Posted: June 4th, 2015
INTRODUCTION TO NURSING
726.1.2: Therapeutic Communication – The graduate demonstrates therapeutic communication skills necessary to promote patient safety and positive patient outcomes.
726.1.3: Basic Principles of Safety & Quality – The graduate plans a safe care environment to promote safety and quality care for patients, the providers, the immediate environment, and the community.
726.1.4: Cultural Awareness – The graduate creates patient care plans that demonstrate awareness of and sensitivity and respect for cultural differences, beliefs, and values.
726.1.5: Theories of Growth & Development across the Life Span – The graduate uses the nursing process to plan patient care that incorporates the theories of human growth and development into the care process.
726.1.6: Health Perception/Health Management – The graduate determines the impact of the health perceptions of individuals and communities on the promotion of health and health management strategies.
The nursing process is used as a problem-solving framework to plan and provide safe, patient-centered care to patients and their families. The incorporation of therapeutic communication, growth and development and cultural concepts in the planning and provision of care promotes patient safety and ensures quality care.
Jane Vuong is a 24-year-old single Vietnamese woman living in the United States on an academic visa. She has been attending the local university for two years, studying cellular biology as an undergraduate. She comes from an affluent Vietnamese family. Her parents are paying for her education. They want her to come back to Vietnam with her doctorate and take over the research lab owned by her uncle. Jane is a straight-A student who spends much of her time studying. She makes extra money by working part-time in the molecular biology laboratory in the university campus research center. She takes the subway or rides her bicycle to get around.
Jane enjoys working out doing Quan Khi Dao at the local martial arts school. One day while working out, she feels a severe tightness in her chest and says she is having difficulty breathing. Susan, a regular attendee in the class, brings Jane to the emergency department where you work. You note that Jane is having trouble speaking, appears anxious, and her lips are dusky. You are able to hear a wheezing sound when she breathes. She denies a history of asthma but says that she has some allergies which she generally treats with herbs. Susan takes you aside and tells you that she has noticed over the past month that Jane has seemed out of breath after taking the stairs up to the martial arts studio and that she no longer rides her bike to the studio.
Because of the severity of Jane’s symptoms, the doctor decides to admit Jane for evaluation and observation. The physician orders supplemental oxygen, a chest X-ray, blood tests, and a regular diet. Jane’s anticipated stay is two days.
Once on supplemental oxygen, she is better able to communicate, and you begin to do a general assessment and take a history. Here are some of your findings:
Diet: Jane states that she is proud that she only eats a traditional Vietnamese diet of fresh vegetables, chicken, rice, and noodles. Much of the food she eats is prepared with Nuoc mam (fish sauce), soy sauce, sour lemons, bean sprouts, and scallions. She prefers to eat banh khuc (rice ball), banh cuon (rolled rice pancake), and pho bo (beef and noodle soup). You note that she is very slender, verging on being underweight.
Religion: Jane states she is a Mahayana Buddhist. She goes to the Buddhist temple early each morning for meditation and communion with her dead ancestors. She says her meditation brings blessings from her ancestors, and they watch over her and help her succeed and stay healthy.
Health history: Jane admits she has had a dry cough for several months, which she attributes to allergies. She says her allergies have kept her from riding her bike to work. She continues to smoke one pack of cigarettes daily and says smoking does not bother her. She laughs and says she could never quit because her roommate smokes too.
Six months earlier she tested positive for hepatitis B. The diagnosis surprised her because she did not show any symptoms. She denies drug use but admits to being sexually active. She reports having five sexual partners in the past six months. She states: “I meet guys at the college bar and we have weekend flings. I like it this way, so I don’t have to be involved in any type of long-term relationship, which can make life really complicated.” When asked if she uses protection, she shrugs and says, “Sometimes.” She claims that no one told her that hepatitis B was sexually transmitted, but she is not worried because she says she is over it now.
Exam: During her examination, red circular burns were found on Jane’s chest. On Jane’s back, there are reddened abrasions. When asked about these strange marks, Jane explains that she was having difficulty breathing earlier in the week, and went to a Vietnamese medicine man who treated her with “coining” on her back and “cupping” on her chest to remove the bad air. He also gave her an herbal mixture and told her to boil it and breathe the steam from the mixture three times daily. She says it really helped her.
Jane’s primary nursing diagnosis is “impaired gas exchange.”
A. Write an analysis paper (suggested length of 2 pages) in which you do the following:
1. Summarize (suggested length of 1 paragraph) Jane’s history.
2. Assess which stage Jane is in for each of the following theories, using her history and behavior:
• Erikson’s adult growth and development theory
• Freud’s adult growth and development theory
• Maslow’s needs theory
3. Discuss how you could adapt care to meet Jane’s cultural needs.
a. Justify each adaptation.
4. Explain how the nursing process could assist you in planning Jane’s care, including one specific example.
5. Discuss which techniques of therapeutic communication you would use in order to carry out Jane’s plan of care, including one specific example.
a. Explain a potential barrier to therapeutic communication with Jane, based on her history and background.
B. Select two of the following additional nursing diagnoses, given Jane’s history:
• Knowledge deficit
• Activity intolerance
• Alterations in health maintenance
Note: All of these diagnoses are reasonable diagnoses for Jane; you are not evaluated on which ones you select.
1. Complete a nursing diagnoses chart for each of the two chosen diagnoses, using the attached “Nurse Care Plan Templates,” with the following information:
a. Subjective data that supports the diagnosis
b. Objective data that supports the diagnosis
c. Problem (nursing diagnosis)
e. Signs and symptoms
f. Two short-term patient outcomes to be achieved before discharge
g. One long-term patient outcome to be achieved two weeks to six months after discharge
h. Nursing interventions that describe what the nurse will do to help the client meet each short-term and long-term outcome
Note: Interventions must should be culturally and developmentally appropriate when applicable.
i. Rationale for each nursing intervention, including why this nursing intervention is relevant to helping the patient achieve the corresponding goal
C. When you use sources, include all in-text citations and references in APA format.
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.
Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.
Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.
1. Nursing Care Example link opens in new window
2. Nursing Care Plan Template 1 link opens in new window
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