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Nursing Teaching & Learning Plan Assignment Help
Mary Johnson, a 65-year-old Caucasian female, presents with symptoms of depression

Nursing Teaching & Learning Plan Assignment Help

Mary Johnson, a 65-year-old Caucasian female, presents with symptoms of depression

July 17th, 2024 Ace My Homework

Study Notes: Presentation Writing Guide:

Teaching & Learning Plan for Mary Johnson: Managing Geriatric Depression

Teaching Objective(s) Content (Evidence-based with references) Teaching & Learning Method(s) (How are you going to teach) Time Frame (How long) Evaluation of Learning The learner (Mary) will identify at least three symptoms of depression and explain their impact on daily life. Depression symptoms in older adults, including:

Persistent sadness
Loss of interest in activities
Sleep disturbances
Changes in appetite and weight
Fatigue
Difficulty concentrating
Somatic complaints (e.g., unexplained pain)

Impact on daily life:

Reduced engagement in activities
Social isolation
Decreased self-care
Impaired cognitive function
Increased risk of physical health problems

(References: Gundersen and Bensadon, 2023; Krishnamoorthy et al., 2020) 1. Verbal explanation and discussion: Explain depression symptoms and their impact using simple language.

Visual aids: Use a chart illustrating common depression symptoms in older adults, highlighting both psychological and somatic manifestations.
Personal reflection: Encourage Mary to identify which symptoms she has experienced and how they have affected her daily activities.
Screening tool demonstration: Introduce a simplified version of the Geriatric Depression Scale to familiarize Mary with standardized assessment methods. 25-30 minutes Evaluation will be successful if Mary can:
List at least three symptoms of depression, including at least one somatic symptom.
Explain how these symptoms have impacted her daily life, providing specific examples.
Demonstrate understanding of how depression symptoms might differ in older adults compared to younger individuals.
Show willingness to use a simple self-assessment tool for monitoring her symptoms. The learner (Mary) will demonstrate knowledge of at least four evidence-based, non-pharmacological strategies for managing depressive symptoms. Evidence-based non-pharmacological strategies:
Physical activity: Regular, moderate exercise tailored to ability
Social engagement: Participation in group activities and maintaining connections
Mindfulness and relaxation techniques
Establishing a consistent sleep routine
Cognitive-behavioral therapy (CBT) techniques
Problem-solving therapy
Bright light therapy
Music therapy

(References: Kalita and Żylicz, 2024; Srifuengfung et al., 2023) 1. Interactive discussion: Explore coping strategies Mary has tried or is interested in trying.

Demonstration: Guide Mary through a brief mindfulness exercise and a simple CBT technique.
Handout: Provide a written summary of non-pharmacological strategies with practical tips for implementation.
Role-play: Practice using problem-solving techniques for a specific challenge Mary faces.
Video presentation: Show short clips demonstrating various non-pharmacological interventions (e.g., light therapy, music therapy). 35-40 minutes Evaluation will be successful if Mary can:
Describe at least four non-pharmacological strategies for managing depression.
Demonstrate a basic mindfulness technique and one CBT skill (e.g., challenging negative thoughts).
Create a personal action plan incorporating at least three non-pharmacological strategies into her daily routine.
Explain the potential benefits of these strategies in her own words. The learner (Mary) will explain the importance of integrated treatment approaches, including therapy, support systems, and medication management in addressing depression. Benefits of integrated treatment:
Synergistic effects of combining therapies
Personalized care addressing individual needs
Improved treatment outcomes and reduced relapse rates
Comprehensive management of co-existing conditions

Components of integrated care:

Psychotherapy (e.g., CBT, interpersonal therapy)
Pharmacotherapy
Social support interventions
Lifestyle modifications

Importance of medication management:

Proper dosing and timing
Monitoring for side effects
Regular follow-ups with healthcare providers

(References: Srifuengfung et al., 2023; Voineskos et al., 2020) 1. Case study presentation: Present a simplified case study illustrating the benefits of integrated treatment.

Group discussion: Explore Mary’s thoughts and experiences with different treatment components.
Informational brochure: Provide a brochure on local mental health resources and support groups.
Medication management activity: Guide Mary through creating a medication tracking tool.
Q&A session: Address any concerns or questions Mary has about different treatment modalities. 30-35 minutes Evaluation will be successful if Mary can:
Articulate at least three benefits of an integrated treatment approach for managing depression.
Identify the key components of her current treatment plan and explain how they work together.
Demonstrate understanding of proper medication management, including the importance of adherence and follow-ups.
Express willingness to engage in various treatment modalities, or explain any reservations she may have. The learner (Mary) will describe the connection between lifestyle factors (nutrition, sleep, physical activity) and depression management. Key lifestyle concepts:
Impact of nutrition on mood and mental health
Importance of sleep hygiene for mood regulation
Benefits of physical activity for depression management
Strategies for improving overall lifestyle habits

Specific interventions:

Mediterranean diet principles
Sleep optimization techniques
Gradual increase in physical activity
Stress reduction methods

(References: Gundersen and Bensadon, 2023; Kalita and Żylicz, 2024) 1. Interactive presentation: Use visual aids to explain the connection between lifestyle factors and mood.

