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Miss C Plan of Care

Stephanie Charney

Department of Nursing, Delaware Technical Community College

NUR320-602 Health Assessment

Professor Kristen Bell

February 18th, 2024

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Delaware Technical Community College

NUR 320 Health Assessment
RN to BSN program: Plan of Care Chart
STUDENT NAME: Stephanie Charney
DATE: 2/16/24

Nursing plan of care

Identified Identified Plan/ Projected Community Resources/
problem/need: goal or Interventions: Evaluation/ Referrals: (Must be
(include supporting outcome: (Provide rationale/ Outcomes: actual resources from
subjective and objective and cited evidence (How will you the client’s community.
data) to justify the measure that it Include Name, address,
rationale) worked?) web address, and phone
number)

Christiana Care Weight

Management Center
Risk of cardiovascular Stress 501 West 14th Street
Wilmington Hospital
health compromise management: Self-report of Gateway Building, 4th Floor
Maintain regular well-being, Wilmington, DE 19801
302-623-3475
Subjective: Maintain sleep schedule, Follow up lipid
https://christianacare.org/us/en/
Edema, stress, low cardiovascul Therapy, Yoga, panel, Exercise wellness/weight-care-and-manag
exercise tolerance ar health Deep breathing tolerance tests, ement
Objective: Decrease in
Elevated BMI, elevated Weight loss: BMI, physical Cardiology Physicians
cholesterol, family Nutrition plan, assessment of 1 Centurian Drive, Abby Medical
history Exercise program edema Center, Suite 200
Newark, DE 19713
302-366-8600
https://cardiocppa.com/

Mild daily
Dermatitis moisturizer to
minimize eczema
Subjective: flare ups,
Patient report of Alleviate Hypoallergenic
eczema on her hands symptoms soap, Avoid Self-report of Burke Dermatology
and an occasional spot and reduce triggers, symptom 774 Christiana Rd #107, Newark,
DE 19713
on her neck that is itchy, skin Antihistamines for reduction, (302) 230-3376
patchy, and reddened irritation itching, Potential follow up https://burkedermatology.com/
Objective: prescription of assessment of
Visible eczema on corticosteroids if skin health
patient’s hands initial suggestions
do not resolve the
issue
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Miss C Plan of Care

Miss C, a 27-year-old nurse, presents as a seemingly well adult, but a thorough health

assessment reveals underlying concerns. Through psychosocial, physical, and cardiovascular

examinations, she reports eczema on her hands and an occasional itchy, red, patchy area on her

neck. Additionally, her job-related requirements, including frequent use of gloves and hand

sanitizer, exacerbate visible eczema on her hands. Miss C also reports swelling in her legs after

prolonged standing, elevated BMI, high cholesterol, family history of cardiovascular issues, and

subjective experiences of edema, stress, and low exercise tolerance.

Miss C confronts considerable challenges in managing cardiovascular risk factors due to

the demanding nature of her nursing job. Long shifts, rotating schedules, and constant glove and

hand sanitizer use create obstacles for maintaining a regular sleep schedule, attending therapy,

consuming nutritious meals, and engaging in stress-reducing activities. Aware of the importance

of a consistent sleep schedule, Miss C's job demands disrupt her circadian rhythm. Participating

in therapy and incorporating stress-reducing activities is hindered by the unpredictable and

irregular hours required in her nursing profession.

Addressing her cardiovascular risk factors requires recognition of the intricacies imposed

by her occupation. Continuous exposure to gloves and hand sanitizer, alongside variable weather

conditions, complicates the management of her dermatitis. The constraints of her professional

obligations limit her ability to implement a consistent skincare routine and avoid triggers that

may exacerbate her dermatitis.

To enhance Miss C's well-being, interventions must accommodate the unique challenges

posed by her nursing job. This may involve flexible scheduling for therapy, resources for

on-the-go nutritious meals, and exploring alternative stress-reducing activities adaptable to

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unpredictable work hours. Addressing the impact of continuous glove and hand sanitizer use on

her dermatitis requires a personalized skincare plan tailored to her profession's constraints while

aiming to alleviate the effects of the skin condition.

