Care plan Essay Example

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care plan

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Nursing care Plan for Janet Grey

Introduction

Alcoholism is an addiction disorder that results from the uncontrollable and continued consumption of alcohol. This leads to alcohol dependence where the victim cannot generally do without alcohol despite knowing its harmful effects. Alcoholism is detrimental to one’s health and in most cases results into social and relationship problems. Alcoholics develop the alcohol dependence syndrome which is also referred to as dipsomania. Alcoholism over long periods of time results into tolerance where the victim hardly gets drunk and augments the incapability of the alcoholic’s ability to break the habit. Upon discontinuing alcohol consumption the victim develops the alcohol withdrawal syndrome. Many risk factors such as organ damage, relationship problems, depression, stress and strained relationship are associated with excessive alcohol intake over prolonged duration of time (Melinda, Jeanne & Lawrence, 2011). Alcoholism like any other drug addiction is treatable disease. Medical care helps the patient to break the addiction. This paper seeks to discuss the nursing plan that was used on Janet Grey to help her with her alcoholism problem.

Literature review

Alcohol dependence dates back to thousands of years ago. Drunkenness and alcoholism was associated was associated with many social problems and its medical consequences were established back in the 18th century. Agapios a Greek wrote that alcoholism resulted into nervous system toxicity and other disorders such as paralysis. Efforts to prohibit alcohol have failed and many countries use huge amounts of money in cost of alcohol dependence and abuse. Alcoholism is known to cause many physical effects on the victim such as pancreatitis, cirrhosis, epilepsy and dementia. Other effects include cardiovascular problems which results to death in some cases, damage of the nervous system, malabsorption and sexual dysfunction. There are also psychiatric problems associated with alcoholism such as psychosis, organic brain syndrome, panic disorder, anxiety, depression, confusion and schizophrenia (John, 2006). Alcohol use in conjunction with other drugs leads to augmented depression. These orders differ for both men and women. Women with alcohol dependence experience major depression, anxiety, borderline personality disorder, panic disorder and bulimia. Men on the other hand experience more narcissistic personality disorder, impulse disorder, bipolar disorder. Women according to literature reviewed have a long history of physical abuse and domestic brutality which leads to increased dependence on alcohol. The cases of child abuse, assault, rape and violence recorded as a result of alcoholism are just many. Social problems as a result of drunkenness lead to isolation from friends and family. This in turn results into divorce and conflicts in marriage (Dennis, l, Jay M and William, S, 2011).

Efforts to discontinue alcohol use can be detrimental if not well executed. Alcohol dependence results into stimulation of the receptors in the nervous system when alcohol intake is abruptly stopped the nervous system suffers hysterical synapse firing that results into seizures, hallucinations, heart failure and shakes (Melinda et.al, 2011).

Alcohol abuse can be prevented through abstinence where one completely refuses to engage in alcohol intake. The other method can be through alcohol detoxification through the substitution of benzodiazepines. Group therapy and psychotherapy also helps address issues related to alcoholism these groups have helped to maintain alcohol abstinence. Rationing and moderation, studies have shown that this can eventually lead into total abstinence. Medication helps to discontinue alcohol abuse through the use of drugs such as disufiram, naltrexone, temposil, topamax; other medications such as benzodiazepines can worsen the situation of alcoholism and make it more acute. Studies reveal that topiramate reduces alcohol carves and withdrawal intensity and improves the patient’s perception about life (Melinda et.al, 2011).

Research statement

Alcoholism continues to be the main reason behind many domestic problems. Many relationships have gone sore as a result of alcohol dependence and as a result many homes have split up due to the problems that result from alcohol. Children are abandoned everyday by their parents who cannot desist from consuming alcohol. A solution needs to be found for such so that children upbringing is not disrupted by alcoholism. Medical practice is one of the areas that have helped alcoholics deal with dipsomania mainly through nursing plans and psychiatric sessions. Nurses as well as psychiatrics take the patient through lessons which in the long-run helps the patients to stop alcoholism. This has helped to reduce the number of alcoholics and suicide which result from alcoholic addiction.