Lifestyle assessment activity: Guide Mary in completing a simple lifestyle assessment questionnaire.
Goal-setting exercise: Work with Mary to set realistic, achievable lifestyle improvement goals.
Handout: Provide a list of practical tips for improving nutrition, sleep, and physical activity habits.
Demonstration: Show simple exercises or relaxation techniques suitable for older adults. 35-40 minutes Evaluation will be successful if Mary can:
Explain how nutrition, sleep, and physical activity affect mood and mental health.
Identify at least three lifestyle changes that could positively impact her depression management.
Create a weekly plan that incorporates small, achievable lifestyle improvements.
Demonstrate willingness to work with healthcare providers to optimize her lifestyle habits for better mental health.

This revised teaching plan incorporates insights from the most recent research on geriatric depression management. It emphasizes a comprehensive, integrated approach to treatment, highlighting the importance of non-pharmacological interventions alongside traditional therapies. The plan aims to empower Mary with up-to-date knowledge and practical skills to manage her depression effectively, while also addressing related lifestyle factors. Regular follow-up and ongoing support will be crucial to reinforce learning and adjust strategies as needed.

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Assignment Example
NURS202P Geriatric Depression Teaching Plan Presentation
– This is a Geriatric Depression Teaching Plan Presentation. You need to create a presentation 13 slides (excluding title page and reference page.

– Must reflect the information given in your care plan and ESPECIALLY your teaching plan.

– Each body slide needs to have speakers notes that will be in the NOTES section NOT on the slide.

– Each slide must have a image (Tip: use the designer tool)

– APA format

Patient Health Information:
– Name: Mary Johnson
– Date of Birth: 2/14/1959
– Age: 65 years old
– Gender: Female
– Height: 64 inches (5 feet 4 inches)
– Weight: 150 lbs
– Race: Caucasian
– Ethnicity: Non-Hispanic
– Religion: Catholic
– Marital Status: Married
Notes:
– Mary Johnson, a 65-year-old Caucasian female, presents with symptoms of depression, including persistent sadness, fatigue, and a significant decrease in interest in daily activities. Her medical history includes hypertension and osteoarthritis, for which she takes Lisinopril and acetaminophen. Mary reports difficulties with sleep, a decreased appetite, and a recent weight loss of 5 pounds. Her HEENT assessment reveals no abnormalities, and her physical examination shows she is independent in most ADLs but requires minimal to moderate assistance for specific tasks such as bathing and using a cane for walking. She has a decreased appetite and is at low risk for aspiration, but she struggles with maintaining her weight. Her speech is clear and fluent, and she demonstrates signs of apathy and sadness without significant anxiety. Mary’s mood and behavior reflect her depressive symptoms, and she is encouraged to engage in social and religious activities for emotional support. A care plan is in place focusing on nutritional support, mental health therapy, and pain management, with regular follow-up visits to monitor her progress and adjust interventions as needed.
Care Plan for Patient Problem
Problem Status: Active
Problem Type: Mental Health
Problem Category: Geriatric Depression
Disease Process or Etiology Contributing to Patient’s Problem:
Mary Johnson, a 65-year-old female, is experiencing geriatric depression. This condition is characterized by persistent sadness, fatigue, and a significant decrease in interest in daily activities. Contributing factors include chronic pain from osteoarthritis, recent life changes, and a decrease in appetite leading to a recent weight loss of 5 pounds. The depressive symptoms are compounded by a lack of social interaction and diminished engagement in previously enjoyed activities.
Subjective and Objective Data Specific to Patient Problem:
• Subjective Data: Mary reports feeling persistently sad, having lost interest in activities she used to enjoy, experiencing difficulties with sleep, and noting a decreased appetite with recent weight loss.
• Objective Data: Mary appears sad and apathetic. Observations indicate she requires minimal to moderate assistance for some ADLs and has experienced a weight loss of 5 pounds in the past month. Her mood and behavior reflect depressive symptoms characteristic of geriatric depression.
________________________________________
Patient Goals:
1. The patient will demonstrate an improvement in mood and increased engagement in daily activities.
Timeline: Within 4 weeks
2. The patient will achieve stable weight maintenance or a gradual increase in weight.
Timeline: Within 4 weeks
3. The patient will report improved sleep quality and a reduction in depressive symptoms.
Timeline: Within 4 weeks
4. The patient will establish and attend a support system or mental health therapy sessions.
Timeline: Within 2 weeks
________________________________________
Interventions
Independent Interventions:
Intervention Frequency Rationale Evaluation
Encourage participation in social activities and senior support groups Weekly Social support and engagement can reduce feelings of isolation and improve mood in geriatric depression. Monitor Mary’s involvement in activities and support groups through observation and self-reports.
Monitor and document changes in mood, appetite, and sleep patterns Daily Ongoing documentation helps track the effectiveness of interventions and guides necessary adjustments in care. Regularly review documented observations during follow-up visits to assess progress.
Collaborative Interventions:
Intervention Frequency Rationale Evaluation
Refer to a geriatric mental health specialist for counseling or therapy Once Specialized therapy can address geriatric depression by providing tailored interventions and coping strategies. Confirm Mary’s appointments with the specialist and review feedback from the therapist regarding Mary’s progress.
Consult a dietitian for nutritional counseling to address decreased appetite and weight loss Once Nutritional counseling can help manage appetite issues and promote healthy weight maintenance in older adults. Review the dietitian’s recommendations and monitor Mary’s adherence to the meal plan and any changes in her weight.
________________________________________
Rationale
Rationale: The care plan addresses geriatric depression through both independent and collaborative approaches. Encouraging social engagement and monitoring mood and appetite are crucial for managing depressive symptoms and improving quality of life for elderly patients. Collaborative efforts with mental health specialists and dietitians ensure a comprehensive approach to addressing the multifaceted needs of geriatric depression.
Url: National Institute of Mental Health – Depression in Older Adults
________________________________________
Conclusion/Summary:
Mary Johnson’s care plan is designed to address her geriatric depression with a focus on improving mood, managing weight, and enhancing sleep quality through a combination of independent and collaborative interventions. The plan includes encouraging social activities, monitoring symptoms, and working with a mental health specialist and dietitian to provide a holistic approach to her care. Regular follow-ups will be conducted to evaluate progress and adjust the care plan as needed to meet Mary’s goals and improve her overall well-being.

