The Patient Story
The patient interviewed is a 21-year-old Caucasian female who will be referred to as C.L.; she was recently diagnosed with Pulmonary Hypertension (PH) and wants to seek more information about how to manage the disease. She is currently a nursing student at the University of Minnesota who enjoys playing soccer, being a part of her student organizations, and hanging out with her friends. C.L. experiences symptoms and complications such as dyspnea (shortness of breath), dizziness, chest pain, activity intolerance, and weakness due to her PH. These symptoms are felt when she exerts herself too much. Recently, every day activities such as walking have made her experience these symptoms, which is why she came to the clinic. She has a very supportive family that consists of a twin sister –who also goes to the University of Minnesota—and her two parents who want to help in any way they can.
Assessment
Learner(s): C.L. would like to be the main learner of her illness, but she also wants her parents, close friends, and roommates to be aware of how her PH will affect
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her. The teaching session will most likely only consist of C.L., but her parents and friends will be welcomed to join. Most of her caregivers –including herself—are millennials, so those learner characteristics (interactive and virtual environments, multitasking, and technology focused) and recommended teaching strategies (having access to the internet, using technology, and using reliable websites) will be used (Lewis et al., 2014, p. 55). Physical Factors: C.L. is a 21 years old, female who is easily fatigued. She states that “breathing is difficult when walking or exerting a lot of energy.” Pulmonary Hypertension is her primary diagnosis and acquiring this diagnosis has been difficult for her, yet her current mental status is normal. This new diagnosis may be causing her extra stress or anxiety, yet she wants to remain positive. Her hearing, visual, and motor abilities are appropriate, except when she is exerting herself; she becomes dizzy and experiences shortness of breath. She is not on any drugs that will affect her learning and has no additional medical problems. Psychological Factors: C.L. feels worried about her diagnosis will change her life. She states that, “it is difficult to process,” but she does not seem to be in a state of denial. She is very mature at such a young age to be in handling this life changing diagnosis with great positivity. One can tell that C.L. has self efficacy because she is willing to learn and wants to make changes that will help her live with PH. She states that, “although it will be difficult to adjust, I will try to stay positive.” Sociocultural Factors: She believes that her condition will be life altering and not easy, but she is willing to try her best to maintain a very normal life. She is Catholic and believes that “God has a plan.” She is currently a sophomore in college studying nursing, so her health literacy is quite proficient. Her primary language is English and her reading ability is also proficient. Her past and present occupation has been being a student. She currently lives in an apartment near the university with her six roommates. Her parents do not live in the same vicinity as her, but she is concerned about becoming a burden to them because they support her financially. Learner Factors: The patient knows that everyday physical tasks can be difficult. She notes that exertion causes her chest pain, dyspnea, and other symptoms, but besides that she does not know sufficient information about PH. Learning how to cope on a daily basis and how to adjust to her new diagnosis is what C.L. believes to be most important thing to learn first. Her health care provider has given her some information on PH, but she is not too sure what it all means. She seems ready to change her behaviors and is willing to give it her all. A prior learning experience that C.L. has experienced in school and has helped her learn is talking over the information provided and using visual aids. She says she learns best visually, but can also learn in other forms. Her VARK test listed her as a multimodality learner, which indicates that she can use combinations of visual, aural, reading/writing, and kinesthetic strategies to effectively learn. (http://vark-learn.com/strategies/multimodal-strategies/) The learning environment she prefers would be in an informal setting among peers, but she does not mind learning on her own. She would like her caregivers and close friends to be aware of the different signs and symptoms she could encounter, so they are prepared if anything abnormal happens. Other Significant Factors: C.L. is insured under her parents, so she is not worried about this factor. She enjoys walking to class and other places that are near her, but she also has a car that she can use to go to appointments or to areas that she may not be able to walk to. Her city of residence is Minneapolis, Minnesota. She is a Roman Catholic, and believes that this diagnosis will make her faith stronger because she knows God has a plan for her. She wants to trust in what he plans and will try her best to maintain her health. Learning Needs: 1. C.L. wants to learn how to cope in her everyday life and find techniques to help manage the symptoms she has been experiencing because she would like to live a long and normal life. She wants to be able to do almost all of the things she is involved in. 2. She wants to learn about her medications because she wants to know what they are for and how to take them correctly, so they will be effective. She wants to be able to reduce the frequency of her symptoms to enjoy everyday activities. 3. C.L. would like to learn about different support groups that she could join. She wants to learn about this because she knows it can be easier to live with a chronic disease accompanied by the support from others. Diagnosis and Outcome Identification Activity intolerance related to imbalance between oxygen supply and demand evidenced by dyspnea consequent to exertion, discomfort consequent to exertion, and generalized weakness (Lewis et al., 2017, p. 122). 1. The learner will state symptoms of adverse effects of exercise and report onset of symptoms immediately by the end of the teaching session (cognitive). 2. The learner will verbalize an understanding of the need to gradually increase activity based on testing, tolerance, and symptoms by the end of the teaching session (cognitive). 3. The learner will demonstrate increased tolerance to activity of personal choice two weeks from now (psychomotor). Readiness for enhanced coping related to recent pulmonary hypertension diagnosis evidenced by awareness of possible change, desire to enhance social support, and desire to enhance use of spiritual resource (Lewis et al., 2017, p. 297). 1. The learner will seek social support for problems associated with coping by the end of the week (affective). 2. C.L. will describe two effective coping strategies by the end to the teaching session. (cognitive). 3. The learner will use spiritual support of personal choice at least once by the end of the week (affective). Planning an Optimal Learning Environment C.L.
mentioned that she would like to learn in an informal setting where she can learn with her peers. An optimal environment for C.L. to learn more effectively would be a small study space in her apartment instead of a classroom or in a hospital room; this would provide an informal, quiet environment that C.L. is already used to. This teaching session will be done during the weekend because C.L. is very busy with school during the week. Some of the resources that will be used include Wi-Fi, one laptop (either the patient’s or an available one), and her mobile device. Her roommates, friends, or parents will be allowed to join her teaching session, but are not obligated to come. Privacy will be kept by putting up a sign on the study room door stating that the room was reserved. Also it is important to notify her potential caregivers to arrive on time to the session, so they do not
interrupt.
