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INTRODUCTION The history of professional nursing begins with Florence nightingale. She envisioned nurses as a body of educated women, when women were neither educated nor employed in the public services. Later in last century nursing began with a strong emphasis on practice. Following that came the curriculum era which addressed the questions about what the nursing students should study in order to achieve the required standard of nursing. As more and more nurses began to pursue higher degrees in nursing, there emerged the research era. Later graduate education and masters education was given much importance. The application of the theory to provide a nursing care is given much of importance. Many a nursing schools and colleges have developed their curriculum based on a theory and so only the students apply the theory in the patient care. As a part of my advanced nursing practice ,I have selected one patient for providing care based on the Orem’s Self Care Theory. The main objectives of this process were:  to assess the patient condition by the various methods explained by the nursing theory  to identify the needs of the patient  to demonstrate an effective communication and interaction with the patient.  to select a theory for the application according to the need of the patient  to apply the theory to solve the identified problems of the patient  to evaluate the extent to which the process was fruitful.

Demographic data  Name  Age  Sex  Education  Occupation  Marital status  Religion  War d  Hospital No.  Address

Mr. Basavaraj B.K 60 years Male 8th standard Coolie Married Hindu Casuality 02111033 Nelavagilu Kumarapatanam P.O Rannebennur T.Q Haveri(dist) Type 2 D.M ,Meningo-encephalitis


Presenting history of Client brought to the hospital with complaint of body pain ,fever, disorientation, and decreased food illness Presenting signs and intake on 16/1/2011. Patient has urine output is symptoms reduced and blood glucose level is 211mg/dl. Catheter and ryle’s tube is inserted. 40% of oxygen administration given and antibiotics started .To correct blood sugar 40 units of Human Actrapid 40 ml of Normal Saline is infused at rate of 1ml/hr as per GRBS.On 18.1.2011. patient became restless, non verbalizing and unconscious. So patient is intubated and connected to ventilator on SIMV mode due to desaturation.Patient is also having renal failure now and RFT values are elevated.So they are planning to do dialysis.

Past health history

He had past history of DM and was on OHA for past 20 years. His family is a joint family .He is living with his son.

Family history

Socio-economic status

Poor economic status. He is the earning member of the family. He was taking a mixed diet.. He had bad habbits of chewing tobacco.But stopped 1 year back. Married.

Personal history

Marital/ sexual history

Physical Examination Region Remarks

General Unconscious,moderately built ,now inadequate nutrition. appearanc e Skin Skin has the changes as in normal old age, with slight loss of elasticity. Mild edema present over ankle region. Eyes Hearing Neck & Throat Mouth Pupil reaction is normal. Pallor of conjunctiva is noted. No signs of infection. Ears are normal without any discharge. No nodules or ulcers palpated over the pinna. Mild distension of neck veins present. Normal thyroid glands. Tonsils are normal with no signs of inflammation.ET tube present. Oral hygiene is maintained. Slight coating of the tongue present. Discolouration of the tooth present, no loss of tooth. Dental caries present. Respiratory Rate: 20 breath per minute. Symmetrical chest expansion. Crackles present. S1 and S2 heard normally. No murmurs or other abnormal heart sounds heard. Peripheral pulses were feeble. No varicosities present. Peripheral pulses are feebly palpable. Mild pallor present. Abdomen is distended , hepatomegaly present. Bowel sounds are sluggish. He is unconscious .Some involuntary movement o extremities poresent.No fracture or joint abnormality present.

Respiratio n Heart Sounds Vascular System Abdomen Musculos keletal

Whenever there is an inadequacy of any of these self care requisite. The self care agency is the acquired ability to perform the self care and this will be affected by the basic conditioning factors such as age. Orem. Therapeutic self-care demand is the totality of the self care measures required. the nurse has to select required nursing systems to provide care: wholly compensatory. health care system. theory of self care.System Reflexes: Genitourinary system All the deep tendon reflexes and superficial reflexes were poor. partly compensatory or supportive and educative system. the person will be in need of self care or will have a deficit in self care. gender. developmental and health deviation self care requisites. She received her Bachelor’s and Masters of sciences in nursing education in 1939 and 1945 consecutively. Application of Orem’s theory of Self care deficit The theory of self care deficit was proposed by Dorothea. She was born in Maryland in 1914. There are mainly 3 types of self care requisites such as universal. family system etc. she explains self care as the activities carried out by the individual to maintain their own health. . Once the need is identified. The self care is carried out to fulfill the self-care requisites. In the theory of self care. urine output is less.e. the nursing activities and the use of the nursing systems are to be evaluated to get an idea about whether the mutually planned goals are met or not. theory of self care deficit and the theory of nursing systems.E. Once the care is provided. The self care deficit theory proposed by her is a combination of three theories. Bladder is catheterized. i. No urinary infection. The care will be provided according to the degree of deficit the patient is presenting with. Thus the theory could be successfully applied into the nursing practice. The deficit is identified by the nurse through the thorough assessment of the patient. She completed her basic nursing education from Washington in 1930s.