New Patient Teaching
Initial Teaching
Teaching Topic: Understanding Geriatric Depression and Coping Strategies
Learning Outcome(s):
1. The patient will be able to identify symptoms of depression and understand their impact on daily life.
2. The patient will learn techniques for managing depressive symptoms and improving mood.
3. The patient will understand the importance of attending therapy sessions and utilizing support systems.
4. The patient will gain knowledge of healthy eating practices and their role in managing depression and weight.
Learner(s):
• Patient: Mary Johnson
Readiness to Learn:
• Emotional Barrier: Mary may be feeling overwhelmed or hopeless due to her depressive symptoms.
• Age or Developmental Barrier: Adjustments in communication methods to suit her age and cognitive abilities.
Teaching Method(s):
• Verbal Explanation and Discussion: To explain the nature of geriatric depression and discuss coping strategies.
• Handout: Provide a handout summarizing symptoms of depression, coping strategies, and resources for support.
• Video: Show a short educational video on managing depression in older adults and the benefits of therapy.
Evaluation:
• Teach Back: Ask Mary to explain back the key concepts of depression, coping strategies, and the importance of therapy.
• Evaluation Notes: Ensure Mary can articulate understanding of the symptoms, coping techniques, and reasons for attending therapy.
Continued Needs:
• Needs: Mary may need ongoing support and reinforcement of the information provided. Regular follow-ups to ensure she is engaging with therapy and managing symptoms effectively.
Additional Notes:
Mary’s teaching included a discussion on recognizing the signs of depression and understanding how these symptoms can affect her daily life. She was provided with a handout detailing coping strategies, such as engaging in social activities, practicing mindfulness, and maintaining a routine. A video was shown to illustrate the importance of therapy and the role of support groups. Mary was asked to reflect on the information and demonstrate her understanding of these concepts. Continued follow-up will be essential to assess her engagement with therapy and adherence to the provided strategies for managing depression.
URL for Additional Resources:
National Institute of Mental Health – Depression in Older Adults

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Teaching & Learning Plan
The following table provides information to utilize in developing your Teaching & Learning Plan. Each column in the teaching and learning plan form should include the appropriate information related to the individual client needs identified in the Nursing Care Plan. You are expected to develop 3 Teaching Objectives with the supporting documentation as noted on the page below. Any questions that you have concerning Teaching & Learning Plan should be directed to your instructor.

Detailed Teaching Plan
Teaching Topic Understanding Geriatric Depression and Coping Strategies
Learning Outcome(s) 1. Identify depression symptoms and their impact on daily life.
2. Learn techniques for managing depressive symptoms and improving mood. 3. Understand the importance of attending therapy and using support systems.
4. Gain knowledge of healthy eating practices for managing depression and weight.
Learner(s) Patient: Mary Johnson
Readiness to Learn Emotional Barrier: Mary may feel overwhelmed.
Age or Developmental Barrier: Consideration of her age and cognitive abilities.
Teaching Method(s) Verbal Explanation and Discussion: Discuss depression symptoms and coping strategies.
Handout: Summarize depression, coping strategies, and support resources. Video: Educational video on managing depression and benefits of therapy.
Evaluation Teach Back: Mary will explain depression symptoms, coping strategies, and therapy importance.
Evaluation Notes: Assess Mary’s understanding and her ability to communicate key concepts.
Continued Needs Needs: Ongoing support and reinforcement of information.
Follow-Up: Regular check-ins to review Mary’s engagement with therapy and adherence to strategies.
Additional Notes Mary was given a handout and watched a video about depression management. She demonstrated understanding of the information through a teach-back method. Follow-up is necessary to ensure continued engagement and progress.

Medication Order
Medication Dosage Route Frequency Indication Duration Start Date End Date
Sertraline Hydrochloride 50 mg Oral Once daily Depression Indefinite 07/16/2024 TBD
Normal Saline (0.9% NaCl) 1000 mL IV Infuse over 8 hours Hydration and supportive care As needed 07/16/2024 TBD
________________________________________
Protocol/ Note: This protocol ensures that Sertraline is administered correctly, with clear instructions for the patient and steps for ongoing management and follow-up. Effective medication management requires a partnership between the healthcare provider and the patient. Regular communication and supportive follow-up are key to successful depression treatment.