Regina is a 20 year-old single female who is struggling to obtain her business degree at a mid-sized university. In the last two and a half years she has only received 26 credit hours. Seeing that she is having problems, her adviser along with her parents, suggested that she attend therapy. Regina is frequently having anxiety about germs and performing certain rituals in order to lessen her anxiety. In order to be comfortable in her classes, she feels she must arrive early, find a specific desk on a certain row, and thoroughly clean the desk and seat before she can be seated. Also, before she can leave her off-campus apartment in the morning, she is finding herself spending more and more time cleaning her apartment, then showering and getting dressed, and then cleaning the bathroom thoroughly. Regina also has found herself fearful of eating in restaurants and going to eat at family and friends homes. Her fear of germs is intensifying and prohibiting her from having adequate relationships. This is leaving her to feel quite isolated and lonely.
It just so happens that I believe that I can best and most effectively “lend a hand” when a person is at their bodily weakest. From a single semester of shadowing—a total of 11.75 hours—under physicians and surgeons alike, I have experienced a taste of the medical field from the fascinating gruesome finesse of an open-heart surgery to the day-to-day clinical patient interaction that makes up so much of a medical professionals career. From a community standpoint, I believe that a person does not need to be a doctor to express and achieve care. Because of that, I have joined organizations such as Chords4Kids on the TCU campus—that sings nostalgic songs from the 2000s to down-syndrome children at the local education center as well as at retirement homes, and other events alike—and the TCU GO Center, which mentors local high-school students during their college application process. For the later, I have been given the responsibility as the Executive Organizer for their annual “College Access Day” which provides local students with college information workshops and campus tours. I have also actively
During the interview, the Physical Therapist I conferred with was very thorough and straightforward in his responses to the questions that were given. I decided to interview another one of my mother’s fellow co-workers, Mr. Stephen Chan, considering his new experiences in the Physical Therapy field. I met with Mr. Stephen Chan at the Kaiser Permanente Outpatient Orthopedic Clinic that is located in Union City. The essential subject matters that we discussed consisted of his Major and Minor in college, the Residency Program that he takes part in, variations of attitudes, and advantages in the workforce.
The patient, LL, is a twenty four year old female who was diagnosed with obsessive-compulsive disorder five years ago. Around the ago of eighteen, LL started to experience many symptoms of obsessive-compulsive disorder. She had just started her freshman year at a local college and moved into the dorms with a random roommate. LL was constantly washing her hands and grossed out by the germs, so she came to realize she had a phobia of germs. She would begin sweating and having major anxiety when people went to shake her hand or her roommate would touch her food or any of her things. LL started skipping class and isolating herself in her room in order to avoid contact with other people. When her grades dramatically declined,
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
Advanced practice registered nurses play a significant part in extending access to health care by providing primary care and specialty care services to clients. Advanced practices registered are mentors, educators, researchers, and administrators. According to Health Resources and Services Administration, “Ninety-six percent of the NP workforce reported being in clinical practice, providing direct patient care” (Health Resources and Services Administration 2016). Furthermore, “Nearly three percentages were in faculty positions and approximately one percent was in administrative positions”(Health Resources and Services Administration 2016).
Emily is a neonatal intensive care unit (NICU) nurse of 11 years. Emily routinely provides care for babies as small as 800 grams (about 1 and ¾ pounds), babies born with drug addictions, and the routine twins and triplets born as a result of fertility medications and assisted reproductive technologies (ART). As a strong Christian woman, Emily wasn't sure she could fulfill the tasks required of her when she first came on. Nor did she think she could cope with the occasional “expiration” of a young life. However, after more than a decade, Emily continues to provide exemplary care to babies, and parents alike, in the first few weeks and months of life. Throughout her decade long career, Emily has seen much change and continues to see the landscape transform within her small part of the nursing community.
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There were a number of nursing priorities identified, the patient also has hypertension. The key priority for nursing care with this patient is her learning disabilities and the potential communication barriers that may occur. The patient’s hypertension is well controlled with medication for these reasons I will focus this assignment around communication barriers with people with learning disabilities, the importance of good communication between the multi-disciplinary team within the unit. I will also explore any issues with consenting to the procedure as it is imperative that the patient is fully aware of the procedure and understands the possible risks and complications.
Today, many Americans face the struggle of the daily hustle and bustle, and at times can experience this pressure to rush even in their medical appointments. Conversely, the introduction of “patient-centered care” has been pushed immensely, to ensure that patients and families feel they get the medical attention they are seeking and paying for. Unlike years past, patient centered care places the focus on the patient, as opposed to the physician.1 The Institute of Medicine (IOM) separates patient centered care into eight dimensions, including respect, emotional support, coordination of care, involvement of the family, physical comfort, continuity and transition and access to care.2
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