Application Of Orem's Self-Care Deficit theory In Nursing Practice

Submitted to: Mrs.Kamli prakash Vice principal (HCN)

Submitted by: Arjun kumawat m.sc.nursing1syr

Submitted on: 13/06/2011

PATIENT PROFILE Areas Name Age Sex Education Occupation Religion Diagnosis Patient details Mrs. Sumitra devi 56 years Female M.A. House wife Hindu DM with HTN with Cirrhosis of liver

Marital status Married

Theory applied Orems theory of self care deficit. For Mrs. Sumitra Devi She came to the hospital with complaints of high fever with chills and rigor. Patient suffering from vomiting and semiconscious. She developed these complaints suddenly and went to local hospital for treatment. There is no improvement in health and then she was adimtted in HIHT. DATA COLLECTION ACCORDING TO OREMS THEORY OF SELF CARE DEFICIT 1. BASIC CONDITIONING FACTORS Age Gender Health state Development state Sociocultural orientation Health care system Family system Patterns of living Environment resources 56 year Female High fever with chills and rigor. Patient suffering from vomiting & semiconscious.. Ego integrity vs despair M.A. Indian, Hindu Institutional health care Married, husband working in private job At home with partner Rural area, items for ADL in easy reach, no special precautions to prevent injuries Husband, daughter, son

2. UNIVERSAL SELF-CARE REQUISITES Breaths with difficulty & no pallor cyanosis Air Water Food Elimination Activity/ rest Social interaction Prevention of hazards Fluid intake is in sufficient. Edema is not present Turgor normal for the age Hb 10.6gm%, BMI = 14.Food intake is not adequate or the diet is not nutritious. Voids and eliminates bowel with urinary incontinence. Completely on bed since she is semiconscious Could not elicited, since she is semiconscious Need instruction to on care of body and prevention of falls. Need instruction to family on improvement of nutritional status. Promotion of normalcy Improving condition.

3. DEVELOPMENTAL SELF-CARE REQUISITES Maintenance of developmental environment Prevention/ management of the conditions threatening the normal development 4. HEALTH DEVIATION SELF CARE REQUISITES Adherence to medical regimen Family members report the problems to the physician when in the hospital. Cooperates with the medication, Not much aware about the use and side effects of medicines Awareness of potential problem associated with the regimen Family members are not aware about the actual disease process. Not compliant with the diet and prevention of hazards. Not aware about the side effects of the medications Modification of self image to incorporates changes in health status She maintains is self image. Could not elicited, since she is semiconscious Could not do, since she is semiconscious

Adjustment of lifestyle to accommodate changes in the health status and medical regimen.

Slowly improve his health.

5. MEDICAL PROBLEM AND PLAN Physicians perspective of the condition: Diagnosed Lt. Gaglionic bleed with post craniotomy and is on the following medications: s. no. Inj. Metrogyl 1. Inj. amikicin 1. Tab Diamox 2. Inj. Rantac Tab. 3. cefizan 4. Inj. prexarom 5. Inj. combitac 100ml 500mg 250mg 50mg 200mg 4ml 1.2 ml IV IV orally IV orally IV IV TDS BD TDS BD BD TDS OD Name of the drug dose rout frequency

Medical Diagnosis: DM with HTN with cirrhosis of liver. Medical Treatment: Medication and physical therapy. AREAS AND PRIORITY ACCORDING TO OREMS THEORY OF SELF-CARE DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS. Air Water Food

Elimination Activity/ Rest Solitude/ Interaction Prevention of hazards Promotion of normalcy Maintain a developmental environment. Prevent or manage the developmental threats Maintenance of health status Awareness and management of the disease process. Adherence to the medical regimen Awareness of potential problem. modify self image Adjust life style to accommodate health status changes NURSING CARE PLAN ACCORDING TO OREMS THEORY OF SELF CARE APPLYING THE OREMS THEORY OF SELF-CARE DEFICIT, NURSING CARE PLAN FOR MRS. sumitra devi COULD BE PREPARED AS FOLLOWS A. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: FOOD ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS Inability to maintain the ideal nutrition related to inadequate intake and knowledge deficit OUTCOMES AND PLAN

a. Outcome: Improved nutrition b. Nursing Goals and objectives Goal: To achieve optimal levels of nutrition. Objectives: Mrs. Sumitra devi family memberswill: List the food items rich in iron, which are available in the locality. c. Design of the nursing system: Supportive, educative, d. Method of helping: guidance support Teaching IMPLEMENTATION Mutually planned and identified the objectives and the patient were made to understand about the required changes in the behavior to have the requisites met. EVALUATION Mrs. Sumitra family members understood the importance of maintaining an optimum nutrition. . The supportive educative system was useful for Mrs Sumitra ---------------------------------------------------------------B. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: NUTRITIONAL REQUIREMENT: INADEQUATE