New Vital Signs Data
________________________________________
Vital Sign Measurement Location Position Notes
Blood Pressure 130/85 mmHg Left Arm Sitting Within normal range for age.
Heart Rate 78 bpm N/A N/A Regular and within normal limits.
Respiratory Rate 16 breaths/minute N/A N/A Normal respiratory rate.
SpO2 98% N/A N/A Adequate oxygen saturation.
Oxygen Delivery Method None N/A N/A No supplemental oxygen required.
Temperature 98.6 °F Oral N/A Normal body temperature.
Weight 145 lb N/A N/A Weight stable; within normal range for height.
Glucose Level 105 mg/dL N/A N/A Normal fasting glucose level.
Time Since Last Meal 8 hours N/A N/A Fasting state for glucose measurement.
________________________________________
Interventions
1. Monitor Vital Signs: Continue to monitor blood pressure, heart rate, respiratory rate, and SpO2 regularly to ensure stability and track any changes in Mary’s condition.
2. Hydration: Ensure adequate hydration and document intake as Mary receives IV fluids.
3. Glucose Monitoring: Check glucose levels as part of ongoing assessment and adjust diet or medications as necessary.
________________________________________
Additional Notes
• Blood Pressure: At 130/85 mmHg, Mary’s blood pressure is within an acceptable range for her age. Regular monitoring is recommended to manage and prevent potential complications.
• Heart Rate: A heart rate of 78 bpm is normal and suggests that Mary’s cardiovascular system is functioning well.
• Respiratory Rate: The respiratory rate of 16 breaths per minute is normal, indicating that Mary’s respiratory function is stable.
• SpO2: An oxygen saturation level of 98% indicates that Mary’s oxygen levels are adequate, and no additional oxygen therapy is necessary at this time.
• Temperature: A body temperature of 98.6 °F is within the normal range, and there are no signs of fever or hypothermia.
• Weight: Mary’s weight of 145 lb is stable. Continue to monitor for any significant changes that might indicate issues such as fluid retention or malnutrition.
• Glucose Level: A glucose level of 105 mg/dL is normal for a fasting state. Continue to monitor as part of overall health management.

Teaching Objective(s) Content
(Evidence-based with references) Teaching & Learning Method(s)
(How are you going to teach) Time Frame

(How long) Evaluation of Learning

After identifying the teaching needs during the assessment, the objective should be created.

The objectives are the main ideas that you want your learner(s) to understand and apply after the teaching experience. Two or three objectives should be identified for the teaching experience. Each objective should start with the stem below:

The learner (client) will …

Once the objectives for the teaching plan have been created, content must be selected. Depending on what is being taught, a reference to where the content was found should be identified.

Content should be applicable to the audience. Considerations on the use of terminology and complexity should be incorporated into the selection of the content.

The teacher will discuss …

When determining how to share the content during the teaching experience, be sure to think about the various learning styles. Learning styles may include auditory, visual and cognitive. The following are some examples of presentation formats:

• Diagrams
• Charts
• Videos
• Handouts
• Brochures
• Hands on Simulation
• Demonstration of skills

The material will be presented by …
The amount of time for the teaching experience will depend on the individual and the amount of content presented. Consider timing of when the teaching experience will take place. If during discharge, allow 10-15 minutes depending on the amount and complexity of the content.

This teaching experience will take …
Evaluation of learning occurs after the content has bene presented. Evaluation can be a verbal acknowledgement, return demonstration or the completion of a brief survey. The type of evaluation is dependent upon the type of teaching and the type of content presented.

The teaching experience will be successful if the learner is able to …

Student Name:

Client Code: M001

Nursing Diagnosis Priority # 1

Instructor: _ika Cepero___________

Date: June 15, 2024

Grade:

Teaching & Learning Plan

Assessment of Client’s Readiness to Learn Physical
– Complexity of task: The client can physically engage in demonstrations and practice with assistive devices but may require breaks due to joint pain.
– Environmental effects: Home environment is supportive but may have physical barriers affecting mobility.
– Health status: Chronic pain from osteoarthritis impacts mobility and endurance.
– Gender: Female, which may influence preferences for certain assistive devices. Description of Findings:
The client’s physical readiness allows for participation in teaching activities, with consideration for breaks and adaptations due to joint pain.
Emotional
– Anxiety level: Moderate anxiety related to fear of falling and worsening joint pain.
– Support system: Good support from family members during teaching sessions.
– Motivation: High motivation to regain mobility and independence.
– Frame of mind: Open and receptive to learning new strategies.
– Developmental stage: Older adult stage, requiring respect for experience and consideration of aging-related concerns. Description of Findings:
Emotional readiness supports engagement in learning activities with reassurance and encouragement during sessions.

Experiential
– Level of aspiration: Aspires to maintain independence in daily activities despite physical limitations.
– Past coping mechanisms: Adaptive coping mechanisms, but adjustment to chronic pain ongoing.
– Cultural background: Catholic background influences beliefs about suffering and healing. Description of Findings:
Past experiences and cultural beliefs will be integrated into teaching strategies to enhance relevance and acceptance.

Knowledge
– Present knowledge base: Basic understanding of osteoarthritis and its management.
– Cognitive ability: Intact cognitive abilities, prefers visual and hands-on learning.
– Learning disabilities: None reported.
– Learning styles: Visual and hands-on learning styles preferred. Description of Findings:
Client’s learning preferences indicate the use of visual aids and practical demonstrations will be effective in enhancing comprehension.
Conclusion of Findings of the Readiness to Learn Move forward with teaching
Hold teaching plan- describe rationale and discuss strategies to prepare the client for teaching.

Cultural Considerations Description of findings and how to incorporate into the teaching plan.
The client’s Catholic background will be respected, integrating beliefs about suffering and healing into pain management discussions to foster trust and engagement.

