This is my blog 4. I wrote about how I was doing in school and how our summer was shaping up as a family. Leaving my job and going back to school has been a big change in our home life affecting everyone. This is an easy topic for me with lots of material to talk about.
Moving along in semester two is easier than I thought (so far). After the disaster that was semester 1, I thought I was in store for more of the same. Things seems to be better at the moment, and with only four weeks left I can’t see how wrong things could go.
I was worried about the children being off for the summer. It’s working out so far, the little one has gone to an extended visit to Grandma and Granddad’s farm in the UK. He’s having a blast, he has two sets of grandparents to keep busy and an endless supply of cousins to play with. He has signed up for soccer, athletics and tennis to keep him active, and the weather over there is fantastic (unusual for a British summer!).
The big one is working her first full time summer job as a Camp counselor. The first week was a rough one for her, but she handled it well and is doing amazing. She is tired and grumpy but I’m hoping that she will get used to working long hours soon. I’m still driving her around but she is cycling to work a couple days a week and it doesn’t seem as hectic as before.
I was regretting going through the summer at the start of the semester, my friends are hanging out at the beach with their kids or having pool parties and I’m stuck as school, but it’s only one summer and I will be thankful when I’m finished earlier than expected. We have lots planned in August and I will make the most of my time off. There will be lots of beach days and pool parties. We even having a flying lesson planned.
This is my care plan created for my clinical placement this semester. I received a good mark for this and I am proud of the work I put into it. This is a definite improvement over my first one.
|Assessment Data||Nursing Diagnosis and Related Goals||Nursing Interventions and Rationale||Evaluation|
|· “I ate my toast and cheese”
· “I don’t feel like eating today. This doesn’t look like something I would order for breakfast”
· Pt. ate 50% of breakfast on 4/7/17 and no breakfast on 5/7/17.
· Food needs to be removed as soon as pt. is finished.
· Pt. is unsteady on feet, moves slowly and nervous of syncope.
· Pt is pale and has poor skin turgor.
· 04/7/17 Vitals
Chest clear, symmetrical
Bowel Q4 normal
· 05/7/17 Vitals
Bowel Q4 normal
3/7/17 – 54.5 Kgs
4/7/17 – 54.7 Kgs
5/7/17 – 55.0 Kgs
|At risk of imbalanced nutrition, less than body requirements related to inadequate food intake, and an unwillingness to eat as evidenced by low body weight, pale colour, poor skin turgor and muscle tone, amenorrhea, bradycardia and weakness.
· Sort-term goal 1: increase nutrition to normal body requirements by the end of week 2.
· Short-term goal2: Increase and maintain good electrolyte balance after two days of admission.
· Long-term goal 1: Patient stops losing weight and begins to gain weight by the end of one week after admission.
· Long-term goal 2: Coordinate a plan of care with a multidisciplinary approach (Family Doctor, Dietician, and Psychologist) to be in place by discharge.
Disturbed thought process related to severe malnutrition, psychological conflicts, sense of low self-worth, and perceived lack of control as evidenced by altered sleep patterns, fatigue, anxiety, and depression.
· Short-term goal 1: Pt has improved sleep and is relying less on medications to help sleep patterns within two weeks.
· Short-term goal 2: A reduction in anxiety and depression levels, leading to a reduction in medication levels within two weeks.
· Long-term goal 1: Pt will re-examine positive and negative self- perceptions by the time of discharge.
· Long-term goal 2:
Pt. will identify and use resources outside of the hospital to increase and maintain self-esteem levels and self-concepts by time of discharge.
|Ensure appropriate nutrition and total calories per day to relieve acute starvation.
A gradual refeeding prescription ensures steady weight gain and reduces risk of medical complications (Perry, 2014)
Administering parenteral fluids is an effective way to restore fluid balance.
Maintaining a good electrolyte balance will prevent further bradycardia, weakness and improve skin turgor (Perry, 2014).
Ensure patient that the treatment is not designed to produce obesity.
Patients will have an overwhelming fear of weight gain and obesity (Perry, 2014).
Successful nutrition care planning will involve a multidisciplinary team approach to cover all aspects of care. Involving pt. in care planning will encourage success (Perry, 2014).
Maintaining a consistent schedule helps induce sleep, making it easier for pt to fall asleep.
Regular exercise and an increased activity level will improve sleep quality. (Perry, 2014)
Reinforcing pt’s reaction to or expressions of anxiety around food. Talking or expressing feelings will reduce anxiety. Offering food and liquids without comment or judgement will lessen the anxiety around mealtimes, reducing anxiety and depression (Perry, 2014).
The effect of body image may influence other aspects of self-concept and self-esteem. Encourage expression of thoughts and feelings, including depression and grief, fear and anger. (Perry, 2014)
An in-patient treatment centre or community support group will help integrate a new body image into her self-concept and help with continuation of care and support (Perry, 2014).
|· Short-term goal 1: Has been met. Patient is receiving NG tube feed along with regular diet to increase nutrition to normal body requirements of 2002 calories per day.
· Short-term goal 2: Has been met. Patient is producing sufficient output after NG tube feed and regular liquid intake maintaining an electrolyte balance as seen by lab results.
· Long-term goal 1: Goal has been met. Patient has stopped losing weight as evidenced by the daily weight.
· Long-term goal 2: Goal has not been met. This will require more time. Pt has been seen by Doctor and Dietician.
· Short-term goal 1: Goal has not been met. Pt needs more time to maintain a strict schedule and increase activity level and to reduce need for sleep medication.
· Short-term goal 2: Goal has not been met, will require more time and possibly specialised help from psychology.
· LT goal 1: Has not been met, patient needs more time. This is a very long term goal with specialised psychological help.
· LT goal 2: Has not been met, pt has some reluctance to seek a support group but will consider an in-patient program.
The last piece is a discussion post on Art therapy as a trend in healthcare and a paragraph on what is the key to collaborative work.
The trend analysis I would like to focus on is the area of Art therapy. Pediatric and Psychological wards have always used art activities as a way for patients to express themselves or to relive the boredom of being stuck in the hospital. There is a new trend emerging that engages other patients in art therapy as a way to promote self-reflection, emotional injury healing, reduction in symptoms, reduce stress and anxiety, and alter behaviors and thinking patterns.
Art therapies is an umbrella term that covers music engagement, movement based creative expression, expressive writing, and visual art therapies such as painting and colouring.
My best collaborative work came when we were doing an assignment for Human growth and development. We were to do a presentation on ‘the freshman 15’ the weight a new student supposedly gains while eating here at the school. I didn’t know the other girls in my group very well and we hardly spoke about our project at all. We each knew what area we were covering and we got it done individually. Finally on the day of the presentation we emailed our slides to one person who put it all together. We each got 100%.
The key to a successful collaboration is communication at the outset. Everyone should know what they are doing and the due date. We should have the confidence in each other to get it done. We are adult learners after all.