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Homework answers / question archive / Identifying Patterns of Illness and Wellness Case Study: Informant: Patient
Identifying Patterns of Illness and Wellness Case Study: Informant: Patient. Reliable historian (once she woke up in the ED) Chief Complaint: S.A. is a 35 year-old female with altered mental status who is brought by EMT via ambulance to the ED at NY Medical Center (NYMC). Her neighbors called 911 after observing S.A. pacing in circles outside her apartment building in the middle of the night, uttering incoherent sentences to “imaginary people.” History of Present Illness: S.A. is a Registered Nurse working in the Operating Room in a Level I trauma center hospital. She is currently on medical leave after having a “melt-down” at work. S.A. recently completed rehabilitation for substance abuse. She seemed to be doing well and getting ready to return to work, but in the past week, she reports “celebrating her sobriety” with friends and believing she could tolerate a glass or wine or two. However, she relapsed quickly. On the day of admission to NYMC, S.A. admits to taking her prescription oxycodone as well as her psychotropic medications while drinking alcohol, smoking some marijuana, and eventually being offered heroin, which she ended up snorting with her boyfriend. She remembers asking for help as she was spinning out of control, but nobody took her seriously. S.A. has no recollection of leaving her apartment or being picked up by EMT; only that she woke up in the ED. Past Medical History: February 1990: Tonsillectomy and adenoidectomy secondary to frequent Strep. throat 1992: Diagnosed with asthma 1997: Diagnosed with scoliosis. Wore a Boston brace for two years and three months 2002: Diagnosed with depression. Prescribed antidepressant by psychiatrist (initially fluoxetine Hcl but when “it didn’t work adequately”, quetiapine was added), but sometimes “forgets” to take her medications. Started psychotherapy. May 2015: Back surgery for herniated disk and stenosis. Prolonged post-operative pain; was started on oxycodone for pain control. July 2015: ED visit due to alcohol poisoning and drug overdose, requiring naloxone Hcl. Follow-up visit with PCP, noted to be hypertensive with BP 160/110. August 2015: Began Alcoholic Anonymous but refused inpatient drug/alcohol rehabilitation. Was able to return to work in September 2015 and was “clean” for six months when she admits to begin drinking alcohol intermittently, but was able to hide it from fellow healthcare colleagues. May 2017: Completely lost concentration on three different occasions while being scrubbed in during surgery, endangering patient safety. Admitted to her nurse manager that she had been struggling with addition after her back surgery two years ago and that she needed additional help. Allergies: Sulfa drugs (develops mouth blisters); seasonal allergies (pollen, grass) Past Hospitalizations: February 1990: T&A 1992 & 1993: Hospitalized for exacerbation of asthma May 2015: Back surgery for herniated disk and stenosis (5 day hospital stay) July 2015: Overnight stay for observation post alcohol poisoning and drug overdose Surgical History: See “Past Hospitalizations” Social History: Alcohol use: Social drinker (2-3 drinks/week) prior to May 2015 when consumption increased to binge drinking up to 2 bottles of wine or 6 drinks in one night Tobacco use: 2 packs/day x 15 years; quit 2 years ago Current Medications: Fluoxetine Hcl 30 mg tab, 1 tab PO once daily Quetiapine 300 mg tab, 1 tab PO daily at night Oxycodone 30 mg tab, 1 tab PO Q12H Budesonide HFA 2 puffs BID Ethinyl estradiol and norgestrel, 1 tab once daily Ibuprofen 600 mg Q6H prn for break through back pain Polyethylene glycol 3350, 17 Grams in 8oz of water once daily Family History: Mother: deceased at age 65 from breast cancer Father: 67 – hx of HTN and in remission from colon cancer Siblings: - One brother age 38 diagnosed with obesity, HTN and diabetes (Type II) at age 33 - One sister age 32 – Pap test at age 30 showed cervical dysplasia Children: None Past Health Maintenance: Infectious Diseases: Usual childhood illnesses. No history of rheumatic fever Immunizations: Immunizations are up to date except annual flu vaccine, which she refuses Transfusions: None Mammogram: GYN referred for mammogram, S.A. refused; did not think it was necessary Colonoscopy: None Pap test: last Pap smear three years ago was negative S.A. reports seeing her primary care provider annually, but admits that she is currently overdue for a visit (last seen July, 2015). She sees her psychiatrist every six months. S.A. admits