DUCLAYAN, RHOZEN MHYCA BSN 1- N104

CASE STUDY #1:

Mrs. Melai Hontiveros is a 32-year old female admitted in a psychiatric unit with severe
depression secondary to diagnosis of ovarian malignancy. She becomes tearful during
history taking. She is accompanied by her husband and 10-year old child. Her husband
appeared anxious but supportive and attentive. He is working as an accountant in Makati
City. She was diagnosed with ovarian cancer 4 months back and underwent bilateral
salphingo-oopherectomy and hysterectomy 2 months ago. She is undergoing chemotherapy
due its metastatic pattern. For the past 3 weeks she started sitting lonely, decreased ADL,
repeated crying spells, decreased talks, neglects hygiene, muttering to self, decreased sleep
and appetite, neglecting her child care, complains of severe pain in the body. Three days
ago, she attempted suicide by consuming rat poison. Current assessment finding: her
general appearance is a teary eyed young woman, ill-kempt, clinging to her husband
looking perplexed, not talking, poor nutritional intake. When asked about her illness, she
cries inconsolably on repeated asking expressed sadness of mood.
Critical thinking in Nursing Practice
Based on the situation apply the following theories:
1. Nightingale Theory
2. Martha Rogers
3. Jean Watson
4. Faye Glenn Abdellah
5. Virginia Henderson
6. Ida Jean Orlando
7. As a student nurse, use the theory of Patricia Benner
8. Sister Carol Agravante

1. NIGHTINGALE THEORY
A. Nursing the Sick
Assessment:
 Mrs. Melai Hontiveros reduced ADL, had recurrent weeping bouts, reduced talking,
neglected hygiene, mumbled to herself, and reduced She lacks sleep and hunger, neglects
kid care, and complains of acute discomfort in her body.
 Her overall appearance is that of a teary-eyed young woman who is ill-kempt, clutching
to her spouse looking bewildered, not conversing, and eating poorly.
 She attempted suicide by consuming rat poison.
 She was diagnosed with ovarian cancer 4 months
Plan
 I shall encourage the patient to accomplish as much for himself as feasible. If the patient's
depression is severe, she may require additional guidance with everyday tasks. To
promote sleep, practice good sleep hygiene. Initiate a therapeutic connection with the
patient.
 offer a welcoming, judgment-free environment and employ therapeutic communication
techniques like active listening and acknowledgment.
 Examine your physical appearance, including your hygiene, grooming, and posture.
 Encourage the sharing of ideas or concerns through speech, and tolerate expressions of
grief, hatred, and rejection. Normal acknowledgment of these sentiments
 Spend some time hearing sadness, suicidal ideas, and low self-worth expressed in words.
 Encourage loved ones to show their concern, hope, and affection for the sufferer.

B. The Physical Setting

1. Assessment of the home, neighborhood and place of employment
 Mrs. Melai neglects personal hygiene, thus in my capacity as a nurse, I will
implement the 13 cannons of Nightingale, which is personal hygiene. I will
also encourage her to take a bath and assist in a caring manner.
 Because she tried suicide by ingesting rat poison, I'll make sure the client
consumes meals and beverages that are safe.
 Mrs. Melai began to sit alone, decreased her activities of daily living, had
frequent fits of crying, decreased conversation, neglected hygiene, muttered to
herself, lost her appetite and sleep, neglected her child's care, and complained
of severe body pain. In light of her situation, I will apply Nightingale's 13
Canons, Chattering Hope, and Advice, in which I will give her advice based
on facts rather than my opinion and speak to her as a person in a
compassionate manner.

C. Environmental Psychological
 She is concerned for her family if they undergo the same trauma she did.
 By modifying the patient's behavior and/or the surroundings, you can reestablish a
suitable schedule of positive reinforcement for the individual.
D. Nutrition Plan
 Remind her that milk is a rich source of vitamin D and to drink lots of water.
Depression may occasionally result from having very low amounts of this vitamin
in your body.
  Encourage her to eat nutritious, whole foods like fruits and vegetables.

