Student: Haley Patterson

Clinical Instructor: K. G

Nursing Care Plan

Initials: JA*

Significant Medical Diagnoses: Seizures, Osteoarthritis, Alzheimer’s Disease, Gastroesophageal

Reflex Disease (GERD) (more related to pharynx than esophagus), Osteoporosis.

Safety Considerations: risk for choking, risk for falls (bone fractures, choking on vomit), risk for

wondering

Activity level and restrictions: Immobile and wheelchair bound, cannot bear weight as muscle

has atrophied, must use a Hoyer lift to transfer to sitting or lying positions, arthritis in hands and

cannot move them limiting activities.

Activities of Daily Living: Bathing, feeding, dressing is fully limited and is entirely dependent

for ADL’s.
Assessment of issue (NANDA Nursing Diagnosis): Impaired swallowing
Assessment Data Planning or Client Nursing Rationale for Evaluation or
Outcomes Interventions or Interventions result of the
Plan intervention
Issue of Short term by the Use thicken up in The resident was Coughing was not
exploration: end of shift: oatmeal, yogurt swallowing juice absent during
Impaired No coughing and ensure as the best, which oatmeal and
swallowing expressed by the those foods caused was thickened to yogurt but reduced
resident during or most swallowing pudding from last shift.
Subjective data: after eating yogurt difficulties, make consistency where The kitchen staff
does not, does not and oatmeal at sure she is sitting as her meals were prepared the
respond to verbal breakfast to at 90 degrees in honey like and oatmeal thicker
comments or decrease the risk her chair, use was choking after which appeared to
questions. of choking. smaller portion swallowing those help as coughing
sizes when foods (Sura, was quite less than
Objective data: Longer term: To feeding, and Madhavan, the shift before.
coughing after receive all providing juice Carnaby & Crary, When coughing
swallowing, nutrients required with thicken up 2012). To prevent began, she was
delayed on the Canadian after each bite. deterioration or patted on the back
swallowing, food Food Guide for Wearing a night tooth pain caused and was told that
refusal, repetitive each day and to guard at night, by bruxism, she’s doing good.
swallowing, make JA feel more having a registered ensuring the right After a coughing,
bruxism only after relaxed and less dietician to help nutrients are being teeth grinding
coughing (appears stressed after JA receive the consumed because began and she was
to be due to coughing. required nutrients the resident lost comforted by
stress). needed for her, her appetite very having her back
and to comfort JA quickly after a few and arms stroked
after an episode of bites and didn’t gently and it
coughing as it can want to eat after appeared to help
be scary and coughing began. as she smiled and
painful. Comforting JA began eating
may reduce her shortly after again.
stress and make
her feel at ease so
she can continue
to eat her breakfast
and receive the
right amount of
nutrients after a
coughing episode
(Sura, Madhavan,
Carnaby & Crary,
2012).
Assessment of issue (NANDA Nursing Diagnosis): Impaired verbal communication
Assessment Data Planning or Client Nursing Rationale for Evaluation or
Outcomes Interventions or Interventions result of the
Plan intervention
Issue of Short term by the To stimulate Introducing music JA responded very
exploration: end of shift: To senses through therapy, and well to physical
Impaired verbal get JO to respond touch (textured massage and/or touch, mostly
communication via non-verbal or blankets), sounds sensory rubbing her back
verbal (music), visual stimulation may and her arm
Subjective data: communication stimulation stimulate her (hands were
does not talk, does through a sensory (paintings, cognitive avoided due to
not respond to stimulus to pictures). Look functioning arthritis). JA
verbal comments exercise her into JA’s history through calming would appear less
or questions and cognition which of past hobbies, the resident down in discomfort
makes little eye appears to be activities she behaviourally and (stopped grinding
contact. impaired. enjoyed, important has shown to have teeth) and would
relationships in a positive fully smile with
Objective data: Longer term: To her life and use therapeutic effect her teeth while
Responsive to achieve them for cognitive which may allow making direct eye
verbal interventions stimulation (ex. her to contact during the
communication relevant to JA’s looking at pictures communicate physical touch.
through some eye life before LTC of her loved ones, more effectively She was also
contact, inability which may allow feeling soil if she of her needs while responsive
to use speech or JA to be enjoyed gardening in the facility verbally to
communicate expressive etc.). (Registered questions and
through body verbally or non- Nurses’ encouraging
language, sullen verbally to Association of comments
facial expressions. communicate her Ontario, 2016). however, language
needs within the was jumbled and
LTC facility. non-
comprehendible.

*Initials have been changed for confidentiality reasons.

References:

Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older
Adults: Assessment and Care (2nd ed.) Toronto, ON: Registered Nurses’ Association of
Ontario.

Sura, L., Madhavan, A., Carnaby, G. and Crary, M.A., 2012. Dysphagia in the elderly:
management and nutritional considerations. Clinical interventions in aging, 7, p.287.