to drinking alcohol daily while taking psychotropic medications and opioids, but states she still has been “functioning” in her job as nobody has noted a change in behavior (until the most recent incidence). She used to be active in various recreational sports and work out regularly (34 days/week) at a gym. However, her general health status has suffered since her back problems began and she no longer exercise. S.A. has also gained ~20 Ibs due to “eating too much junk food,” especially take-out Burger King, Wendy’s and Chinese food. She also believes her medications are making her fat. Systems Review: Constitutional: Weight 165 lbs. including recent weight gain of ~ 20 Ibs; height 5’5” HEENT: Occasional epistaxis. Wears glasses for myopia and follows up with ophthalmologist annually; no diplopia or eye pain. Hx of T&A Respiratory: History of asthma; last exacerbation 3/2017; takes asthma medications as prescribed; Pneumonia once at age 17 (did not require hospitalization); denies TB or TB exposure Cardiac: Hypertension in 7/2015; no medications. No other history of cardiac anomalies; no palpitations; no HTN Vascular: No history thrombosis or aneurysm Hematologic: No known blood or clotting disorders G.I.: Takes polyethylene glycol daily for chronic opioid induced constipation since 5/2015 GU: Menarche was at age 15; regular 28-day menstrual cycles, moderate-to-heavy. One pregnancy resulting in an elective abortion in 2001. Compliant with daily birth control pills since age 20. No history of STDs. Endocrine: No known diabetes or thyroid disease Neuromuscular: Chronic back pain Rheumatic: no history of gout, rheumatic arthritis, or lupus Dermatological: no rashes or pruritus Emotional: Depression, anxiety. Labs / Diagnostic studies: CBC: WBC 4,500; Hgb 11.0Gm/dL; Hct 33.2%; MCV 80.0; Plts 255,000mcL; Retic count 0.4% BMP: Na 143 mEq/L; K 4.1 mEq/L; Cl 103 mEq/L; CO2 25 mEq/L; Glu 95 mg/dL; BUN 9 mg/dL; Creat 0.8 mg/dL LFT: T bili 2.0mg/dL; Alk Phos 155 IU/L; AST 38 IU/L; ALT 48 IU/L; T protein 7.0 g/dL; Albumin 3.5 g/dL LIPID PANEL: Triglycerides 225 mg/dL; Total cholesterol 242; HDL 70mg/dL; LDL 172mg/dL U/A: SG 1.008 pH 7.5, negative Urine Toxicology (10-panel): Positive for opiates, marijuana, cocaine, benzodiazepines IDENTIFYING PATTERNS OF ILLNESS AND WELLNESS WRITING ASSIGNMENT GRADING RUBRIC Using the provided case study, identify ALL of the patient’s illness patterns and health promotion patterns. Health promotion patterns are those behaviors the patient is doing that can lead to a healthier lifestyle. Illness patterns include those behaviors the patient is doing that may lead to an unhealthy lifestyle. Develop at least three NANDA nursing diagnosis, one of which is psycho-social in nature. Prioritize the problems and develop appropriate interventions with rationales. Finally, provide expected outcomes. Student Total Score 1. Develops an in-depth, thoughtful paper that identifies appropriate patterns of illness and health promotion patterns and presents a coherent, organized analysis of these patterns 2. Demonstrates understanding of and develops three appropriate nursing diagnoses, presents them in priority order incorporating interventions, rationales and goals utilizing collected data 3. Incorporates at least three health promotion references other than course text. 4. Writes in clear college level prose. Utilizes APA formatting appropriately. Able to develop an in-depth paper that identifies the patient’s patterns of illness AND health promotion patterns. Provides a coherent and organized analysis of BOTH the patterns of illness and health promotion patterns. Demonstrates superior understanding of patterns of illness and health promotion patterns through accurate and appropriate nursing diagnoses that are prioritized, with interventions, rationales and goals. Identifies more than three appropriate nursing diagnoses. Able to integrate references smoothly into the paper and identifies and cites referenced material consistently. Utilizes more than three health promotion references. Able to achieve enhanced clarity through elaboration, detail, vocabulary use, sentence complexity and variety. Correct spelling and grammar used. APA formatting is utilized appropriately. 25-Superior 35-Superior 20-Superior Able to develop a paper that identifies the patient’s patterns of illness AND health promotion patterns. Provides an analysis of BOTH the patterns of illness and health promotion patterns, but some areas are weak or contained limited information. Demonstrates adequate understanding of patterns of illness and health promotion patterns through accurate and appropriate nursing diagnoses that are prioritized, with interventions, rationales and goals. Identifies three appropriate nursing diagnoses 20-Superior | Able to select relevant references and utilize them appropriately and identify and cites referenced material consistently although perhaps awkwardly at times. Utilizes three health promotion references. 