Operational variables

Population of interest – alcoholics

Independent variables – long term alcohol effects

Dependent variable – treatment of alcoholism

Approach

The best method is to start with analyzing the problems Grey has had and the experiences she is been through. This I will divide into social, biological and psychological problems.

Social problems

Janet grey is a thirty one year old mother of two who is considered as depressive and alcoholic. According medical records she is to be discharged from the anti-depressant pills that she has been taking. Janet has been drinking as long as she can remember and her current record is averagely four to five times a week. Although she drinks every time she has confirmed that not all occasions she gets drunk but when she does get drunk she advances to get a black out. Janet also uses marijuana from time to time but she explains that she prefers alcohol to marijuana. The major source for the marijuana is from her friends when she is attending a party or relaxing. Janet has friends especially from her work place who support because it gets quite hard to keep time.

The other perspective is that Janet views herself as a bother to her family and wishes that she did not exist. She also has a big problem with parenting just like many other alcoholics. Hers has gone to extreme that she literally lost her daughter to the child services. This was as a result of her incapability to get herself together ten years ago. Her son also lives with her brother’s family; she accepts and confirms that her son is taken care of. The fact that she visits her son from time also explains that she misses him very much but she is not in a condition of taking care of him. Janet explains that she feels very bad about being a terrible mother to her wonderful son. Janet also has a boy friend who she says is not like the best boyfriend but he still counts.

Psychological problems

The main issue that bothers Janet psychologically, she has so much issues in her head that she thinks the only way out is to kill herself. Because she feels sad all the time she is not drinking then she drinks every time to make herself numb to any feelings and it only this moment that she feels normal. She has also lost her ability to concentrate over years, previously she was a very good reader but at the moment she has lost that ability.

She also lives with guiltiness of not being a good mother to her children and from time wishes that they could be together. At time she suffers from panic attacks especially when she thinks about her daughter whom she does not know about her whereabouts. She also has this chain smoking problem which happens in a random cycle but she does not yet know what triggers it. Though she has not been hearing the voices then she has been seeing things during her day to day activities. Good example that she gave was when she was at the cemetery where her dad was buried.

She claimed to have seen an eagle which was flying slightly over them, her sister could not see the eagle until she touched her. Another case was when she saw this old lady who had died two years earlier walk down the street. However she protests about being taken to psyche ward and she does not understand the reason for her being there. She has this issues that cannot leave her mind like being an awful mother, being stressful to her family and negative thinking concerning her life and the fact that she should not be there.

Biological problems

Her biological health is ok, from the average observations made. She has good appetite for the food, she has not had any weight loss and her memory is good. She has also expressed the fact that she is sexually active and sex drive is normal. Through the evaluation Janet confirmed that she has been experiencing shortness of breath and chest pains. This mostly happens when she freaks out but recovers after ten to fifteen minutes of relaxation.

Priority issues

The nursing plan will use Grey’s experiences, which will be analyzed to draw the best remedy that can be offered to her to resolve her addiction problem. Information will be collected from the discussion/interview we shall have with Grey on her stand with the alcoholism situation. We shall draw out a table to compare the advantages and disadvantages of alcohol abuse. The other information will be collected from observation, consultations from other professionals handling the patient and previous records and relevant literature

Instrument

Prior to our chat with Grey I will have come with questions that I will use to get information that will be of help to drawing the plan that will be used on Grey. I will create a friendly environment that will make Grey open up about how she really feels about her situation. From her past and present experience it will assist to determine the medical assistance that will be offered to her as well as place her on psychotherapy.

Sampling strategy

The study is on Grey who is a patient faced with an alcoholic problem. This the information collected will be used collectively to device the best mode of action to help her break her addiction problem and most importantly show her the positivity of life.

