to continue communication and interation with family memebers.
• Family memebers might be given education on coping and problem solving methods .
• If required they might be encouraged for professional support

Role function mode :

Assessment of behavior

Patient claim: iam on sick leave. I cannot teach . I need someone to help me with my house duties . My husband is helping as much as he can .

Assessment of behavior .

Focal stimuli

Breast Cancer .

Contextual stimuli .

• BCS
• Chemotherapy .

Present nursing diagnosis .

Insufficienct in fulfilling roles .

Nursing Diagnosis: Insufficiency in fulfilling roles : Nursing interventions .

• Personal responsibilities regarding motherhood and spouce .
• Encouraged to face obstacles in roles and share lately encouraged stressors.
• Parents are given opportuniities regarding childcare .
• Support sysytems are evaluated.
• Encouraged to speak to her employer about her present situatiuon .
• It is emphasized that the emplyer might have requests from the individial and a planning that is suitable for both sides can be made

Physiologic mode.

Aseessment of behaviour

Patient claim: It took me one month before i can completely use my arm after the surgery . I was not able to use that arm . My doctor told me that i could use that arm in anyway when i moved it i felt burning. Therefore i limited my activities .

Assessment stimuli .

Focal stimulus .

• Breast conserving surgery,
• Sentinel lymph nose biopsy .

Contexual stimulus .

Burning .

Possible Nursing disagnosis .

• Altered nutrition : under/over nutrition risk ,
• Nausea- vomiting risk .

Elimination .

• Constipation risk
• , Diarrhea risk .

Rest and protection .

• Sleep disturbance risk .

Fluid electrolyte .

• Fluid volume insufficiency risk .

Present nursing diagnoosis :

Impairment of physical motion (Arm- shoulder)

Nursing diagnosis :

• Impairment of physical motion ,
• Nursing Interventions .

Early period .

• Limited ROM exercise ,
• finger-wrist motions on postoperative dat 1 ,
• Elbow motions on postoperative day 3 ,
• Informed about active arm-elbow exercise program after consulting with the surgeon and sutures and drains withdrawn.
• Patient encouraged to comply with the exercises,
• repetition number and variation are increased .
• informed that these exercises should be done three times a day for 20 minutes until normal angles are obtained in all moves.
• Patient is encouraged to engage in daily activities .
• A boooklet including exercises is handed out .

Late period .

• Two- three times a day rest of the affected atm and elevation ,
• Three - four times a day , opening and closing the affected arm for 15-25 times above the heart level,
• Not sleeping over the side of the affected arm ,
• Apply the exercise program for 20 minutes three times a day