NURSING DIAGNOSIS Inadequate nutrition less than body requirements related to semi consciousness and ryles tube feedings. OUTCOMES AND PLAN a. Outcome: improved nutritional status Maintain the ability to improve nutritional status. b. Nursing Goals and objectives Goal: To achieve optimal levels of nutritional status. Objectives: Mrs. Sumitra will: Able to maintain normal nutritional status. c. Design of the nursing system: Partly compensatory with family members d. Method of helping: 1. Guidance: Assess the various hindering factors for maintaining nutritional status and how to tackle them. 2. Support: Assess the nutritional status of the client. Maintain the intake and output chart

3. Teaching: Teach the family members the limitation in the intake of the patient has and the cooperation required

4. Promoting a developmental environment: Teach the family and help them to practice how to help the patient according to her needs IMPLEMENTATION Maintained regular diet. Included all fruit juices, dhal soups, milk etc. EVALUATION Client family members are comfortable and gained knowledge regarding nutritional status maintainence. The partly compensatory system was useful for Mrs. Sumitra ---------------------------------------------------------------------C. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: ACTIVITY ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS Self-care deficit: dressing, toileting related to restricted joint movement, secondary to the inflammatory process in the joints. OUTCOMES AND PLAN a. Outcome: improved self-care

b. Nursing Goals and objectives Goal: To achieve optimal levels of ability for self care. Objectives: Mrs. Sumitra will:

perform the dressing activities within limitations utilize the alternative measures available for improving the toileting c. Design of the nursing system: Partly compensatory with family members d. Method of helping: 1. Guidance: Assess the various hindering factors for self care and how to tackle them. 2. Support: Make the patient use commodes or stools to perform toileting and insist on avoidance of squatting position Provide assistance whenever needed for the self care activities Provide encouragement and positive reinforcement for minor improvement in the activity level. 3. Teaching: Teach the family members the limitation in the activity level the patient has and the cooperation required 4. Promoting a developmental environment: Teach the family and help them to practice how to help the patient according to her needs IMPLEMENTATION Mutually planned and identified the objectives and the patient were made to understand about the required changes in the behavior to have the requisites met. EVALUATION They performed the dressing activities with minimal assistance

Patient family members verbalized that They will perform the activities as instructed to get her ADL done. The partly compensatory system was useful for Mrs. Sumitra ---------------------------------------------------------------------D. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PAIN CONTROL ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS Ineffective pain control related to lack of utilization of pain relief measures OUTCOMES AND PLAN a. Outcome: improved pain self control

b. Nursing Goals and objectives Goal: To achieve reduction in the pain. Objectives: Mrs. Sumitra will: describe the total plan of pharmacological and non pharmacological pain relief c. Design of the nursing system: supportive educative d. method of helping: Guidance: Explore the past experience of pain and methods used to manage them. . Support:

Provide rest to the joints and avoid excessive manipulations Provide hot and cold application to have better mobility. Encourage exercises to the joints by immersing in the warm water. Teaching: Teach the non pharmacological method to the patient once the pain is a little reduced.

IMPLEMENTATION Administer medications as prescribed by the physician Reduce unnecessary disturbance of the client. EVALUATION She demonstrated slight reduction in the pain behaviors. The supportive educative system was useful for Mrs. Sumitra -------------------------------------------------------------E. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PREVENTION OF HAZARDS. ADEQUACY OF SELF CARE AGENCY: INADEQUATE NURSING DIAGNOSIS Potential for fall and fractures related to semiconscious. OUTCOMES AND PLAN a. Outcome: Absence of falls and injury to the patient b. Nursing Goals and objectives

Goal: prevent the falls and injury and to maintain a good health. Objectives: Mrs. Sumitra will: remain free from injury as evidenced by: c. Design of the nursing system: supportive, educative, promotive d. method of helping: Support Never leave the client alone in the unit Assess the patients gait, activities and the mental status for any confusion or irritability. Encourage the family members to use supportive devices as required. IMPLEMENTATION Accompanied the client all the time by nurse and family members. Assessed patient mental condition continuously for any signs of irritability. EVALUATION . Patient explained the various measures that they will take to prevent the injury. The supportive educative system was useful for Mrs. Sumitra ------------------------------------------------------------------

EVALUATION OF THE APPLICATION OF SELF CARE DEFICIT THEORY The theory of self-care deficit when applied could identify the self care requisites of Mrs. Sumitra from various aspects. This was helpful to provide care in a comprehensive manner. Patient family members were very cooperative

REFERENCES Alligood M R, TomeyA M. Nursing Theory: Utilization &Application .3rd ed. Missouri: Elsevier Mosby Publications; 2002. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002 George JB .Nursing Theories: The Base for Professional Nursing Practice .5th ed. New Jersey :Prentice Hall;2002.