SMART Goals: Cardiovascular Risk Factors

One of the proposed SMART goals for Miss C is focused on stress management. The

objective is for her to engage in daily deep breathing exercises and maintain a regular sleep

schedule. Stress reduction activities, including 10 minutes of deep breathing, will be practiced at

least three times a week. These activities will be incorporated into short breaks during work

shifts, demonstrating the adaptability of the intervention to her rotating schedule (Khan et al.,

2021). The relevance of stress reduction in cardiovascular health is well-established (Rozanski et

al., 2019). Chronic stress contributes to the development and progression of cardiovascular

diseases. The goal is time-bound, requiring consistent implementation over the next 12 weeks,

ensuring a sustained effort to positively impact Miss C's cardiovascular health.

Another vital SMART goal for Miss C involves achieving and maintaining a healthy BMI

through lifestyle modifications. This includes adopting a balanced diet and engaging in regular

exercise, targeting at least 150 minutes per week. Achievability is enhanced through planning

meals ahead, carrying healthy snacks, and incorporating shorter, high-intensity workouts

adaptable to her unpredictable work schedule (Wadden et al., 2020). The relevance of weight

management in cardiovascular health cannot be overstated (Fruh, 2017). Excess weight

contributes to various cardiovascular risk factors, including hypertension and dyslipidemia.

In conclusion, the proposed SMART goals for Miss C, targeting stress management and

weight loss, provide a comprehensive intervention plan to navigate the complexities of her
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cardiovascular risk factors. By addressing these specific aspects, the plan aims to enhance her

overall cardiovascular health. The incorporation of short breaks during work shifts for stress

reduction and adaptable lifestyle modifications for weight loss underscore the practicality and

relevance of these interventions in her unique professional context. The interventions proposed

align with evidence-based practices and guidelines, emphasizing their potential benefits for Miss

C's cardiovascular health.

SMART Goals: Dermatitis Management

The first SMART goal related to dermatitis management focuses on incorporating a daily

moisturizer routine to alleviate eczema symptoms and reduce skin irritation. Miss C aims to

apply a mild, fragrance-free moisturizer to her hands and affected areas at least twice a day,

especially after handwashing. Achievability is enhanced by keeping a travel-sized moisturizer at

work for convenient application during breaks, ensuring consistency in the skincare routine. The

relevance of this goal lies in recognizing the pivotal role of proper moisturization in minimizing

eczema flare-ups and soothing dry, irritated skin (Fornal et al., 2022).

The second SMART goal is centered around identifying and minimizing exposure to

triggers that cause eczema flare-ups. Miss C will maintain a trigger journal to track potential

triggers, regularly measure their impact on her skin condition, and discuss trigger avoidance

strategies with her healthcare provider. This comprehensive approach addresses the relevance of

reducing exposure to triggers for effective dermatitis management (Weidinger et al., 2022). This

goal requires the implementation of trigger avoidance strategies over the next 16 weeks,

emphasizing a longer timeframe due to the dynamic nature of identifying and managing triggers
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(Chiesa Fuxench et al., 2019). A subsequent evaluation of results will provide measurable

insights into the effectiveness of the implemented strategies.

In conclusion, the proposed SMART goals for Miss C in managing dermatitis,

specifically eczema, offer a targeted and practical intervention plan. By emphasizing daily

moisturization and trigger avoidance, the goals aim to alleviate symptoms and reduce the

frequency of flare-ups. The achievability and relevance of these goals are underscored by

incorporating convenient strategies for consistent application of moisturizer and a systematic

approach to identifying and minimizing triggers. These interventions align with evidence-based

practices and guidelines, emphasizing their potential benefits for Miss C's dermatological

well-being.

Cardiovascular Health Management and Evaluation Criteria

In addressing Miss C's cardiovascular health, the intervention plan centers on regular

follow-up appointments and assessments. Monitoring changes in BMI, cholesterol levels, and

stress levels will provide a comprehensive overview. Additionally, the evaluation will extend to

include a thorough examination of improvements in sleep patterns and overall stress reduction.

Miss C will have met her cardiovascular health goals when there is evidence of weight loss, a

demonstrated improvement in stress levels, the achievement of a consistent sleep schedule, and

adherence to stress reduction techniques.

Dermatitis Management and Evaluation Criteria

Turning attention to dermatitis management, evaluation criteria encompass the

assessment of the frequency and severity of eczema flare-ups, alongside the impact of
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interventions on itching and skin irritation. Success in dermatitis management for Miss C will be

evident through a visible reduction in eczema flare-ups and skin irritation. Additionally, her

ability to identify and avoid triggers effectively will signify achievement in dermatitis

management. Regular follow-ups and assessments for both cardiovascular health and dermatitis

are crucial to monitor progress, make necessary adjustments to interventions, and ultimately

enhance Miss C's overall health and well-being. The success of these goals not only improves

Miss C's health outcomes but also underscores the adaptability and effectiveness of

patient-centered care, demonstrating a commitment to continuous refinement within the dynamic

context of her professional life.