In case of Mr.  Environment Rural area. not sedentary living.  Health care system  Family system  Patterns of living Institutional health care Married. .Now on ventilator due to unconsciousness and desaturation.  Development state  Socio cultural issues Adult male He had formal education till 8th std and was working as a coolie worker. Living with family members. BASIC CONDITIONING FACTORS:  Age  Gender  Health status 60 yrs male Meningoencephalites . Thus. Basavaraj with Meningoencephalites and on ventilator is not able to do the ADL by himself. Theory of self-care deficit was applied to this patient to provide a comprehensive need based care to the patient. the nursing system is wholly compensated. The application and evaluation of the theory is as follows.  Resources UNIVERSAL SELFCARE REQUISITES: He is the bread winner of the family. Joint family with wife and son.

vitamins and minerals to protect from bacterial infection and to promote easy recovery.Sugar is restricted as he is diabetic. His 24 hrs urine output 350ml . calories . Patient is on I. Patient is also restrained to prevent the accidental self injuries and removal of tubings. fluids .V.toileting.  Promotion of human functioning DEVELOPEMENTAL SELFCARE REQUISITES: Maintenance of Not able to feed self and performing the mouth care . Patient is connected to mechanical ventilator on SIMV mode. bathing and other self care .  Elimination  Activity/rest  Social interaction No social interaction. Reassured the client relatives that they should carry out their role or function and meet ADL of patient and support the patient to return to his normal level of living. The diet was mainly fluid diet rich in protein. Air  Water No spontaneous breathing.NS and DNS. His daily living activities were restricted since patient is unconscious and on mechanical ventilator.  Food Ryle’s tube feeding. Chest physio and limb & ROM exercises done.  Prevention hazards Side rails of the cot are raised to protect from of hazards.

Patient relatives seek medical facilities when they feel he is disoriented. Modification of self image to incorporates changes in health status Finding difficulty in adjusting with the patient’s Adjustment of lifestyle illness and hospitalization and role changes in to accommodate family. regimen They cooperate with the medication. food intake & Prevention/management activities are decreased and his temperature is of the conditions threatening the normal increased. the regimen Relatives have adapted to the illness and inability of patient to carry out daily living activities . Not aware about the side effects of the Awareness of potential problem associated with medications and complications of disease process. development HEALTH DEVIATION SELF CARE REQUISITES Patient relatives report the problems to the Adherence to medical physician when in the hospital and sometimes neglects and try to manage the problem by self. Not much aware about the use and side effects of medicines. Not aware about the actual disease process. changes in the health status and medical regimen MEDICAL PROBLEM AND PLAN .developmental environment activities.

6-1. Doxy 100mg BD Inj. Dalacin 600mg IV TID Neb. With Asthalin QID Inj. Type 2 Diabetes Mellitus. Medical Treatment: Medication . He is getting the following medications: Inj.35)(elevated) S.Creatinine – 2. Dopamine @ 5ml/hr IV Infusion IVF.6)(elevated) Sodium – 135mEq/l(135-145) Potassium – 5.5)(elevated) Medical Diagnosis: Meningoencephalites. Rezat 120mg IV OD Inj. AREAS AND PRIORITY ACCORDING TO OREM’S THEORY OF SELF-CARE DEFICIT: IMPORTANT FOR PRIORITIZING THE NURSING DIAGNOSIS.8 mg/dl(0. Investigations: RBS – 211 mg/dl(60-150) (elevated) BUN – 135 mg/dl(8.Physician’s perspective of the condition: Diagnosed with Meningoencephalites.7 mEq/l (3. Monocef 2g IV BD Inj. Pyogenic meningitis. Air Water Food Elimination Activity/ Rest Solitude/ Interaction Prevention of hazards Promotion of normal function Maintain a developmental environment.ventilator support. respiratory therapy and physiotherapy. Pyogenic meningitis.5.DNS/NS with Optineuron @ 75ml/hr IVF. . Ampicillin 2gm IV BD Tab. 40ml NS with 40units of Human Actrapid infusion @1ml/hr as per GRBS .4. Pan 40mg IV OD Inj. Type 2 Diabetes Mellitus.Now he is on ventillator due to unconsciousness & desaturation.

bathing. role changes and uncertain future.Ineffective airway clearance related to inability to raise secretions as evidenced by diminished breath sounds and cough reflex. Altered body temperature. Thus in the patient Mr. 7. 4. Adjust life style to accommodate health status changes and medical regimen Problems identified and prioritized nursing diagnosis: 1. Hyperthermia related to infectious process.Fluid volume excess related to reduced renal function and decreased urine output. grooming etc related to altered level of consciousness secondary to brain infection 6.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 and medical regimen. Imbalanced nutrition less than body requirement related to inability to take food secondary to loss of consciousness. 5. Adherence to the medical regimen Awareness of potential problem. Self-care deficit eating. Anxiety (family members) related to abrupt change in health status of family member. 2. hospital environment. . Impaired physical mobility related to loss of consciousness. 3. Basavaraj the areas that need assistance were… Air Water Food Elimination Activity/ Rest Prevention of hazards Promotion of normalcy Maintenance of health status Awareness and management of the disease process.