Data analysis

It should also be taken into account any risk factors that may be a stumbling block to progress. This may be from the patient or the problem might have unique characteristics. The nurse should make use of relevant literature to check on documented cases and possible solutions. The response to drug therapy should be collaborated with prescribing doctor. (Andrea, A, 2001)

This report shall be followed by a documentation of the results. The nurse in collaboration with other participating doctors shall make a call whether the plan care is working or not. From this point the issue of the patient response will determine whether the care plan needs to be modified or restructured as a whole.

The most important thing to consider in this plan care is the fact that Janet wants to be dead than alive. It will up to me to ensure that Janet can perceive that life is more important to her than she can see. The other issues to be dealt with are the ones she will personally identify such as;

  • Panic attacks,

  • Inability to concentrate,

  • Determination of the source of her chest pains,

  • Addiction to alcohol and

  • Chain smoking.

  • Eliminate these negative thoughts in her head that are the driving force for her attempted suicide.

The evaluation shall be levels of;

  • Task not met at all

  • Task partially met

  • Task completely met

From the comparison we will go through the goals set and compare with present state. We shall have an interview with the patient and as she explains her state record will be taken to provide overall analysis. After the analysis several points will be noted especially for the case where there has been poor result.

We shall review whether the plan is still viable for the state of the patient and what changes should be made. It is also important to enquire how the patient feels about the plan. At this point the nurse will be capable of predicting the best intervention id need be that highly depends on the overall assessment.

Expected outcomes

  • Janet should be able to live a normal life without thinking of committing suicide. She should be stronger to confront the challenges rather than find ways of escaping them.

  • Janet should be able to accept her status along the care plan to help her get out of it. It is only after accepting that she has a problem that we can work as team to find the solution.

  • Get her back to a normal life where she can concentrate and read books, report to work on time and get more involved in raising her son.

  • Enable Janet to stop drinking and have the ability to resist the urge of consuming the alcohol herself.

  • Through counselling services we can get Janet to believe that she is important to her family and friends and not only stressful and a bad mother.

  • Having a complete health life, elimination of her chest pains and other possible medicals conditions

Ethical consideration

The use of the medical method is based on the fact that depression is a disease or condition which affects the spirit, body and mind. (David, H., n.d) The cognitive behavior therapy will help Janet get back her social life into track, through understanding how her thoughts influences her actions then she can get some control on her impulses. This method gives a chance to take a look at her life and realize it not as bad as it seems (John, 2006).

Furthermore she will also receive the psychotherapy treatment from the mental doctors after assessment as agreed. The assessment will gauge the extent of damage that has been caused by the depression and anti depressants will be administered appropriately.

The use of treatment has been successful over years. Records have shown that since the introduction of food and drug administration and requirement of labeling medications, which reduced antidepressant prescribing, cases of suicide among the young people, have increased by 18 % in the year 2003-2004 in the United States.

There should be provision of specific anti depressants, lithobid to stabilize her moods and clozaril to help eliminate bizarre thoughts. When they are well combined her likelihood of attempting suicide any more will be reduced. (Dennis et.al 2011)

The first approach is intended to bring the actual events clearly to Janet’s mind. Every one suffering from alcoholism finds it difficult to accept it. It is therefore very important that a patient is given time means and space to contemplate the issue before accepting the reality. One way of assisting addicts find the truth is by use of such tables to separate the good and the bad.

Once the patients make the list it is very easy to consider the truth that alcohol has done more harm than good in their lives. Having a plan is good and you feel responsible to keep the promise of playing by your own rules. It also helps one have a guide line through which to follow, it is difficult to control reduced drinking if you do not have a program for it. (Melinda, S, Jeanne, S and Lawrence R, 2011)

The medical treatment is useful because it can provide treatment to control the alcohol withdrawal symptoms like nausea, shaking and sweating. Other oral medications like antabuse, depade and acamprosate are used to reduce alcohol dependence; vivitrol is available for injection and last longer in the body (Sara-jo, 2001).

