INEFFECTIVE COPING Nursing Care Plan

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.

 

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