Wholly compensatory and supportive – educative nursing system  Assess for the patency of airway.8. Risk for complications increased ICP related to increase in body temperature and cerebral metabolic demands. The patient will maintain normal airway clearance as evidenced by ease of breathing and ability to bring out secretions.  Auscultate breath sounds noting the areas of decreased ventilation and presence of The patient is maintaining clear airway as evidenced by normal respiratory rate 20/mtand SpO2 95% and absence of .Risk for impaired skin integrity related to immobility and prolonged bed rest secondary to unconsciousness NURSING PROCESS ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT NURSING DIAGNOSIS (diagnostic prescription) OUTCOMES AND PLAN (Prescriptive operations) IMPLEMENTATION (Control operations) EVALUATION. (Regulatory operations) THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: Air ADEQUACY OF SELF CARE AGENCY: Inadequate 1. 10.Deficient knowledge (family members) about the disease process. Ineffective airway clearance related to inability raise secretions as evidenced by diminished breath sounds and cough reflex. its management and complications. 9.

Provide nebulisation with duolin respules. Maintain humidification of the oxygen. volume as evidenced by output in proportion with the input.  Assess for fluid excess by checking intake – output chart.  Check for jugular vein distension and orbital edema.Fluid volume Patient will excess.BP and for edema. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: Water ADEQUACY OF SELF CARE AGENCY: Inadequate 2. Place the patient in a slightly head end up position.  Maintain hourly Patient’s urine output is less when compared to intake. Provide chest physiotherapy and postural drainage.hypervolemia related maintain to reduced renal function normal fluid and decreased urine output . breath sounds .     adventitious secretions. Remove secretions by suctioning to clear airway. .Output is 350ml/day.

8F from 101.  Administer antipyretics as per physician’s order. temperature as evidenced by absence of infection.intake output chart.  Increase fluids to replace fluids lost through increased metabolism and diaphoresis as per intake –output chart.creatinine levels.  Provide well ventilated room.2 F .  Administer antibiotics as per Patient’s fever has decreased to 98. Patient Hyperthermia related to maintain normal body infectious process.  Administer diuretics as per doctors order.  Routinely check BUN and S. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: Promotion of normal function ADEQUACY OF SELF CAREAGENCY:Inadequate will 3.  Assess the vital signs every second hourly.  Apply tepid sponging.Altered body temperature.

 Monitor fluids administered through I. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: Food ADEQUACY OF SELF CAREAGENCY:Inadequate 4.  Remove secretions by suctioning .V route and Ryles tube and calculate daily caloric intake to determine adequacy of caloric intake. and postural drainage to prevent infections. Imbalanced nutrition less than body requirement related to inability to take food secondary to loss of consciousness. The patient will maintain normal nutritional status as evidenced by adequate intake of food and normal intake and output chart  Assess the patients nutritional status.  Select nutritional Patient’s nutritional status inadequate evidenced inability take food self as patient is ventilator.chest physiotherapy.order.  Provide catheter care. is as by to by the on .  Maintain aseptic precaution while giving suctioning and during other procedure.

hair care). THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: Activity ADEQUACY OF SELF CAREAGENCY:Inadequate 5. bathing. related to altered level of consciousness secondary to brain infection. easily digestable fluid diet.supplements to provide additional calories. The patient will achieve self care activities within normal limit as evidenced by normal level of consciousness and ability to perform ADL’s. The patient is unable to perform self care activities and he is still on ventilator.  Educate the patient family about prescribed diet that will maintain nutrition.  Meet patient’s activities of daily living such as(giving sponge bath. iron. mouth care. protein. grooming etc. and fluids. .  Provide small and frequent.  Assess the patient’s level of consciousness and ability to perform the activities of daily living.toileting. Self-care deficit eating.  Maintain intake and output chart.

The application of this theory revealed how well the wholly compensatory and supportive and educative system could be used for solving the problems of unconscious patients who are on ventilator.Basavaraj from various aspects. Evaluation of the Application of Self Care Deficit Theory The theory of self care deficit when applied. Patient was unconscious and family members were very cooperative.  Change the position every second hourly and give back care and massage.  Encourage family members to assist in meeting patient’s self care activities.. . This was helpful to provide care in a comprehensive manner. could identify the self care requisites of Mr.  Meet the patient’s nutritional needs by giving food through ryle’s tube.