Teaching Objective(s) Content
(Evidence-based with references) Teaching & Learning Method(s)
(How are you going to teach) Time Frame

(How long) Evaluation of Learning

(How is success of the teaching measured)

(1) The learner will demonstrate proper use of assistive devices to improve mobility and reduce joint strain.

Types of assistive devices for mobility support such as canes, walkers, and braces.
Techniques for safe and effective use of assistive devices to prevent falls and minimize joint strain.
References: National Institute on Aging guidelines for choosing and using assistive devices (NIA, 2023).
Hands-on demonstration: Client will practice using various assistive devices under supervision, focusing on correct adjustments and movement techniques.
Role-playing scenarios: Simulate real-life situations where the client must use the device safely.
Discussion: Explain the benefits and limitations of each device type with visual aids (charts, diagrams). Approximately 25-30 minutes, allowing sufficient time for practice and questions. Evaluation will be through a return demonstration where the client showcases their ability to correctly use chosen assistive devices in simulated scenarios.
(2) The learner will identify signs and symptoms of exacerbation of osteoarthritis and when to seek medical assistance.
Common signs and symptoms of osteoarthritis exacerbation such as increased joint pain, swelling, stiffness, and reduced range of motion.
References: Arthritis Foundation guidelines on recognizing osteoarthritis symptoms (Arthritis Foundation, n.d.).

Presentation: Visual presentation with diagrams illustrating symptoms and their severity.
Interactive discussion: Client will discuss personal experiences and relate symptoms to their own condition.
Quiz and discussion: Brief quiz to identify symptoms followed by a discussion on recognizing and responding to these symptoms. Approximately 15-20 minutes based on client interaction and comprehension. Evaluation will involve a brief quiz to identify symptoms of osteoarthritis exacerbation and a discussion to assess client’s ability to recognize and respond to these symptoms.
(3) The learner will demonstrate understanding of strategies to manage chronic pain associated with osteoarthritis.

Evidence-based pain management techniques such as physical therapy exercises, medication management, and lifestyle modifications (e.g., weight management, joint protection techniques).
References: American College of Rheumatology guidelines on osteoarthritis management (Smith et al., 2020).
Hands-on demonstration: Client will practice joint protection techniques and physical therapy exercises.
Discussion: Explain medication management principles and lifestyle modifications, using visual aids as needed.
Role-play: Simulate scenarios where the client discusses pain management strategies with a healthcare provider. Approximately 20-30 minutes depending on client’s engagement and comprehension. Evaluation will be conducted through a return demonstration of joint protection techniques and a verbal discussion about medication management and lifestyle modifications.

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Care Plan Form
The following table provides information to utilize in developing your nursing care plan. Each column in the Care Plan Form should include the appropriate information. You are expected to develop 3 Nursing Diagnoses with the supporting documentation as noted on the page below. The first Nursing Diagnosis of the Care Plan Form should be the priority nursing diagnosis. Before completing the Care Plan Form visit DocuCare and chart the patient assessment.

PRIORITY Nursing Diagnosis
Behaviors

Subjective (Non-observable)

Subjective Data should be clear, concise and specific to the
Nursing Diagnosis

Example Subjective Data- what the family relates, states or reports.

Objective (Observable)

Objective Data should be clear, concise and specific to the Nursing Diagnosis

Example Objective Data- what is observed or measured. May include the client’s behavior, vital signs, lung sounds, urine output, laboratory data, diagnostic testing (etc.) as related to the specific nursing diagnosis.
Subjective Data:
• Mary reports feeling persistently sad.
• She has lost interest in activities she used to enjoy.
• She experiences difficulties with sleep.
• She notes a decreased appetite with a recent weight loss of 5 pounds. Objective Data:
• Mary appears sad and apathetic.
• She requires minimal to moderate assistance for some ADLs.
• Observations indicate a weight loss of 5 pounds in the past month.
• Her mood and behavior reflect depressive symptoms characteristic of geriatric depression.
Stimuli

Focal Stimuli- Individual needs, the level of family adaptation, and changes in the family environment
Contextual Stimuli-Influences the situation- Coping Mechanisms, diagnosis, symptom severity and co-morbidities
Residual Stimuli- Beliefs, behaviors and personal experiences
Focal Stimuli: Mary needs support in managing her depression and maintaining her daily activities. Her family needs to adapt to her increased needs for emotional support and physical assistance. The family may need to make adjustments to accommodate Mary’s condition, ensuring that their environment is supportive and responsive to her needs.
Contextual Stimuli: Mary’s coping mechanisms may be weakened due to chronic pain and depressive symptoms. She has been diagnosed with depression and chronic pain from osteoarthritis. Her depressive symptoms are moderate to severe, further compounded by co-morbidities such as hypertension and osteoarthritis, which contribute to the complexity of her condition.
Residual Stimuli: Mary’s religious beliefs as a Catholic may influence her coping strategies and willingness to engage in therapy. Her beliefs, behaviors, and personal experiences play a significant role in how she manages her illness and responds to treatment, potentially affecting her overall prognosis and engagement in care plans.
Describe: Mary needs support managing her depression and daily activities. Her family must adapt to provide increased emotional support and physical assistance, potentially making environmental adjustments. Her coping mechanisms are weakened due to chronic pain and moderate to severe depressive symptoms, compounded by co-morbidities like hypertension and osteoarthritis. Additionally, her Catholic beliefs influence her coping strategies and engagement in therapy, affecting her overall management and response to treatment.
Mode

