Mr. Zamudio suffered
from a car accident while he was on a taxi cab hit by a bus. He lost his both
feet and other minor fractures throughout his body. Mr. Zamudio was very
upset because he knows that he can never dance again. Impaired Adjustment may be
more useful than Ineffective Coping in the initial period after a
stressful event. This is a nursing care plan sample about ineffective
coping of Mr. Zamudio, 28 years old, dancer.
Assessment:
Subjective: "I'm a dancer! How can I dance now without my both feet?" sadly said by the patient.
Objectives:
- Verbalization of
inability to cope
- Inability to meet role
expectations
- Worrying
- Anxious
- Fatigue
- Rejecting social support
- Impaired social participation
- Alcohol dependent
- Lack of goal-directed
behavior
- Destructive behavior
toward self
- Change in usual communication patterns
Diagnosis:
Ineffective coping
related to changes in body integrity secondary to loss of body part
disfigurement secondary to trauma.
Planning:
After 4 hours of nursing
interventions, the patient will make decisions and follow through with
appropriate actions to change provocative situations in the personal
environment and will verbalize feelings related to emotional state and will
focus on the present. The patient will identify response patterns and the
consequences of resulting behavior. The patient will identify personal
strengths and accept support through the nursing relationship.
Interventions:
- Establish rapport or
nursing-patient relationship with Mr. Zamudio. Spend time with him.
Provide supportive companionship to Mr. Zamudio. Avoid being overly
cheerful and cliché such as, “Things will get better.” Convey honesty and
empathy to Mr. Zamudio. Offer support and encourage expression of
feelings. Let him know you understand his feelings. Do not argue with
expressions of worthlessness by saying things such as, “How can you say that?
Look at all you accomplished in life.” Offer matter-of-fact appraisals and be
realistic. Allow extra time for Mr. Zamudio to respond.
- Determine the onset of Mr. Zamudio's feelings and symptoms and
their correlation with events and his life changes. Assess his ability to
relate facts. Listen carefully as he speaks to collect facts; observe his
facial expressions, gestures, eye contact, body positioning, and tone and
intensity of his voice. Determine the risk of Mr.
Zamudio's inflicting self-harm; intervene appropriately.
- Assess for signs of potential suicide such as history of previous attempts or
threats, changes in his personality, behavior, sex life, appetite, and sleep
habits, preparations for his death like putting things in order, making a will,
giving away personal possessions, and/or acquiring a weapon; sudden elevation
in his mood.
- Assess level of depression of Mr. Zamudio and refer, if he is
depressed, to specialists. Ask Mr. Zamudio to describe his
previous encounters with conflict and how he resolved them. Evaluate whether
his stress response is “fight or flight” or “tend and befriend.”
Encourage Mr. Zamudio to evaluate his behavior. “Did that work for
you?” “How did it help?” “What did you learn from that experience?” Discuss
possible alternatives like talk over the problem with those involved, try to
change the situation, or do nothing and accept the consequences.
- Assist Mr.
Zamudio in identifying problems that he cannot control directly; help him
to practice stress-reducing activities for control such as exercise, yoga. Be
supportive of his functional coping behaviors. Mobilize Mr.
Zamudio to gradually increase activity: Identify his activities that
were previously gratifying but have been neglected: personal grooming or dress
habits, shopping, hobbies, athletic endeavors, and arts and crafts.
Encourage Mr. Zamudio to include these activities in the daily
routine for a set time span.
Evaluation:
After 4 hours of nursing
interventions, the patient made decisions and follows through with
appropriate actions to change provocative situations in the personal
environment and verbalized feelings related to emotional state and was focus on
the present. The patient was identified response patterns and the consequences
of resulting behavior. The patient was identified personal strengths and
accepts support through the nursing relationship.
For more samples of nursing care plan you are free to check it out in our NCP LIST page.
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