THEORY APPLICATION INTRODUCTION SYSTEM MODEL. the client system has propensity to seek or maintain a balance among the various factors. The client may be an individual. and /or prescribing.a community or an aggregate. out put and feed back constitute adynamic organizational pattern. the internal conditions of regulation become more complex. a family.The system may adjust to the environment to itself.BETTY NEUMAN A theory is a group of related concepts that propose action that guide practice. MAJOR CONCEPTS . As an open system the client. The Neuman’s system model has two major components i. both with in and out side the system. relationships. and assumptions or propositions derived from nursing models or from other disciplines and project a purposive. Neuman seeks these forces as stressors and views them as capable of having either positive or negative effects. In the development towards growth and development open system continuously become more differentiated and elaborate or complex.e. stress and reaction to stress. The ideal is to achieve optimalstability. a group. The client in the Neuman’s system model is viewed as an open system in which repeated cycles of input. As they become more complex. definitions. Reaction to the stressors may be possible or actual with identifiable responses and symptom. that seek to disrupt it. systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing.2. predicting. explaining. both the client and the environment may be affected either positively or negatively by the other. A nursing theory is a set of concepts. Exchange with the environment are reciprocal. process.

The flexible line of defense is dynamic and can be changed/altered in a relatively short period of time. the line of resistance. and social/cultural expectations and activities. It is considered to be the usual level of stability in the system. The person's system is an open system and therefore is dynamic and constantly changing and evolving. PERSON VARIABLES Each layer.refers of the physicochemical structure and function of the body.I. Sociocultural . and the strengths and weaknesses of the system parts. These factors include: system variables.refers to relationships. occurs when the amount of energy that is available exceeds that being used by the system. output. or concentric circle. Psychological . and compensation.refers to those processes related to development over the lifespan. Stability. 1996). If the flexible line of defense fails to provide adequate protection to the normal line of defense. the lines of resistance become activated. body temperature regulation ability. Examples of these may include: hair color. 1995. 5. 2. II. functioning of body systems homeostatically. Ideally. 3. or central core. The flexible line of defense acts as a cushion and is described as accordion-like as it expands away from or contracts closer to the normal line of defense. and value systems. Physiological . NORMAL LINE OF DEFENSE The normal line of defense represents system stability over time. in George. is made up of the basic survival factors that are common to the species (Neuman. IV. of the Neuman model is made up of the five person variables. and the core structure. each of the person variables should be considered simultaneously and comprehensively. 4. CENTRAL CORE The basic structure. FLEXIBLE LINES OF DEFENSE The flexible line of defense is the outer barrier or cushion to the normal line of defense. A homeostatic body system is constantly in a dynamic process of input.refers to mental processes and emotions. The normal line of . Spiritual . which leads to a state of balance. genetic features. cognitive ability. 1. or homeostasis. Developmental .refers to the influence of spiritual beliefs. III. feedback. physical strength.

occur between individuals. STRESSORS The Neuman Systems Model looks at the impact of stressors on health and addresses stress and the reduction of stress (in the form of stressors). LINES OF RESISTANCE The lines of resistance protect the basic structure and become activated whenenvironmental stressors invade the normal line of defense. the system can reconstitute and if the lines of resistance are not effective. the resulting energy loss can result in death. job or finance pressures The person has a certain degree of reaction to any given stressor at any given time. VI. prevention is the primary nursing intervention. By means of primary. Stressors are capable of having either a positive or negative effect on the client system.g. role expectations Extra personal . VII. Reconstitution may expand the normal line of defense beyond its previous level. An example is skin. e. RECONSTITUTION Reconstitution is the increase in energy that occurs in relation to the degree of reaction to the stressor. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. If the lines of resistanceare effective. . secondary and tertiary interventions. V. A stressor is any environmental force which can potentially affect the stability of the system: they may be: Intrapersonal . Example: activation ofthe immune response after invasion of microorganisms.g. VIII. or return it to the level that existed before the illness.occur within person.defense can change over time in response to coping or responding to the environment. emotions and feelings Interpersonal . the person (or the nurse) attempts to restore or maintain the stability of the system . The nature of the reaction depends in part on the strength of the lines of resistance and defense. PREVENTION As defined by Neuman's model. e. stabilize the system at a lower level.g.occur outside the individual. e. which is stable and fairly constant. but can thicken into a callus over time. Reconstitution begins at any point following initiation of treatment for invasion of stressors.

