Plan of Care Review 1

Plan of Care Review

Candice Hoffecker
Delaware Technical and Community College
NUR 320
February 19, 2021
Plan of Care Review 2

While collecting my patient's HPI, he identified two health problems which include obstructive

sleep apnea and diverticulitis. During the physical assessment, the patient reported LLQ abdominal pain

7 out of 10. He described the pain as persistent and achy or throbbing. LLQ abdominal tenderness noted

upon palpation. In the care plan, I added risk for infection because if the patient has acute diverticulitis it

is possible that he has or is at risk for infection. Because my patient has not been diagnosed with an

infection, I will continue to monitor for increased temperature, increased pain and encourage an

evidence-based intervention such as a clear liquid diet.

The patient was diagnoses with diverticulosis 3 years ago and remained free of complications

until this current episode of diverticulitis. The patient reported a family history of diverticulosis on the

maternal side of the family including his grandfather and an uncle. The patient's grandfather began

taking a supplement called Slippery Elm. Since starting the supplement, his grandfather has remained

free of diverticulitis. The patient will consult with his GI specialist and primary care physician in the

upcoming visits to see if it’s something he should incorporate into his daily medication regimen. While

proving care for my patient he has remained free in infection and reports pain has decreased. The client

has maintained a clear liquid diet which appears to help decrease pain. The patient has had a weight loss

of 5 pounds. Despite the minor weight loss, the patient maintains a healthy weight. For follow-up care,

the patient was referred to a GI specialist and I gave an online resource for American

Gastroenterological Association. This resource will give the patient up-to-date information about

diverticulosis and diverticulitis and resources and information about symptom management.

The patient also reported a medical diagnosis of obstructive sleep apnea. He explained that he

was often tired in the morning. When I questioned the patient on the frequency of use he reported that

he uses it 50% of the time. According to NCBI, non-compliance with the use of CPAP devices is a

common problem. A study was conducted and showed that after about 10-15 months 15% of patients
Plan of Care Review 3

-abandoned the use of CPAP devices and about 31% had never even commenced use after their

diagnosis. (NCBI, 2008) I identified two issues in my plan of care related to my patient's OSA diagnosis.

The first issue was ineffective breathing pattern because my patient has been diagnosed with this

condition and continued to report feeling tired in the morning. Part of my interventions included

monitoring how the mask fit the patient including assessing for leaks and comfort. Once I knew the mask

fit properly, I continued to monitor oxygen levels and respiratory rate, and patterns every 8 hours at a

minimum.

The main cause for non-compliance with CPAP devices in OSA patients is due to factors such as

sore throat and skin irritation as identified with my patient. One of my interventions included

collaborating with a sleep apnea specialist to identify other options such as the possibility of using a

nose-only mask covering or a skin protectant that could be used to decrease irritation. When my patient

did not meet the goal of 75% or higher CPAP use I reviewed how untreated OSA can affect the body

systems and how heavily affected the heart is if left untreated. Though sleep apnea has not been a

diagnosis in any other family members on the patient's maternal or paternal side, the patient reports

that his father snores badly and also suffers from hypertension so there is a possible link to undiagnosed

sleep apnea.

I have learned the importance of obtaining a thorough family history. I provided better care to

my patient because of the thorough history. Education the patient on the care of these two diseases is

vital for my patient’s health. It also empowers them to provide better self-care management for

themselves.
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Reference

NCBI. (2008, October 15). Long-term compliance with continuous positive airway pressure
in patients with obstructive sleep apnea. https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2679572/