20-Good 30- Good 15- Good 15- Good Develops a paper that identifies the patient’s patterns of illness AND Demonstrates some understanding of patterns of illness and health Limited ability to identify and utilize references or uses them Able to be clear and intelligible at times, but several sentences are not Able to write clearly throughout the paper: sentences may contain occasional errors, the errors rarely impede comprehension. APA formatting is utilized appropriately with some minor errors. health promotion patterns. Provides an analysis of BOTH the patterns of illness and health promotion patterns, but very superficially. 10-Limited Little or no ability to address the criteria for this assignment 5-Severely Limited promotion patterns, nursing diagnoses are not appropriately prioritized and interventions, rationales and goals are incomplete. Identifies two appropriate nursing diagnoses. 25-Limited Demonstrates little or no understanding of illness patterns and health promotion. Does not inconsistently or incorrectly. Utilizes two health promotion references. clear and comprehension is impeded. APA formatting is utilized with major errors. 10-Limited Little or no ability to utilize outside resources or to make distinctions between the resource and own ideas. No references are cited. Utilizes less than two health promotion references 10-Limited Little or no ability to write sentences without basic errors that severely impede comprehension. APA formatting is not used. 10-Severely Limited 5-Severely Limited 5-Severely Limited Adapted from CUNY Proficiency Exam – Scoring guide (Draft 7) Requirements This video provides an overview of the “Patterns of Illness and Wellness” assignment in the NURS 301- Health Assessment course Welcome! I am Dr. Jan Kaminsky, one of the instructors for Nursing 301, Health Assessment! Understanding the patterns of illness and the health promotion practices of our patients is of utmost importance, because you might learn what your patient or client is doing to contribute to their healthy or unhealthy lifestyle. You might feel confused about where to start on this assignment, so this video will help you to understand all of the aspects of a successful Patterns of Illness and Wellness case study assignment. For this assignment: You will read an assigned case study (found on Blackboard under “Patterns of Illness and Wellness” in “Assignments”). A case study includes information about the specific patient that you are working with, such as their chief complaint, history of their present illness, past medical history, allergies, systems review, medications, family history, and more. After closely reviewing the case study, you will develop an in-depth, thoughtful paper that identifies appropriate patterns of illness and health promotion patterns and presents a coherent, organized analysis of these patterns for this patient. Next, you will develop three appropriate nursing diagnoses, presents them in priority order incorporating interventions, rationales and goals utilizing collected data. One of your NANDA diagnoses must be psycho-social in nature. Be sure that you prioritize the problems and develop appropriate Nursing diagnoses with rationales. Finally, provide expected patient outcomes. Once you have assessed your patient’s illness patterns and health promotion patterns, you can better plan for the patient or client’s future needs, and that will result in improved patient outcomes! You definitely want to make sure that you have reviewed APA formatting, and please also be sure to include at least three evidence-based health promotion resources besides your textbook! If you have any questions, please be sure to reach out to your instructor and check Using the provided case study, identify ALL of the patient’s illness patterns and health promotion patterns. Health promotion patterns are those behaviors the patient is doing that can lead to a healthier lifestyle. Illness patterns include those behaviors the patient is doing that may lead to an unhealthy lifestyle. Develop at least three NANDA nursing diagnosis, one of which is psycho-social in nature. Prioritize the problems and develop appropriate nursing interventions with rationales. Finally, provide expected outcomes. APA format, 1500 words, references no older than 5 years.