Secondary-Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing systems. affecting. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. a family. lines of resistance. Psychological. temperature control. The basic core structure is comprised of survival mechanisms including: organ function. Around the basic core structures are lines of defense and resistance (shown diagrammatically as concentric circles) with the lines of resistance nearer to the core. and being affected by it). Lines of resistance and two lines of defense protect this core. dynamic interaction with the environment. The person. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution. On the one hand. Tertiary -Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Each layer consists of five person variables or subsystems:Physical/Physiological.Spiritual. The person is seen as being in a state of constant change and-as an open system-in reciprocal interaction with the environment (i. or a community in Neuman's model. is seen as being in constant. THE ENVIRONMENT .Primary -Primary prevention occurs before the system reacts to a stressor. Developmental. a group.e. and lines of flexible defense. lines of normal defense. with a core of basic structures. PERSON The person is a layered multidimensional being. consist of the central core. NURSING METAPARADIGM A. and on the other hand manipulates the environment to reduce or weaken stressors. ego. usually represented by concentric circle. The person may in fact be an individual. The layers. and what Neuman terms 'knowns and commonalities'. B. it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors. response patterns. Primary prevention includes health promotion and maintenance of wellness. Socio-cultural. genetic structure.

Nursing Outcomes .considered in relation to five variables. Neuman states that. HEALTH Neuman sees health as being equated with wellness. with the person's position on that continuum being influenced by their interaction with the variables and the stressors they encounter. NURSING Neuman sees nursing as a unique profession that is concerned with all of the variables which influence the response a person might have to a stressor. the state of wellness (and by implication any other state) is in dynamic equilibrium. and the use of primary. The external environment exists outside the client system. The client system moves toward wellness when more energy is available than is needed. and take account of patient's and nurse's perceptions of variance from wellness 3. then not only must the patient/client's perceptions be assessed. families and groups to maintain a maximum level of wellness. D.The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. Neuman envisions a 3-stage nursing process: 1. She defines health/wellness as "the condition in which all parts and subparts (variables) are in harmony with the whole of the client (Neuman. The client system moves toward illness and death when more energy is needed than is available. The role of the nurse is seen in terms of degrees of reaction to stressors.based of necessity in a thorough assessment. 1995)". Neuman proposes a wellness-illness continuum. Nursing Diagnosis .these must be negotiated with the patient.The internal environment exists within the client system. and it is the task of nursing to address the whole person. because the nurse's perception will influence the care given. and . interpersonal and extra personal stressors which can affect the person's normal line of defense and so can affect the stability of the system. but so must those of the caregiver (nurse). 2. and with consideration given to five variables in three stressor areas. As the person is in a constant interaction with the environment. These forces include the intrapersonal. Neuman also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness. C. secondary and tertiary interventions. Neuman defines nursing as actions which assist individuals. through nursing interventions to reduce stressors. The person is seen as a whole. rather than in any kind of steady state. and the primary aim is stability of the patient/client system. Nursing Goals .

Immediate and long range goals are structured in relation to the short term goals.Kenchappa 2. The overall goal of the care giver is to guide the client to conserve energy and to use energy as a force to move beyond the present. . Using system model in the assessment phase of nursing process the nurse focuses on obtaining a comprehensive client data base to determine the existing state of wellness and actual or potential reaction to environmental stressors. Sex – Male 4. If it is not met the goals are reformed.Mr. secondary and tertiary interventions.02066670 5. Nursing diagnosis.achieved through primary.Hospital No. Evaluation – evaluation is the anticipated or prescribed change has occurred. Marital status – married. The nursing diagnostic statement should reflect the entire client condition. Outcome identification and planning.75 years 3.Diagnosis –Scrub Typhus. Implementation – nursing action are based on the synthesis of a comprehensive data base about the client and the theory that are appropriate to the client’s and caregiver’s perception and possibilities for functional competence in the environment. STRESSORS AS PERCEIVED BY CLIENT (Information collected from the patient and his Daughter) Major stress area.the synthesis of data with theory also provides the basis for nursing diagnosis. According to this step the evaluation confirms that the anticipated or prescribed change has occurred. ASSESSMENT PATIENT PROFILE 1.DOA:15/1/11 6. or areas of health concern: .it involves negotiation between the care giver and the client or recipient of care. 6. Age . Name . Thrombocytopaenia and ARF. NURSING PROCESS BASED ON SYSTEM MODEL Assessment: Neuman’s first step of nursing process parallels the assessment and nursing diagnosis of the six phase nursing process.

Psychologically disturbed about his disease condition.  Anticipation of changes in the lifestyle and food habits.  Anticipating about the demands of modified life style. local politics. Patient is been diagnosed to have Scrub typhus.Has a supportive spouse and family .Taking mixed diet. loss of appetite.BA and TB. Past expereiences He has no previous experience of hospitalization with similar disease. Patient is in depressive mood and does not interacting. Living with his son and his family. watching TV. Life style patterns: Patient’s occupation is agriculture. The things going to help himself .  Anticipating the needs of future follow up. decreased urine output. Anticipation of the future:  Concerns about the healthy and speedy recovery.His bladder is catheterised and is giving Ryle’s tube feed. Participates in community group meeting i. Now he is having fatigue and weakness of body. spending time with family members and relatives.He cares for wife and other family members. Accordng to him the present disease condition is much more severe than the previous condition.Patient was suffering from severe fever associated with chills and body ache for the past 8 days. But he was hospitalized after herniorraphy.e. Has habits of smoking and occational drinking. He had history of herniorrhaphy 5 yrs back.HTN. thrombocytopaenia and ARF. He has no history of any disease like DM . So he is psychologically depressed. Spends leisure time by reading news paper. Patient is disturbed by the thoughts that he became a burden to his children with so many serious illnesses which made them to stay with him at hospital.anticipating it as a life threatening condition. nausea and vomiting.