2. MARTHA ROGERS
Nursing Care of Mrs. Melai Hontiveros with Rogers’ Model
 With Rogerian model, the process of caring Mrs. Melai Hontiveros begins with pattern
appraisal.
 Nursing care involves pattern appraisal, mutual patterning and evaluation.
Pattern Appraisal
 This visible rhythmical pattern is a manifestation of evolution towards dissonance
 Mrs. Hontiveros has pattern manifestation of dissonance… depression with suicidal
ideation, ovarian malignancy and pain.
 She has low educational background – elementary graduate.
 A pattern activity of health is noted through reports of a positive operative course.
 Patterning has to be directed towards reduction in perceived dissonance with her personal
and environmental field.
 Pain is a manifestation of fear… links her illness to her personal belief of being punished
for her past sins.
 Appraisal is needed in her sleep patterns, nutrition and her perception of self.
 Appraisal can be grouped into exchanging patterns, communication patters and relating
patterns.
 Time between nurse and Mrs. Hontiveros is needed to foster her healing.
 During the process, the nurse must rely on her personal institution and insight regarding
the emerging pattern.
 All these patterns form the unitary pattern of Mrs. Hontiveros.

Mutual Patterning
 The process is mutual between the nurse and Mrs. Hontiveros.
 The surgery performed, the medications she is receiving are patterning modalities.
 Patterning activities planned by the nurse for the patient… therapeutic, touch,humor and
imagery.
 The patient needs to be assessed fully regarding her ability to understand and agree with
different patterning modalities.
  Therapeutic touch can be introduced to the patient.
 Touch is introduced and incorporated into the management of pain, helps in energy
transmission for healing and helps in developing trust in the nurse.
 Teach her how to center the energy and channel her energy to the area of pain.
 Use humor for increasing socialization and developing self-confidence and developing
worthiness.
 Human environmental patterning needs to involve the other individuals who shareher
environment including husband and son.
 Options are introduced relating to increase communication and hygiene patterns.
 The entire family is involved to power as knowing participants in charge.

Evaluation
 The evaluation process centers on perceptions of dissonance that exist after the mutual
pattern activities.
 The appraisal process is repeated.
 Manifestations of worry, pain, fear, sadness of mood have to be appraised with family
members
 A summary of the dissonance and/or harmony that is perceived is then shared with Mrs.
Hontiveros and mutual patterning is modified or instituted and indicated based on the
evaluation.

3. Jean Watson
 Mrs. Melai Hontiveros is a 32-year-old female confined to a psychiatric
facility with significant depression as a result of an ovarian cancer
diagnosis. According to Jean Watson's belief, love and care will be shown
while nursing the patient. I will establish a helping-trust connection with
others that includes congruence, empathy, non-possessive warmth, and
sickness. This caring component will assist both the nurse and the person
being breastfed in accepting both the expression of negative and positive
sentiments.

4. Faye Glenn Abdellah

Classification of Selected Abdellah Selected Nsg. Criterion measure
needs Nsg. Problem Implement action
Basic care need To maintain - Measures required -Short-term goal
appropriate hygiene to maintain
and physical comfort; cleanliness, physical - The client was able
to promote optimal comfort, and activity to articulate
health via healthy Preparedness and healthcare practice
activities such as sleep, as well as and select alternate
exercise, rest, and safety and body actions to conduct
sleep; to promote mechanics. ADLS after 1 hour of
safety through the adequate nursing
prevention of health -Monitor for suicidal interventions.
hazards such as risk.
accidents, injuries, or -GOAL MET
other trauma; and to
prevent the spread of
infection.

Sustenal care needs Recognize the body's

psychological -After two weeks of
reactions to illness Assess the client for nursing care, the
situations. and point out reasons client can
for living communicate a
positive idea of sleep
and understand her
own personal
strengths and
Remedial care needs limitations.
recognizing and
accepting good and Provide comfort.
negative expressions, -Develop and
feelings, and Spend time with the implement affective
reactions customer one on one. methods for
Use empathy; strive decreasing depression
to comprehend what
a client is saying and
transmit your
comprehension to the
client.
Restorative need
To use community Provide information
resources to assist in based on the
the resolution of requirements of the After 2 days of
challenges caused by patient. Do not nursing interventions,
disease. overburden the the client was able to;
 patient.
Verbalize accurate
knowledge condition
of understanding of
treatment regimen.