Nursing Diagnosis
Diseases and illnesses are unpleasant, burdensome, and dramatic events that can completely alter someone’s life. Living with diseases and illnesses is not an easy thing particularly if it is a prolonged illness or a chronic progressive illness. Different factors, including age and mood changes, can further increase the intensity and the impact of the illness on an individual. For patients who have to undergo these distinct changes, their lives change. The disease can evolve into a universe for the patient, absorbing and shaping the individual, altering them as individuals, patients, and their overall life. Depending on its nature and severity, an illness can turn into a life-shaping experience (Giannoula, et al., 2018).
Patient’s illness patterns
Illnesses are dynamic. Societal changes, cultural changes, and technological advances, viewpoints on how to handle illnesses are also changing. Treatment options, as well as the patient’s position within the illness, are changing. Patients are playing active roles in their health today (Bombard, et al., 2018). Some of these roles help their conditions while others worsen their health status. A patient’s illness patterns constitute the specific patient’s behaviors negatively contributing to their health. In this particular case, for instance, S.A. is struggling with substance abuse, mental health issues, and hypertension. Her behaviors need to focus on bettering her health status about these specific conditions. However, some of her behaviors contribute to and worsen her present status.
For example, she began drinking a glass or two of wine in celebration of her sobriety that led to a quick relapse. She also reports drinking alcohol, smoking marijuana, and snorting heroin while taking her psychotropic medication and prescription oxycodone. She admits to drinking alcohol daily along with her opioids and medication. The substance use worsens her condition. In addition to this, S.A has been consuming a lot of fast foods despite being hypertensive. This has resulted in a 20-pound weight gain, increasing the chances of developing hypertension-related health threats. She no longer exercises due to her back problems. This may have contributed to her weight gain. While the back problems can understandably alter one’s exercising routine, she could get a professional to help her identify and perform appropriate exercises considering her health condition.
Additionally, S.A reports to her primary healthcare provider annually but is currently overdue for a visit. Such delays can affect the quality of her health. Another notable behavior is the lack of exercise. Sometimes she also forgets to take her medications. The above-described behaviors that S.A has adopted have negative impacts on her health. For instance, her alcohol consumption caused her relapse and is fueling her addiction. Additionally, her lifestyle choices, particularly in terms of food consumption and lack of exercise are affecting her blood pressure and increasing her risk of developing other health conditions. Essentially, these behaviors are contributing to her unhealthy lifestyle.
Patient’s health promotion patterns
While some behaviors adopted by patients lead to and promote unhealthy lifestyle choices, others encourage and promote healthy behaviors. The health promotion patterns are the specific behaviors that patients engage in to promote a healthier lifestyle. To engage in health promotion patterns, patients must have a general understanding of their conditions, be well educated on the development of the illness, and have the ability to comprehend and follow instructions. Essentially, the patient needs to understand what it means to have that specific illness and the specific measures that can facilitate the improvement or worsen of the case. With such information, they can make accurate decisions that will aid in the development of a healthy lifestyle (Paterick, et al., 2017).
In this case study, S.A engaged in some behaviors that improved her lifestyle and consequently bettered her health status. S.A is a reliable historian. The fact that she is consistent in storing her medical data makes it easy to analyze her history with certain illnesses, track her progress, and determine how past illnesses affect her life. This helps healthcare workers gather subjective data on the patient’s health, determine their health status, and create a treatment plan that will address the existing health problems while minimizing future risks (Acharya, et al., 2018). She also sees her psychiatrist every six months. This consistency helps her mental state.
Aside from keeping a reliable history of her health, S.A also admits that she needs help to overcome her substance use problem. While this may seem like a minor issue, it is essential since admitting the need for help is often the first step to recovery. S.A is also quite consistent with most of her medication and continues to take them even though she is abusing certain substances. While the substances may alter the functioning of the medication, it is vital to acknowledge that she is consistent with her medication. The behaviors described in this section may seem minor compares to her illness patterns. However, they play a role in her health and wellness.