Major stress areas:     Altered body temperature .  He sees the health care providers as a source of information. Fatigue.e.e. .He tries to consider them as a significant members who can help to overcome the stress  He seeks both psychological and physical support from the care givers. Nausea and vomiting .e. Decreased urine ouput. Talking to his friends and relatives while they come to visit him. planning about the activities to be resume after discharge.  Anticipatory anxiety concerning the restrictions of diet and the life style modifications which are to be followed. diverts the attentions from the pain or difficulties and try to eliminate the disturbing thoughts about the disease and hospitalization and trying to accept the reality etc. going to the temple . Hospitalization .  He sees the family members as helping hands and feels relaxed when they are with him. spending time with grand children.  Involve the patient also in taking decisions about his own care. treatment.  He sets his major goal i.Present circumstances differing from the usual pattern of living.Decreased appetite.  Anxiety regarding ryle’s tube feeding and catheterisation of bladder. follow up etc. STRESSORS AS PERCEIVED BY THE CARE GIVER.  Anticipatory anxiety concerns the recovery and prognosis of the disease negative thoughts that he has become a burden to his children.  Family members will help him to meet his own personal needs as much as possible.  He is trying to clarify his own doubts in an attempt to eliminate doubts and to instill hope.Fever. a healthy and speedy recovery. The things expected of others  Family members visiting the patient and spending some time with him will help to a great extent to relieve his tension. return back to the social interactions etc.  Instillation of positive thoughts i.  Avoiding the negative thoughts i. friends and family members.  Convey a warm and accepting behaviour towards him.

 He sets his major goal i.e. P – 100/mt .  He has the plans to go back home and to resume the activities which he was doing prior to the hospitalization. He sees the health care providers as a source pf information. a healthy and speedy recovery. He tries to consider them as a significant members who can help to over come the stress  He seeks both psychological and physical support from the care givers. The things the client can do to help himself  Patient is using his own coping strategies to adjust to the situations. So patient is psychologically depressed. Future anticipations  Client is capable of handling the situation.102F. But he was hospitalized after appendicectomy and herniorraphy  Client perceived that the present disease condition is much more severe than the previous condition. friends and family members  He sees the family members as helping hands and feels relaxed when they are with him.will need support and encouragement to do so. Evaluation/ summary of impressions There is no apparent discrepancies identified between patients perception and the care givers perceptions. friends and caregivers. INTRAPERSONAL FACTORS Physical examination : Vital Signs T.  He is trying to clarify his own doubts in an attempt to eliminate doubts and to instill hope.  He also planned in his mind about the future follow up . R – 30/mt. BP.  Client's expectations of family.120/80 mm of Hg.Clients past experience with the similar situations  He has no previous experience of hospitalization with similar disease. .

Chest: Respiratory system: . now the nutrition is inadequate due to illness. Ears :  Pinna: no abnormalities and is in straight line with the outer canthus of the eyes.General Appearance Patient is conscious and oriented. Range of motion: Normal .moderately build . Mouth: Tongue: Normal Tooth : Dental carries present. Neck: Trachea is in position. No thyroid gland or lymph node enlargement. No polyps or obstruction present.  No wax collection or ear discharge  Hearing acuity: normal             Nose: No nasal deviation No nasal discharges.       Eyes: Eye lashes: equally distributed Eye lids: no styes or blepheritis Conjunctiva: pale Sclera: white in color Pupils: equally reacting to light No squint or strabismus present. Ryle’s tube present. Gum: No gum bleeding or gingivitis present Uvula: in midline Throat and Neck: Throat: No swallowing difficulty or tonsillitis Neck stiffness present. Head and face:  Hairs are normally distributed  Face is bilaterally symmetrical.

     Gastrointestinal system: Inspection : Normal Auscultation: Sluggish bowel sounds.Patient is taking mixed diet.It is been told that he has taken the immunizations at the specific periods itself .  Range of motion: normal. decreased appetite. Palpation : soft to touch . Palpation: No palpable mass present . 2. Percussion :Normal.  Genitourinary system:  Bladder is catheterised. urine output is less compared to intake.  Diet and nutrition.  Habits. Cardiovascular system:  Heart rate: 100 beat per minute  Heart sounds: Normal. nausea and vomiting . Appetite is decreased .  No sluttering or other speech problems. Neurological system:  Alert.  Sleep – He told that sleep is reduced because of the pain and other difficulties.  Reflexes are normal.    Respiratory rate: 30 breaths per minute. Musculoskeletal system  There are no congenital deformities. . but the food intake is less when compared to previous food intake because of fever . Usually he takes food three times a day. conscious and oriented.patient does not have the habit of drinking or smoking.he has nausea and vomiting.  No haematuria present. Percussion: Normal sounds. Sleep is reduced after the hospitalization because of the noisy environment. no organomegaly.Personal system  Immunizations . no murmurs present. Auscultation: Breath sounds normal.

