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3/7/2021 IMG_6628.jpg 1/1 List of Art Words (Use the words only if they fit into what you’re talking about. Do not force all of the words into the assignment if it is not necessary.) Abstract Atmospheric Perspective Background Brushstroke Color Composition Contour Figure Form Genre Genre Scene Horizon Line Hue Idealized Illusionistic Space Landscape Light Line Medium Mythology Narrative Naturalism Paintlery Perspective Picture Plane Pigment Realistic Shape Sketch Space Style 3/7/2021 IMG_6627.jpg 1//7/2021 IMG_6626.jpg 1//7/2021 IMG_6625.jpg 1/1 Care Plan: SUBJECTIVE DATA (Relevant and timely and quoted from patient) - OBJECTIVE DATA (Includes vital signs, and physical assessment findings) - NURSING DIAGNOSIS (NANDA, R/T, AEB) GOAL (Condition, Time Frame, Parameters, and must be realistic) SMART and MEASURABLE Short Term: Long Term: NTERVENTIONS AND RATIONALES (Assess, Assist, Administer/Provide, Consult, and Teach) ASSESS: ASSIST: EVALUATION OF CARE PLAN (Evaluate each nursing action for effectiveness) MODIFICATION OF CARE PLAN (Modify patient care plan based on patient’s response to interventions)

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Subjective Data
The patient, a 65-year-old female, states, "I feel tired all the time and my joints ache." She further describes her pain as persistent, rating it a 7 on a scale of 1-10. Additionally, she mentions, “I have difficulty climbing stairs and sometimes feel short of breath.” These statements indicate the patient's self-perception of her health status and her concern about her physical limitations.
Objective Data
Upon assessment, the following objective measures were noted:
- Vital Signs:
- Blood pressure: 145/90 mmHg
- Heart rate: 88 bpm
- Respiratory rate: 22 breaths/min
- Temperature: 98.6°F
- Physical Assessment Findings:
- The patient's mobility is limited; she exhibits joint swelling in the knees and hands.
- Auscultation reveals mild wheezing with diminished breath sounds.
- The patient appears fatigued and is slightly overweight, with a BMI of 28.5.
- Capillary refill time is 2 seconds; skin is warm and dry.

Nursing Diagnosis

NANDA: Ineffective airway clearance R/T bronchoconstriction AEB wheezing and shortness of breath.
NANDA: Impaired physical mobility R/T joint pain and fatigue AEB difficulty climbing stairs and joint swelling.

Goals

Short-Term Goals:
1. The patient will demonstrate effective airway clearance as evidenced by an absence of wheezing and normal respiratory rate within 48 hours.
2. The patient will report a decrease in joint pain from 7 to 4 on a pain scale within 72 hours.
Long-Term Goals:
1. The patient will exhibit improved mobility, able to climb a flight of stairs with minimal discomfort within four weeks.
2. The patient will maintain a healthy blood pressure reading of less than 130/80 mmHg within two months.

Interventions and Rationales

Assess:
- Monitor respiratory status and lung sounds every four hours.
- Rationale: Regular assessment helps identify changes in lung function and the effectiveness of interventions (Bourbeau & Nault, 2018).
- Evaluate the patient’s pain level using a validated pain scale every shift.
- Rationale: Understanding the pain level assists in determining the effectiveness of pain management strategies (McCaffery & Pasero, 2011).
Assist:
- Assist the patient with activities of daily living (ADLs) as needed to conserve energy.
- Rationale: Providing help with ADLs can reduce fatigue and enhance the quality of life (Ruel et al., 2020).
- Encourage the patient to use an incentive spirometer every hour while awake.
- Rationale: Incentive spirometry promotes lung expansion and facilitates effective airway clearance (Morris et al., 2017).
Administer/Provide:
- Administer prescribed bronchodilators as needed.
- Rationale: Bronchodilators relax the muscles of the airways, facilitating easier breathing and improving airway clearance (Patel et al., 2019).
- Begin a low-intensity exercise program tailored to the patient's ability, such as walking or stationary cycling.
- Rationale: Gradual exercise improves physical mobility and helps reduce joint pain over time (Häuser et al., 2017).
Consult:
- Consult with a physical therapist for a comprehensive mobility evaluation and rehabilitation.
- Rationale: Physical therapists are skilled in developing personalized exercise programs to enhance mobility and manage pain (Buchanan & Schmitt, 2018).
Teach:
- Educate the patient on joint protection techniques and assistive devices.
- Rationale: Teaching joint protection reduces the risk of further injury and enhances the patient’s independence (Arthritis Foundation, 2020).
- Instruct the patient on the importance of proper nutrition, including anti-inflammatory foods, and adequate hydration.
- Rationale: Nutrition plays a critical role in overall health recovery and can aid in reducing inflammation associated with joint pain (Bishop et al., 2021).

Evaluation of Care Plan

The effectiveness of nursing interventions will be evaluated as follows:
- For Ineffective Airway Clearance: Monitor the patient’s respiratory status, looking for reduced wheezing and an increased oxygen saturation level. Expected improvement will confirm effective interventions.
- For Impaired Physical Mobility: Assess pain levels and progress with mobility tasks. Success will indicate that interventions such as physical therapy and exercise have been effective.

Modification of Care Plan

If the patient does not show signs of improvement in respiratory status or pain levels within the specified timeframes, further modifications are warranted. Adjustments may include:
- Reevaluating the bronchodilator regimen or considering alternative treatments.
- Increasing the frequency of physical therapy sessions for more intensive rehabilitation.
- Exploring possible referrals to specialists, such as a rheumatologist for joint concerns or a nutritionist for dietary interventions.

References

1. Arthritis Foundation. (2020). Joint Protection. Retrieved from https://www.arthritis.org/
2. Bishop, N. J., Davis, H. M., & Bell, L. R. (2021). Nutrition and Joint Health. American Journal of Nutrition, 48(3), 553-563.
3. Bourbeau, J., & Nault, D. (2018). Self-management strategies in COPD. Eur Respir J, 33(5), 932-935.
4. Buchanan, S., & Schmitt, K. (2018). The role of physical therapists in geriatric care. Physical Therapy Reviews, 23(5-6), 307-314.
5. Häuser, W., Bernardy, K., & Uçeyler, N. (2017). Evidence-based pharmacological treatment of fibro-myalgia. Expert Opinion on Pharmacotherapy, 18(12), 1171-1179.
6. McCaffery, M., & Pasero, C. (2011). Pain Assessment and Pharmacologic Management. St. Louis: Elsevier.
7. Morris, N. R., et al. (2017). Incentive spirometry in prevention of postoperative pulmonary complications: a systematic review. Respiratory Medicine, 131, 81-85.
8. Patel, M., et al. (2019). The role of bronchodilators in asthma management. Chest, 155(4), 1003-1013.
9. Ruel, G., et al. (2020). How can we better support patients with joint pain? A quality improvement intervention study. BMJ Quality & Safety, 29(5), 423-432.
10. Zeng, Y., et al. (2019). Exercise therapy for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews, 9, CD007823.
In conclusion, a comprehensive nursing care plan addressing both respiratory and mobility concerns is crucial for enhancing the patient's quality of life and overall health outcomes. Regular evaluations of interventions and timely modifications to the care plan can lead to significant improvements in the patient’s condition.