NANDA nursing diagnosis, problem prioritization, and interventions
A nursing diagnosis provides the basis for identifying and selecting the appropriate nursing interventions that can help in achieving ideal outcomes. A nursing diagnostic process is unique as it directly involves the patient. It is based on the data collected during the interaction with the patient, the interview, and the patient’s medical history. Accurate inferences from patient data during an assessment are necessary when making a nursing diagnosis. In S.A’s case, a problem-based nursing diagnosis is necessary as she is dealing with different health problems. The diagnoses will help identify specific areas that need enhancement to improve her quality of life.
Nursing Diagnosis 1: Ineffective individual coping
The patient has relapsed and has lost control over her alcohol consumption, and she abuses other substances such as marijuana. This affects her health, persona life, and professional life. The condition is evidenced by certain factors associated with this diagnosis. These include confusion, disorientation, hallucinations, forgetfulness, inability to concentrate at work thus risking the lives of her patients, and verbalization of her inability to cope. The desired outcomes in this diagnosis include identifying ineffective coping behaviors, initiating the necessary lifestyle changes, and managing substance use.
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Interventions |
Rationale |
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Complete initial assessment including interviewing family members regarding substance use. |
The information can shed information on the patient’s health status, adherence to medication, triggers, and factors influencing relapse. |
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Determine the patient’s understanding of current and previous situations and methods to cope with her substance use problem. |
Patient information regarding the patient’s acceptance that they need help, personal responsibility, and commitment to change is essential. |
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Encourage verbalization of feelings and emotions along with avoiding triggers. |
The patient will come to terms with her situation and help her avoid people or situations that cause her to use these substances. |
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Institute appropriate measures based on standard hospital policy. |
To avoid skipping medication and consuming drugs with substances. |
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Use peer support to help her deal with her drug urges. |
Self-help groups can help S.A abstain from substance abuse using peer pressure, support, and understanding. |
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Discuss her plans to live without substance use. |
Develop a patient-centered strategy to avoid relapse can aid in tracking changes. |
Nursing Diagnosis 2: Activity intolerance
Activity intolerance is evidenced by the inadequate physiological energy to complete the desired task. In this case, S.A cannot return to work. She is currently on medical leave following her meltdown at work. Since her back surgery, she has not been able to engage in physical exercises. This endangered the lives of patients. It is evidenced by a lack of concentration and inability to engage in physical exercises. The desired outcomes in this situation include participation in physical activities, increased alertness at work, and verbalize the importance of physical exercises.
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Interventions |
Rationale |
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Encourage progressive activity. |
The patient can tolerate activities if they are increased progressively. |
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Encourage the patient to engage in ROM exercises. |
Regular exercising can help in the maintenance of muscle strength. |
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Provide an opportunity for the patient to express emotions and feelings. |
When patients vent and talk about their feelings, they can be in a better state of mind to move forward. |
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Consult physical and occupational therapists |
Physical and occupational therapy will help the patient recover from the back surgery she had two years ago. |
Nursing Diagnosis 3: Ineffective health maintenance
This is the patient’s inability to identify situations that negatively impact her health to avoid them and seek out help. The problem is evidenced by physical symptoms such as confusion and lack of concentration. Other factors that act as evidence of the existing problem include alcohol dependence and inactivity. The desired outcomes, in this case, include verbal awareness of the impact of substance use on individual health and the current situation, accepting responsibility for one’s behavior, and engaging in therapy.
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Nursing intervention |
Rationale |
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Conveying verbal acceptance and separating the patient from the unacceptable behavior. |
Promotes feelings of acceptance and acknowledgment of behavior. |
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Ascertain the reason for abstinence. |
Offers insight on the need to commit to behavioral change. |
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Discuss the current situation and the role of substance use in the situation. |
Ensures the patient can establish the relationship between her situation in life and her substance use to make the decision to change. |
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Maintain firm expectations and provide positive feedback. |
The patient’s willingness to change, support, and motivation can influence positive outcomes. |
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Encourage the patient to be responsible for her recovery. |
Once the patient prioritizes her health, she will be able to stay away from individuals and situations that fuel her substance use. |
Nursing Diagnosis Outline