Developmental factors Patient has his own agricultural fields and now also he is working there. Spiritual belief system Patient is Hindu by religion. They also very supportive to him. travel and transport facilities etc are present at .socio cultural system.  Studied up to 9th standard.Psycho. He believes in god and used to go to temple and also an active member in the religious activities. decreased urine output.  Good and congenial relationship with the neighbors  Has some good and close friend at his place and he actively interact with them. EXTRAPERSONAL FACTORS  All the health care facilities are present at his place  All communication facilities.He told that he could manage the house hold activities very well. Bladder is catheterised and ryle. 3. Other complaints .  Good interpersonal relationship with wife and the children.  Active in the agricultural works and household activities at home .  God social interaction with others. INTERPERSONAL FACTORS  Has supportive family and friends. He has a good social support system present which helps him to keep his mind active.Patient has the complaints of body pain . 5.  Married and has 4 children(2sons and 2 daughters)  Congenial home environment and good relationship with wife and children  Is active in the social activities at his native place and also actively involves in the religious activities too. loss of appetite.s tube feeding is giving.  Good social support system is present.  Active in the religious activities.  Good social adjustment present. He was very active and once he go back also he will resume the activities. 4.  Good social support system is present from the family as well as from the Neighbourhood.  Anxious about his condition  Depressive mood  Patient’s occupation is agriculture and he is Hindu by religion. fatigue and weakness of body. nausea and vomiting.

Anxiety related to abrupt change in health status and hospitalization. 6.his own place. 7. Activity intolerance related to fatigue and weakness of body.  His house at a village which is not much far from the city and the facilities are available at the place.86mm3 (increased) RBS (60-150 mg/dl) .Dolo 650 mg TID IVF DNS @ 60ml/hr with 1 amp.50000 – 4.99.128mg/dl Urea (8-35mg/dl) .7 mg/dl Sodium (130-143 mEq/L) – 141 mEq/L Potassium (3.48 mg/dl (increased) Creatinine (0. Risk for impaired skin integrity related to decreased level of activity and strict bed rest.7gm/dl (decreased) WBC (4000-11000 cells/mm3) . its management and complications. Hyperthermia related to infectious process.6mg/dl) – 1.6-1. Fluid volume excess.1 mEq/L Peripheral smear report – Normocytic normochromic anaemia thrombocyotopaenia.Pan 40 mg IV BD T . 8.00000 cells/mm3) . 3.  Financially they are stable and are able to meet the treatment expenses. eficient knowledge about the disease process. Imbalanced nutrition less than body requirement related loss of appetite. nausea and vomiting. MVI NURSING DIAGNOSIS AND CARE PLAN 1. Investigation Values: Haemoglobin(13-19gm/dl) – 11. Altered body temperature.000 cells/mm3(increased) Platelet (1. with . 2. Risk for complications increased ICP related to increase in body temperature and cerebral metabolic demands. 5. hypervolemia related to reduced renal function and decreased urine output . 4.20. Medications: Inj Monocef 2 gm IV Q12H Inj.000cells/mm3 (decreased) ESR (0-10mm/hr) .5-5 mEq/L) – 4.

CONCLUSION The Neuman’s system model when applied in nursing practice helped in identifying the interpersonal. (3rd ed). 3. Analysis and evaluation of conceptual models of nursing. REFERENCES 1. George JB. secondary and tertiary prevention interventions could be used for solving the problems in the client. intrapersonal and extra personal stressors of Mr. 2. 4.2002. NewJersey : Prentice Hall. Alligood MR.Jacqueline F.p. Nursing Theory: Utilization & Application .Philadelphia: Mosby publications . Philadelphia:FA Davis Company:1995. (3rd ed).). (5th ed).2002. 2002. . Nursing Theories: The Base for Professional Nursing Practice .Kenchappa from various aspects. Alligood M R. Tomey A M. Missouri:Elsevier Mosby Publications. Nursing theorists and their work. (5th ed. Tomey AM. The application of this theory revealed how well the primary. This was helpful to provide care in a comprehensive manner.