Physiologic Mode is the individual’s physical health and functions. (Roy 2012)
Self-Concept Mode is the individual’s beliefs and feelings. (Roy 2012)
Role Function Mode involves the position one occupies in society and the behaviors associated with one’s position (role) in society. (Roy 2012)
Interdependence Mode is associated with one relationships and interactions with others including the giving of love, respect and value. This is a basic underlying need to nurture (Roy 2012).
Physiologic Mode:
• Physical health and functions related to her chronic pain and decreased appetite.
Self-Concept Mode:
• Mary’s beliefs and feelings about herself and her condition.
Role Function Mode:
• Her role within her family and society, which may be affected by her depressive symptoms.
Interdependence Mode:
• Relationships and interactions with others, including the need for social support.
NANDA Nursing Diagnosis/ Problem-Based Nursing Diagnosis

1. Choose a NANDA or Problem-Based Nursing Diagnosis
2. The statement should list only one diagnosis and be listed using the following format- problem followed by “Related to (R/T) the disease process/ pathophysiology
3. Manifested by (signs & symptoms) is not part of the nursing diagnosis and should be written as a separate sentence.
4. Each statement should be supported by rationale

Example: Coping, ineffective family: R/T Temporary family disorganization and role changes. Manifested by significant other’s limited personal communication with client.
Write the PRIORITY Nursing Diagnosis/ Problem-Based Diagnosis and include R/T statement and Manifested by sentence including rationale below:
Nursing Diagnosis: Depression R/T chronic pain and decreased functional ability AEB persistent sadness, loss of interest in activities, difficulties with sleep, decreased appetite, and recent weight loss.
Rationale: Depression is a common comorbidity in individuals with chronic pain and decreased functional ability. Addressing depression is critical to improving overall quality of life and functional outcomes.
Goals/ Outcomes (Short-term/ Long-term) including Timelines/ Timeframes

1. Each client should have one long-term and one short-term goal/ outcomes as part of the Care Plan.
2. Goal/ Outcome statements should be specific (related to the nursing diagnosis/ problem-based nursing diagnosis), measurable, achievable (realistic for the client), clear and concise (don’t use increase or decrease without including baseline data, timelines/ timeframes should be realistic and achievable.
3. Include a date or time at which the expected outcomes and nursing intervention are achieved or evaluated (should be specific as “by discharge date” or “ongoing”).

Definitions:

Short-term Goals/ Outcomes: Those goals that are usually met before discharge or before transfer to a less acute level of care.
Long-term Goals/ Outcomes: Those goals that may not be achieved before discharge but require continued attention by client and/or significant others as indicated.
Short-term Goal:
The patient will demonstrate an improvement in mood and increased engagement in daily activities within 4 weeks.
Long-term Goal:
The patient will achieve stable weight maintenance or a gradual increase in weight within 8 weeks.
Nursing Interventions and Scientific Rationales including Best Evidence with References

Three nursing interventions should be identified with each NANDA Nursing Diagnosis/ Problem-based Nursing Diagnosis. Nursing interventions should be concise, clear, specific, individualized and accomplishable to client and/or family and significant other.

Nursing Intervention #3: Consult a dietitian for nutritional counseling to address decreased appetite and weight loss.
Rationale: Nutritional counseling can help manage appetite issues and promote healthy weight maintenance in older adults. (Reference: Academy of Nutrition and Dietetics)
Evaluation of Client Goals/ Outcomes (Impact)

The Evaluation should address the client’s response to each of the three interventions and if any modifications were needed.
Evaluation Nursing Intervention #1: Mary has shown increased participation in social activities and reports feeling less isolated. Further engagement is encouraged to maintain progress.
Evaluation Nursing Intervention #2: Mary attends regular therapy sessions and reports finding them beneficial. Continued follow-up with the therapist is recommended to ensure ongoing improvement.
Evaluation Nursing Intervention #3: Mary’s weight has stabilized, and she is following the dietitian’s meal plan. Regular monitoring of her weight and nutritional intake will continue to ensure progress.

Nursing Diagnosis #2
Behaviors

Subjective (Non-observable)

Subjective Data should be clear, concise and specific to the
Nursing Diagnosis

Example Subjective Data- what the family relates, states or reports.

Objective (Observable)

Objective Data should be clear, concise and specific to the Nursing Diagnosis

Example Objective Data- what is observed or measured. May include the client’s behavior, vital signs, lung sounds, urine output, laboratory data, diagnostic testing (etc.) as related to the specific nursing diagnosis.
Subjective Data:
• Mary reports, “I feel constant pain in my knees and hips, which makes it difficult to walk or stand for long periods.”
• She states, “The pain is worse in the mornings and after physical activities.”
• Mary mentions, “Pain medications provide some relief but not enough to make me comfortable.”

