Question

I need 3 nursing diagnoses and 9 nursing interventions (3 nursing interventions each) for this Client:

A psychiatric consultant was called to evaluate depression in Victor Alvarez, a 76-year-old-man who appeared dysphoric the day after surgery to repair a broken hip. It was late in the evening, and no one from the admitting team was available, but a social work note in the chart indicated that the patient’s fracture appeared to have been the result of his tripping in his messy apartment. The note also stated that the patient had no children or known living family.The neighbor who had brought Mr. Alvarez to the hospital had stated that the patient had been more reclusive in recent years and that his self-care had worsened after his wife’s death 6 months earlier. Up until the day of the surgery, however, he had been able to function independently in his apartment. The neighbor, a nurse, also mentioned that while they were waiting for the ambulance, her husband had sat with Mr. Alvarez while she searched the apartment for pill bottles. She said she had found only an unopened bottle of acetaminophen and a dusty bottle of a medication used for hypertension.Routine admission laboratory results indicated that Mr. Alvarez had an elevated blood urea nitrogen level, a low albumin level, and a high normal mean corpuscular volume. His blood pressure was 160/110. In addition to medications related to the surgery, the chart indicated that he had received haloperidol 2 mg after a bout of agitation. A nursing note 1 hour after the haloperidol administration indicated that the patient was “worried and stiff.”On mental status examination, Mr. Alvarez was lying at a 45-degree angle in his unkempt bed. He appeared thin and had moderate temporal wasting. His affect was sad, worried, and 20constricted. He appeared stiff and uncomfortable. He did not immediately respond to the interviewer’s questions and comments. His eyes remained generally shut, but they did flicker open a few times, and his body habitus implied that he was awake. After multiple efforts, the psychiatrist was able to get the patient to say “I’m fine” and “Get out.” When asked where he was, Mr. Alvarez said, “My apartment.” When he did open his eyes, the patient appeared confused. He did not respond to other questions and declined to do a clock drawing test. The surgery team had called in a one-to-one companion earlier in the day, and she said that the patient was generally either asleep or trying to get out of bed and that he had not been making any sense all day.

Answer 1

1.Nursing diagnosis

Ineffective coping mechanism related to grieving process as evidenced by death of his wife, dysphoria, reclusive behavior

Nursing intervention

• Assessment the patient coping mechanism to plan for care
• Encourage the client to speak out regarding the feeling,loss .This can make them to feel relaxed by expressing the feelings
• Provide behavior and diversions therapy to understand the reality and accept it and lead a life

2.Nursing diagnosis

Altered cardiac output related to non adherence to medication  as evidenced by high blood pressure ,dusty medication bottle

Nursing intervention

• Monitor vital signs blood pressure and heart rate to get basic information regarding health status and plan for care
• Administer antihypertensive to reduce blood pressure which is high
• Do cardiac monitor as per order to rule out any injury to the heart

3.Nursing diagnosis

Self care deficit related to the disease condition, grievence as evidenced by hesitating to communicate with others, eyes closed,anger

Nursing interventions

• Plan activities of daily living
• Encourage ,motivate and assist to participate in self care
• Provide diversional therapy to come out of depression