Mr. Tepper is working as a janitor in a hospital and he has been fixed in graveyard schedule which he had decided long ago in order for him to get additional income in his paycheck. Because of his style of working hours, Mr. Tepper always get sick because of low immunization and lack of vitamins because of his tight budget. One day, he got chest pain and unable to breathe. He immediately delivered to emergency room at the hospital he is been working. This is a nursing care plan sample about fear of Mr. Tepper, 42 years old, low-income worker.
ASSESSMENT
Subjective:
"I'm afraid of what will be the result of my operation," as
verbalized by the patient.
Objectives:
The patient was diminished his/her self-esteem, he/she has loss competence and
narrowed focus on the source of fear. Vital signs are taken and noted as
follows: Body temperature is 36.5 degrees Celsius, blood pressure is 140/90
mmHg, respiratory rate of 22 cycles per minute, and pulse rate of 108 beats per
minute.
DIAGNOSIS
Fear related to possible
unwanted result as evidenced by narrowed focus on the source of fear and
increase pulse pressure.
PLANNING
After 4 hours of nursing
intervention, the patient will verbalize accurate knowledge of safety related
to current situation.
INTERVENTION:
- Identify sensory
deficits of Mr. Tepper that may be present such as vision or hearing
impairment. Sensory deficits may lead to misinterpretation of his environment.
Determine Mr. Tepper's age or his developmental level. This will help
in understanding on usual or typical fears. Investigate Mr.
Tepper's reports of his subjective experiences, which could be indicative
of his delusions or hallucinations. Note degree of his incapacitation. Be alert
to signs of denial and depression. Be alert to and evaluate potential for his
violence. Measure his vital signs and physiological responses to
situation.
- Stay with Mr. Tepper more often to have him someone else to be
there because it provides him with desired support person that can diminished
feelings of fear. Listen to Mr. Tepper's concern, it promotes
atmosphere of caring and permits exploration of his misperception. Acknowledge
normalcy of fear, pain, despair, and give "permission" to express
feelings appropriately. This promotes attitude of caring and opens door for
discussion about feelings and addressing reality of situation. If necessary,
provide presence or physical contact such as hugging, refocusing attention.
These soothe his fears and provide assurance.
- Manage Mr. Tepper's environmental factors such as loud noises,
harsh lightning, changing of person's location or stranger in care. These can
cause stress to him, especially to adult individuals like him. Speak to Mr.
Tepper in simple sentences and concrete terms because it facilitates his understanding
and retention of information. Provide opportunity for questions and answer
honestly to enhance sense of trust and nurse-client relationship. Avoid arguing
about his perceptions of the situation to limit conflicts when his fear
response may impair rational thinking. Encourage contact with his peer who has
successfully dealt with a similarity fearful situation. This provides a role
model and Mr. Tepper is more likely to believe others who had similar
experience to him. Enhance sense of control by identifying Mr.
Tepper's responsibility for the solutions while reinforcing that the nurse
will be available for help if he desired or needed. Check use of Mr.
Tepper on anti-anxiety medications and reinforce use as prescribed. Assist
in identifying areas in which he control can be exercised and those in which
control is not possible, thus enabling Mr. Tepper to handle fearful
situations. Instruct in use of relaxation or visualization and guided imagery
skills. Explain procedures within Mr. Tepper's ability to understand
and handle to prevent his confusion and overload.
EVALUATION
After 4 hours of nursing
intervention, the patient verbalized accurate knowledge of safety related to
the current situation.
For more samples of
nursing care plan you are free to check it out in our NCP LIST page.
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