Objective Data:
• Grimacing and wincing observed during ambulation and physical examination.
• Limited range of motion in the knees and hips.
• Vital signs: BP 140/90 mmHg, HR 88 bpm (elevated possibly due to pain).
• Radiographic evidence of osteoarthritic changes in the knee and hip joints.
• Gait analysis shows limping and instability.
Stimuli

Focal Stimuli- Individual needs, the level of family adaptation, and changes in the family environment
Contextual Stimuli-Influences the situation- Coping Mechanisms, diagnosis, symptom severity and co-morbidities
Residual Stimuli- Beliefs, behaviors and personal experiences
Focal Stimuli
Mary needs adequate pain management to improve her quality of life and maintain her daily activities. Her family must understand her pain’s impact and support her physical limitations.
Contextual Stimuli
Mary’s pain is exacerbated by her chronic osteoarthritis and is compounded by her depressive symptoms. Her coping mechanisms are strained due to persistent pain and mobility issues, which also affect her emotional well-being.
Residual Stimuli
Mary’s religious beliefs as a Catholic may influence her perception of suffering and her approach to pain management. Personal experiences of chronic pain have shaped her expectations and attitudes towards treatment.
Describe: Mary needs adequate pain management to improve her quality of life and maintain her daily activities. Her family must understand the impact of her pain and support her physical limitations. Her chronic osteoarthritis exacerbates her pain, compounded by depressive symptoms, straining her coping mechanisms and affecting her emotional well-being. Additionally, her Catholic beliefs may influence her perception of suffering and approach to pain management, with personal experiences shaping her expectations and attitudes towards treatment.
Mode

Physiologic Mode is the individual’s physical health and functions. (Roy 2012)
Self-Concept Mode is the individual’s beliefs and feelings. (Roy 2012)
Role Function Mode involves the position one occupies in society and the behaviors associated with one’s position (role) in society. (Roy 2012)
Interdependence Mode is associated with one relationships and interactions with others including the giving of love, respect and value. This is a basic underlying need to nurture (Roy 2012).
Physiologic Mode: Physical health and functional limitations due to chronic pain and osteoarthritis.
Self-Concept Mode: Feelings of frustration and helplessness due to persistent pain.
Role Function Mode: Mary’s role within her family and community is affected by her mobility issues and chronic pain.
Interdependence Mode: Mary’s relationships and interactions with others are influenced by her need for support and assistance.
NANDA Nursing Diagnosis/ Problem-Based Nursing Diagnosis

Example: Coping, ineffective family: R/T Temporary family disorganization and role changes. Manifested by significant other’s limited personal communication with client.
Write the Nursing Diagnosis/ Problem-Based Diagnosis and include R/T statement and Manifested by sentence including rationale below:
Chronic Pain R/T osteoarthritis AEB reported pain severity of 7/10, limited mobility, and facial grimacing during movement.
Rationale:
Osteoarthritis is a degenerative joint disease characterized by pain and stiffness, which can severely limit mobility. The reported pain severity and observed limited mobility indicate a high risk for impaired physical mobility, requiring nursing interventions to prevent complications such as muscle atrophy and joint contractures.
Goals/ Outcomes (Short-term/ Long-term) including Timelines/ Timeframes

Definitions:

Short-term Goals/ Outcomes: Those goals that are usually met before discharge or before transfer to a less acute level of care.
Long-term Goals/ Outcomes: Those goals that may not be achieved before discharge but require continued attention by client and/or significant others as indicated.
Short-term Goal: Mary will report a pain level of 4/10 or lower within one week through a combination of pharmacological and non-pharmacological interventions.
Long-term Goal: Mary will maintain a pain level of 3/10 or lower and demonstrate improved mobility and daily functioning within three months.
Nursing Interventions and Scientific Rationales including Best Evidence with References

Scientific rationales should address how the interventions are going to solve the problem identified and/or attain the outcomes. The rationales should be specific to the intervention and summarized in your own words. There should be a rationale for each of the three nursing interventions.
Nursing Intervention #1: Administer prescribed pain medications as per schedule and monitor for effectiveness and side effects.
Rationale: Proper administration of pain medications can help in achieving adequate pain control, allowing Mary to perform daily activities with less discomfort. (Smith et al., 2020).
Nursing Intervention #2: Implement a physical therapy regimen tailored to Mary’s condition to improve mobility and reduce pain.
Rationale: Physical therapy can enhance joint function, reduce stiffness, and alleviate pain, contributing to overall improved physical health. (Johnson et al., 2019).
Nursing Intervention #3: Educate Mary and her family about non-pharmacological pain management techniques, including heat/cold therapy, relaxation techniques, and the importance of maintaining an active lifestyle.
Rationale: Non-pharmacological interventions can complement medication use and provide holistic pain management, empowering Mary to take an active role in her care. (Doe et al., 2018).
Evaluation of Client Goals/ Outcomes (Impact)

The Evaluation should address the client’s response to each of the three interventions and if any modifications were needed.
Evaluation Nursing Intervention #1: Assess Mary’s pain levels before and after medication administration to determine effectiveness. Modify medication regimen if pain control is inadequate.
Evaluation Nursing Intervention #2: Evaluate Mary’s progress with physical therapy, noting improvements in mobility and reduction in pain levels. Adjust therapy plan as needed.
Evaluation Nursing Intervention #3: Gather feedback from Mary and her family on the effectiveness of non-pharmacological techniques and their adherence to the pain management plan. Provide additional education and support as necessary.

Nursing Diagnosis #3
Behaviors

Subjective (Non-observable)

Subjective Data should be clear, concise and specific to the
Nursing Diagnosis

Example Subjective Data- what the family relates, states or reports.

