NURS FPX 6610 Assessment 2 Patient Care Plan

Name

Capella university

NURS-FPX 6610 Introduction to Care Coordination

Prof. Name

Date

Patient Care Plan for Mrs. Snyder

Patient Information

Patient Identifier: 6700891
Medical Diagnosis: Poorly controlled anxiety, obesity, hypertension (HTN), diabetes mellitus (DM), and hypercholesterolemia.

Nursing Diagnosis 1: Risk of Poor Healthcare Management and Diabetes Complications

Assessment Data

Mrs. Snyder, a 56-year-old married mother of two, is undergoing treatment for hyperglycemia and uncontrolled diabetes. She has a history of consuming high-sugar snacks. Objectively, she was admitted to the emergency department with blood sugar levels ranging from 230 to 389 mg/dL, along with symptoms such as dyspnea, abdominal discomfort, and urination issues. She also has a diagnosis of hypertension.

Goals and Outcomes

Mrs. Snyder will maintain blood glucose levels within the range of 90–140 mg/dL over the next two months.
She will demonstrate improved dietary habits and a reduction in weight within three months by adhering to a low-sugar, balanced diet.

Nursing Interventions and Rationale

Educate Mrs. Snyder on self-care management strategies, including dietary control and regular physical activity. Self-care education enhances patient autonomy and promotes effective diabetes management (USC, 2018).
Teach blood glucose monitoring and insulin administration techniques to ensure proper diabetes management. Self-monitoring helps regulate insulin dosage and dietary intake (Carolina, 2019).
Collaborate with a dietitian to formulate a meal plan that minimizes sugar intake. A structured diet is critical for blood sugar control and preventing diabetes complications (Heart, 2021).

Outcome Evaluation and Re-planning

Daily glucose level monitoring will be implemented. If the goals are not met, interventions such as increased follow-up visits or alternative medication strategies will be introduced.

Assessment Data

Mrs. Snyder reports experiencing anxiety due to her responsibilities at home and the care of her elderly mother. She feels overwhelmed, resulting in high blood pressure and tachycardia. Objectively, she has an inconsistent intake of anxiolytic medications, with vital signs indicating elevated blood pressure (145/95 mmHg) and tachycardia (105 BPM).

Goals and Outcomes

Mrs. Snyder’s anxiety levels will decrease by 50% within one month of implementing non-pharmacological interventions.
Her blood pressure will stabilize at 130/90 mmHg, and her heart rate will normalize within one month.

Nursing Interventions and Rationale

Administer prescribed anxiolytics as directed to help manage her anxiety levels. These medications promote mental stability and reduce anxiety symptoms (Ströhle et al., 2018).
Refer to cognitive behavioral therapy (CBT) sessions to provide structured coping strategies for stress and anxiety management. CBT is an effective intervention for anxiety-related disorders (Pegg et al., 2022).
Connect to a support group for Jewish women facing caregiving stress. Social support plays a crucial role in emotional well-being and stress reduction.

Outcome Evaluation and Re-planning

Weekly reviews of anxiety levels and blood pressure will be conducted. If progress is inadequate, interventions such as medication adjustments or additional therapy sessions will be considered.

Nursing Diagnosis 3: Caregiver Role Strain and Fear of Cancer Treatment

Assessment Data

Mrs. Snyder expresses concerns about undergoing chemotherapy for ovarian cancer while simultaneously managing her mother’s care. She reports experiencing shortness of breath, and objective data indicates an oxygen saturation level dropping to 91% during ambulation, likely due to her obesity.

Goals and Outcomes

Mrs. Snyder will arrange long-term care for her mother within two weeks to allow her to focus on her chemotherapy.
Her oxygen saturation will improve to 95% with ambulation within one month of initiating treatment.

Nursing Interventions and Rationale

Refer Mrs. Snyder to a social worker for assistance in securing long-term care for her mother. This support will alleviate caregiver strain and enable her to focus on her health (Hoyt, 2022).
Implement non-pharmacological pain management strategies, such as meditation and breathing exercises. These interventions help reduce anxiety and manage pain during cancer treatment (Sheikhalipour et al., 2019).
Monitor pain levels and oxygen saturation three times daily to ensure early identification of potential complications.

Outcome Evaluation and Re-planning

If oxygen saturation and pain management goals are not met, alternative strategies, such as supplemental oxygen or adjustments in pain medication, will be explored.

Table Format

Nursing Diagnosis	Assessment Data	Goals and Outcomes	Nursing Interventions and Rationale	Outcome Evaluation and Re-planning
Risk of Poor Healthcare Management and Diabetes Complications	Subjective: Mrs. Snyder reports a history of consuming high-sugar snacks. Objective: Blood sugar levels between 230–389 mg/dL, dyspnea, abdominal discomfort, and HTN.	1. Maintain blood glucose within 90–140 mg/dL in two months. 2. Improve dietary habits and reduce weight in three months.	1. Educate on self-care (USC, 2018). 2. Teach blood glucose monitoring and insulin administration (Carolina, 2019). 3. Collaborate with a dietitian for meal planning (Heart, 2021).	Monitor glucose levels daily. Adjust follow-up visits and medications if needed.
Anxiety Related to Caregiving and Health Issues	Subjective: Mrs. Snyder reports anxiety due to caregiving stress. Objective: BP: 145/95 mmHg, HR: 105 BPM, irregular anxiolytic use.	1. Reduce anxiety levels by 50% in one month. 2. Stabilize BP at 130/90 mmHg and normalize heart rate.	1. Administer anxiolytics (Ströhle et al., 2018). 2. Refer to CBT (Pegg et al., 2022). 3. Connect to a support group.	Weekly monitoring of anxiety and BP. Adjust medications or therapy as needed.
Caregiver Role Strain and Fear of Cancer Treatment	Subjective: Mrs. Snyder fears chemotherapy and struggles with caregiving. Objective: Oxygen saturation drops to 91% during ambulation.	1. Secure long-term care for her mother within two weeks. 2. Improve oxygen saturation to 95% within one month.	1. Refer to a social worker for caregiving support (Hoyt, 2022). 2. Implement meditation and breathing exercises (Sheikhalipour et al., 2019). 3. Assess oxygen saturation and pain levels thrice daily.	If goals are unmet, consider supplemental oxygen or alternative pain management.

References

Carolina, C. M. (2019). Unlocking the full potential of self-monitoring of blood glucose. U.S. Pharmacist. https://www.uspharmacist.com/article/unlocking-the-full-potential-of-selfmonitoring-of-blood-glucose

Hoyt, J. (2022). Assisted living & senior placement agencies. SeniorLiving.org. https://www.seniorliving.org/placement-agencies/

Pegg, S., Hill, K., Argiros, A., Olatunji, B. O., & Kujawa, A. (2022). Cognitive behavioral therapy for anxiety disorders in youth. Current Psychiatry Reports, 24(12). https://doi.org/10.1007/s11920-022-01384-7