5. Virginia Henderson
 Breath normally. In addition to treatment, the individual can aim to minimize depression
by learning to adopt relaxing breathing methods, brief meditations, and positive mantras,"
Manly adds. "These tools can be used to relax the mind and body by encouraging self-
soothing and self-control."
 Consume plenty of food and liquids. Carbohydrates have been shown to increase
serotonin levels in the brain, which has a calming effect. Consume complex
carbohydrates such whole grains including oats, quinoa, whole-grain breads, and whole-
grain cereals. Water has been demonstrated to have inherent calming benefits, most likely
as a result of combating the effects of dehydration on the body and brain.
 Eliminate body waste. In general, you should seek assistance if a problem is interfering
with your ability to operate. If you find it difficult to exercise cleanliness even when you
know you should, or if you believe you wash yourself excessively, you may want
assistance. Therapy is an excellent place to begin.
 Communicate and learn. A forceful communication style, on the other hand, has several
advantages. It can, for example, help you relate to people more authentically, with less
worry and animosity. It also increases your sense of control over your life and decreases
emotions of powerlessness. Furthermore, it grants OTHERS the freedom to live their life.
 Sleep and rest. Deep sleep has repaired the prefrontal system of the brain, which governs
our emotions, decreasing emotional and physiological reactivity and preventing
depression from worsening. Getting enough sleep and taking frequent breaks may have a
huge impact on our mental and physical health. Sleep improves our immune system, our
emotional resilience, and our ability to deal with worry. It also helps us feel better and
make better judgments.
6. Ida Jean Orlando
Assessment:
 Severe sadness is evident in the young woman's watery eyes, unkempt appearance,
clinging to her spouse while seeming bewildered, lack of speech, and bad dietary habits.
Diagnosis:
 Feelings of sadness, tearfulness, emptiness, or hopelessness
Planning:
 to gauge the severity of depression
  to help the client recognize their emotions and start addressing issues.
 to encourage health (teachings)
Implementation:
 Encourage the patient to recognize and express emotions, such as by laughing or
swearing or sobbing (for despair) or laughing (for fear or denial) (fear, anger). Recognize
your anxiety or despair. Don't lie to the patient or tell them everything will be OK. Give
precise details regarding the circumstance. aids customers in recognizing what is
grounded in truth. Ensure that you are available to the client for listening and speaking so
that you can help the patient understand that her spouse needs to work to provide for their
needs, particularly for her medications. As depression lessens, gradually step up your
social engagement. She should be made aware of her sickness, and you should tell her to
get a lot of sleep, eat healthily, keep a healthy weight, and ask for help from family and
friends when you're struggling.
Evaluation:
 After the nurse had examined her, Mrs. Melai felt at rest. After disclosing the source of
her sadness and learning how to avoid it, the patient can now get enough rest and eat to
maintain her healing weight. By following the treatment plan for her patient, the nurse
assessed the effectiveness of the nuns' assistance.

7. As a student nurse, use the theory of Patricia Benner

Domain: The helping role
 I shall check the symptoms and lab results of her ovarian function as the appointed nurse.
and I'll speak slowly in an effort to elicit her sentiments of worry from the tone of their
voices.
Domain: The diagnostic and monitoring function
 increasing their knowledge of Mrs. Melai Hantiveros' ailment (ovarian cancer) and
improving their capacity to judge her prospective state of health and response to various
treatments.
Domain: Administering and Monitoring Therapeutic Interventions and Regimens
 I should take her daughter and suggest that she speak to her mother in order to normalize
the situation as much as possible.
 Nutritional assistance was critical to her health, and especially to her healing.
Domain: Teaching-Coaching function
  I will advise her husband to be patient with his wife and to provide her regular updates on
her illness and her family in order to maximize her involvement in treatment.
8. Sister Carol Agravante
 The CASAGRA Transformative Leadership Model acknowledges that a person's
spirituality is essential to their psychological well-being. Mrs. Melai Hontiveros, a 32-
year-old woman committed to a mental hospital with acute depression brought on by her
diagnosis of ovarian cancer. As a student nurse, I will help the patient become thankful
by using the CASAGRA Transformative Leadership Model. I will carefully discuss with
the patient what is most important to us as humans. "You are you; don't worry about what
others may think of you."