 Gave tepid sponge. 99F.Dolo 650 TID).5 gm IV )  Administer fluids through ryle’s tube as per doctor’s order.  Maintained aseptic technique during IV injections.  Give tepid sponge.  Administered antipyretics(T.  Administer antibiotics as advised(inj.  Administer antibiotics as advised.  Diagnosis is meningo encephalitis.  Provided a well ventillated room.  Monitored vital signs Temperature became normal to 2nd hourly. 1. GOAL PLAN OF ACTION IMPLEMENTATION EVALUATION Patient maintains normal body temperature as evidenced by reduction in temperature to normal level .102F  P – 100/mt  R – 30/mt  Body is hot to touch .  Administer antipyretics. . Maintains aseptic technique during IV injections. SECONDARY PREVENTION:  Monitor vital signs. Hyperthermia related to infectious process.Altered body temperature.  Administer fluids through ryle’s tube as per doctor’s order.  Provide a well ventillated room. Pipzo 4. Objective data:  T.CARE PLAN ASSESSMENT DIAGNOSIS Subjective data: Patient says that I am feeling cold.  Patient looked fatigue.

    . SECONDARY PREVENTION:  Assess general condition of the patient  Maintain I/O chart  Check weight daily.  Taught patient regarding importance of maintaining prescribed fluid restriction. Urine output increased to 860ml with intake of 1800ml. TERTIARY PREVENTION Maintain I/O chart. Restrict intake of sodium and potassium.RFT values are not normal.  Watch for signs of fluid overload. 2)Fluid volume excess related to failure of kidneys to produce urine. pulmonary edema. Patient will achieve and maintain balance in fluid volume state as evidenced by normal I/O and RFT values.  Fatigue present.  Restrict intake of sodium and potassium  Teach patient regarding importance of maintaining prescribed fluid restriction. Objective data:  I/O = 2000/780  RFT is elevated  Appetite is decreased.Subjective data:Patient says that now I am passing only small amount of urine. hypertension. pulmonary edema  Administer diuretics.  Watched for signs of fluid overload. Check weight daily.  Maintained I/O chart  Restricted intake of sodium and potassium. hypertension. Teach patient  Assessed general condition of the patient.

 Maintain intake-output chart.s tube feed.  Prevent and treat infections promptly. 150ml Q2H.  Provided IV fluids as per order. SECONDARY PREVENTION:  Check the nutritional status . Patient maintains adequate nutrition as evidenced by absence of nausea and adequate food intake. Objective data:  Appetite is decreased. Nutrition is inadequate as patient is still continuing ryle. decreased fatigue and fever.  Checked the nutritional status .regarding importance of maintaining prescribed fluid restriction.  Watch for signs of fluid overload.  Provide mouth care. hypertension. Subjective data: Patient says that he feels fatigue as not eating anything.Its inadequate.  Give ryle’s tube feed as per doctors order. .Imbalanced nutrition less than body requirement related to nausea.  Avoided situations that stimulate vomiting.  Provide IV fluids as per order.  Avoid situations that stimuiate vomiting.  Gave ryle’s tube feed.  Provided mouth care. vomiting.  Check RFT values intermittently.  Maintained intakeoutput chart .  Nausea and vomiting present. Nausea and vomiting is decreased.  Getting only IV fluids and ryle’s tube 3.

Objective data:  Patient has facial expression of anxiety.  He looked fatigue .  Provided clear information of daily improvement in condition .Anxiety Patient PREVENTION: related to remains  Explain treatment abrupt change free from measures to the patient in health anxiety as and their benefits in a status and evidenced simple understandable hospitalizatio by language.  Provide clear information of daily improvement in condition.  He has fever. n.  Repeated the information whenever necessary to remove fear. verbalisatio  Clarify the doubts of n and facial the patient .  Convey a calm and empathic environment. Verbalised  Explained the treatment measures to reduction in anxiety. expression. Subjective data: Patient asks that whether my condition is improving and when I can start taking food.  Repeat the information whenever necessary to remove fear. SECONDARY 4.  Patient is repeatedly asking questions regarding his condition. the patient and their benefits in a simple understandable language.feed.  Allowed family members to visit the patient and to give .  Conveyed a calm and empathic environment.  He is less attentive to speech.  Clarified the doubts of the patient .

assessed skin turgor  Turned patient every second hour  Provided back care and back massage. 5.  Turn patient every second hour. Skin is intact.  Inspect skin for evidence of skin breakdown.  Having fever. .  Provide back care and back massage.  Give water bed.  Provide adequate nitrition.  Provided wrinkle-free bed. Patient did not develop skin breakdown.  Inadequate assess skin turgor.  Assessed general condition of the patient  Inspected skin for evidence of skin breakdown. Objective data:  Strict bed rest.  Monitored I/O chart. Patient will maintain intact skin as evidenced by absence of bedsores or skin breakdown PRIMARY PREVENTION  Assess general condition of the patient.  Provided ryle’s tube feed 150ml Q2H.  Fatigue present.Risk for impaired skin integrity related to decreased level of activity and strict bed rest.  Make wrinkle-free bed  Monitor I/O chart.