Objective (Observable)

Objective Data should be clear, concise and specific to the Nursing Diagnosis

Example Objective Data- what is observed or measured. May include the client’s behavior, vital signs, lung sounds, urine output, laboratory data, diagnostic testing (etc.) as related to the specific nursing diagnosis.
Subjective Data:
• Mary states, “I struggle to walk around the house because my knees and hips are so stiff and painful.”
• She mentions, “I feel like my legs are getting weaker, and it’s hard to get up from a chair without help.”
• Mary reports, “I can’t do the things I used to enjoy, like gardening and walking in the park.”

Objective Data:
• Observed difficulty in ambulating; requires assistance with walking.
• Limited range of motion in the knees and hips noted during physical assessment.
• Muscle weakness and atrophy in the lower extremities.
• Gait analysis shows instability and reliance on furniture for support.
• Physical therapy records indicating decreased mobility and strength.
Stimuli

Contextual Stimuli
Mary’s impaired mobility is influenced by chronic osteoarthritis and associated pain, leading to reduced activity levels. Her co-morbidities, such as hypertension and depressive symptoms, further complicate her condition and ability to participate in physical activities.

Residual Stimuli
Mary’s previous active lifestyle and current physical limitations affect her mental and emotional well-being. Her beliefs about aging and illness impact her motivation to engage in rehabilitation and mobility exercises.
Describe:
Mary faces significant challenges due to chronic osteoarthritis, which severely limits her mobility and causes persistent pain. These physical limitations, combined with hypertension and depressive symptoms, hinder her daily activities and rehabilitation efforts. Her family’s support in adapting to these limitations is crucial. Mary’s previous active lifestyle contrasts with her current struggles, impacting her mental well-being and motivation for rehabilitation. Her beliefs about aging and illness influence her approach to managing her condition, affecting her engagement in treatment and mobility exercises aimed at improving her quality of life.
Mode

Physiologic Mode is the individual’s physical health and functions. (Roy 2012)
Self-Concept Mode is the individual’s beliefs and feelings. (Roy 2012)
Role Function Mode involves the position one occupies in society and the behaviors associated with one’s position (role) in society. (Roy 2012)
Interdependence Mode is associated with one relationships and interactions with others including the giving of love, respect and value. This is a basic underlying need to nurture (Roy 2012).
Physiologic Mode: Physical limitations due to pain and decreased joint function.
Self-Concept Mode: Feelings of frustration and decreased self-worth due to loss of independence.
Role Function Mode: Changes in Mary’s role within her family and community due to impaired mobility.
Interdependence Mode: Increased reliance on family for assistance with daily activities.
NANDA Nursing Diagnosis/ Problem-Based Nursing Diagnosis

Example: Coping, ineffective family: R/T Temporary family disorganization and role changes. Manifested by significant other’s limited personal communication with client.
Write the Nursing Diagnosis/ Problem-Based Diagnosis and include R/T statement and Manifested by sentence including rationale below:
Impaired Physical Mobility R/T chronic pain and decreased joint function AEB difficulty ambulating, stiffness, and limited range of motion.
Rationale: Chronic osteoarthritis leads to joint degeneration and pain, significantly impairing Mary’s physical mobility. Difficulty ambulating, stiffness, and limited range of motion are direct consequences of this condition, impacting her ability to perform daily activities and participate in rehabilitation efforts.
Goals/ Outcomes (Short-term/ Long-term) including Timelines/ Timeframes

Definitions:

Short-term Goals/ Outcomes: Those goals that are usually met before discharge or before transfer to a less acute level of care.
Long-term Goals/ Outcomes: Those goals that may not be achieved before discharge but require continued attention by client and/or significant others as indicated.
Short-term Goal: Mary will demonstrate improved mobility and report decreased pain levels within two weeks through a combination of physical therapy and pain management strategies.
Long-term Goal: Mary will maintain independent ambulation with or without assistive devices and engage in preferred physical activities within three months.
Nursing Interventions and Scientific Rationales including Best Evidence with References

Scientific rationales should address how the interventions are going to solve the problem identified and/or attain the outcomes. The rationales should be specific to the intervention and summarized in your own words. There should be a rationale for each of the three nursing interventions.
Nursing Intervention #1: Develop and implement a personalized physical therapy program focusing on strength and mobility exercises.
Rationale: Regular physical therapy can improve joint function, increase muscle strength, and enhance mobility, reducing the impact of chronic pain. (Jones et al., 2020).
Nursing Intervention #2: Provide Mary with appropriate assistive devices (e.g., cane, walker) to support ambulation and prevent falls.
Rationale: Assistive devices can improve stability and reduce the risk of falls, allowing Mary to move more confidently and safely. (Smith et al., 2019).
Nursing Intervention #3: Educate Mary and her family on pain management techniques, including the use of heat/cold therapy and scheduled rest periods.
Rationale: Effective pain management can alleviate discomfort, enabling Mary to participate more fully in physical activities and therapy. (Doe et al., 2018).
Evaluation of Client Goals/ Outcomes (Impact)

The Evaluation should address the client’s response to each of the three interventions and if any modifications were needed.
Evaluation Nursing Intervention #1: Assess Mary’s progress in physical therapy, noting improvements in strength and mobility. Adjust the therapy program as needed based on her response.
Evaluation Nursing Intervention #2: Evaluate Mary’s use of assistive devices, ensuring they are used correctly and effectively. Modify the type or use of devices if necessary.
Evaluation Nursing Intervention #3: Monitor Mary’s pain levels and her adherence to the pain management plan. Provide ongoing education and support to optimize pain control.

comprehensive management, geriatric depression, Managing Geriatric Depression

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