Five patient problems have been identified for P.S. (See care plans – with goals, nursing interventions, and outcome evaluations – for each patient problem in Appendix B.) The five problems identified for P.S. are: (1) ineffective self-health management r/t perceived seriousness and decisional conflicts; (2) imbalanced nutrition, more than body requirement r/t excessive intake in relation to metabolic needs; (3) risk for unstable blood glucose level r/t dietary intake, inadequate blood glucose monitoring, and lack of acceptance of diagnosis; (4) activity intolerance r/t imbalance between oxygen supply/demand and sedentary lifestyle; and (5) deficient knowledge r/t lack of knowledge about ...view middle of the document...
Based on these guidelines, interventions should be selected for P.S. that motivate and support him to: (1) understand the consequences of his behaviors, (2) feel positive about the benefits of changing his behaviors, (3) plan his changes in easy steps over time, (4) plan coping strategies to prevent relapse, (5) make a personal commitment to adopt health-enhancing behavior changes by setting and recording his goals and strategies, and (6) share his behavior change goals with others (Tierney, Hughes, & Hamilton, 2011).
Based on the available diagnostic data it is difficult to predict exactly what the immediate future held for P.S. If his stress test indicated decreased circulation to the heart muscle, a cardiac catheterization may have been performed. If his stress test indicated he was in no immediate danger, I suspect he would be discharged and referred to back to his health care providers in Ohio for follow-up. His physician may consider changing his prescription medications to more effectively control his hypertension and type 2 DM.
P.S. should be encouraged to set specific, attainable goals, but ultimately his behavior is his responsibility. His health care providers should resist the urge to set goals for him or coerce him into accepting goals he did not set for himself to increase the likelihood of compliance.
P.S.’s medical and family history, current health-related behaviors, and the pathophysiology of CAD with the comorbidity of DM indicate it is likely he will continue to suffer from complications of CAD – which over time will lead to cardiac ischemia, myocardial infarction, and eventually his death. Significant modifications of his diet and activity level may slow the disease progression and increase his life expectancy, but statistically his most probable cause of death will eventually be heart disease.
American Heart Association. (2012). Atherosclerosis. Retrieved from:...