Vivitrol acts on the brain and reduces the craving for the alcohol after a period of abstinence, acamprosate is meant to control the symptoms associated with long period of abstinence like insomnia and anxiety and depade gives a sick feeling later to those who take alcohol. Generally these drugs respond differently to patients but majority has shown positive progress. (Dennis, l, Jay M and William, S, 2011)

Limitations

Janet does not like to be in the psyche ward and she also does not see the importance of being in the psyche ward. It will be hard for her to get through rehabilitation or once she has made it through drag her right back where she was because most of her friends are like or worse than her and will bringing drugs to her. Alcohol withdrawal is always characterized by many adverse effects, Janet will therefore need a lot of support from her friends and family whom she is afraid will help her as she maintains that she has continually disappointed on many occasions. Janet has in the past used drugs such as marijuana this is definitely going to cause more withdrawal effects such as shaking and anxiety. Grey is constantly worried about her daughter who was taken up by the children services, this has made her feel so regret so much about being a bad mother and its is likely to make her go back to drug and alcohol abuse in order to forget her predicament. She will therefore need 24 hour observation and numerous psychotherapeutic counseling sessions.

Four priority nursing problems in the nursing care plan

Nurses are every day faced with issues in the course of their line of duty. Many of the challenges nurses face when drawing out the nursing care plan can be divided into four. The first problem is the in assessing the data of the patient. Data collection is a vital step in all medical practices; data needs to be carefully taken because it determines the medication that is likely to be administered. A nurse should check for the vital signs, no minute detail should be left out; a nurse should also take note of the patient’s remarks and queries. A nurse is expected to inquire as much information as she/he can from the patient. This is at times very difficult as some patients are not that open and refuse to speak openly. The data collected should be vigilantly analyzed to determine the health standing of the patient which helps the problem (Sara-jo, 2001). The second nursing issue is diagnosis; after a nurse has identified the health problem it is important that he/she diagnoses the patient it is requisite that as a nursing diagnosis is formulated. The diagnosis should prioritize on the objectives and plan. When diagnosing a patients all parameters of lifestyle, family and medical history should be put into consideration. The third issue is planning, a nurse has to use formalized care maps and code of behaviors to carry out essential interventions to realize the care goals. All plans made should strategize on improving on what the patient can do to improve his health problem (Andrea, 2001). The plan should outline a workable solution and suggest an activity that the patient can undertake this usually hard to do as different plans and maps work for different people and therefore the nurse has to come with a robust plan. The last issue in nursing care is the implementation and evaluation, plans set should be implemented, this normally involves working in a group and a nurse is therefore supposed to delegate the responsibilities of each plan step. Each member of the health team should know the patient’s health status and diagnosis and it’s the responsibility of the nurse to distribute such information. The feedback of findings from the team and the patient as well should be noted and scrutinized for observable changes or improvements. Any changes should be evaluated using the input from the health team and the patient.

Reference list

Andrea, A, (2001). Critical-thinking-the-nursing-process. Mount St. Mary College.

David, H (n.d) Australian suicide prevention foundation. Suicide Retrieved on; 19/5/11 from: <http://www.suicideprevention.com.au/pages/?id=45&tid=9>

Dennis, l, Jay M and William, S1. (2011). Suicide Retrieved on; 19/5/11 from: <http://www.medicinenet.com/suicide/page5.htm#treatment>

Dennis, L, Jay M and William, S2 (2011). Alcohol abuse and alcoholism <http://www.medicinenet.com/alcohol_abuse_and_alcoholism/page2.htm#17whatmedications>

John, H, (2006) Physical exercise to help with addiction. Retrieved on; 19/5/11 from: <http://en.allexperts.com/q/addiction-alcohol-2053/physical-exercise-help-addiction.htm>.

Melinda, S, Jeanne, S and Lawrence R1, (2011) Suicide prevention. Retrieved on; 19/5/11 from: <http://helpguide.org/mental/suicide_prevention.htm>

Melinda, S, Jeanne, S and Lawrence R2, (2011) Alcohol addiction treatment and self-help. Retrieved on; 19/5/11 from :< http://helpguide.org/mental/alcohol_abuse_alcoholism_help_treatment_prevention.htm>

Sara-jo W, (2001) Nursing Process, Wallace Community College