Referral to Specialized Healthcare Providers

Recognizing the multifaceted nature of Miss C's health concerns, a collaborative

approach involving specialized healthcare providers is vital. We will refer Miss C to Burke

Dermatology for comprehensive dermatological care, Christiana Care Weight Loss Center for

personalized weight management strategies, and Cardiology Physicians, P.A. which are all

located in proximity to her home and workplace thorough, specialized evaluations. These

referrals aim to provide Miss C with tailored interventions and expertise to address her unique

health challenges effectively.

Reflection

Conducting a comprehensive health assessment for Miss C has been an insightful and

rewarding experience. The integration of psychosocial, physical, and cardiovascular

examinations unveiled critical details about her health status, shedding light on both apparent and
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underlying concerns. The meticulous exploration of her dermatitis and cardiovascular risk factors

allowed for the identification of interconnected health issues, emphasizing the importance of a

holistic approach to nursing assessment (Ghorbani & Salsali, 2018).

In navigating Miss C's unique challenges as a nurse, the assessment highlighted the

intricate balance needed to address both physical and occupational health aspects. The

recognition of her job-related factors, such as continuous glove and hand sanitizer use, as

contributors to dermatitis underscored the significance of understanding occupational influences

on health. This experience showcased the necessity for nurses to possess a diverse skill set that

encompasses not only clinical knowledge but also an understanding of the social and

occupational contexts shaping an individual's health.

Holistic Health and the Importance of Thorough Nursing Assessment

The holistic health assessment of Miss C reinforces the interconnectedness of physical,

psychosocial, and occupational factors in shaping an individual's well-being. Holistic health, as

encompassed in this assessment, acknowledges the intricate interplay of diverse elements

influencing an individual's health status (Mandal et al., 2020). The importance of thorough

nursing assessment skills cannot be overstated, as they serve as the cornerstone for developing

personalized and effective interventions.

The multifaceted nature of Miss C's health concerns illustrates the need for nurses to go

beyond the surface symptoms and delve into the various dimensions of an individual's life. A

comprehensive understanding of occupational influences, lifestyle factors, and individual

preferences allows nurses to tailor interventions that not only address immediate health issues

but also consider long-term well-being.

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In conclusion, the holistic approach to nursing assessment emphasizes the importance of

recognizing the entirety of an individual's health experience. Thorough nursing assessment skills

enable the identification of not only the evident health concerns but also the underlying factors

that may contribute to or exacerbate these issues. This experience reinforces the significance of

continually refining and expanding nursing assessment skills to provide patient-centered care

that promotes holistic health and addresses the unique needs of each individual. Holistic health,

as demonstrated through Miss C's assessment, serves as a guiding principle in fostering optimal

well-being and underscores the vital role of nurses in promoting comprehensive and

individualized healthcare.
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References

Fornal, R., Książkiewicz, A., Fornal, A., & Zarzycka, D. (2022). Atopic dermatitis: Current

standards of diagnosis and treatment, including the latest methods of management.

Postępy Higieny i Medycyny Doświadczalnej, 76(1), 282-299.

Fruh, S. M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long‐term

weight management. Journal of the American association of nurse practitioners, 29(S1),

S3-S14.

Fuxench, Zelma C. Chiesa, et al. "Atopic dermatitis in America study: a cross-sectional study

examining the prevalence and disease burden of atopic dermatitis in the US adult

population." Journal of Investigative Dermatology 139.3 (2019): 583-590.

Ghorbani, F., & Salsali, M. (2018). Concept of holistic in nursing: A review article. Education

and Ethics In Nursing, 7(3-4), 23-30.

Khan, Wahaj Anwar A., et al. "A field investigation of the relationship between rotating shifts,

sleep, mental health and physical activity of Australian paramedics." Scientific reports

11.1 (2021): 866.

Mandal, L., Seethalakshmi, A., & Rajendrababu, A. (2020). Rationing of nursing care, a

deviation from holistic nursing: A systematic review. Nursing Philosophy, 21(1), e12257.

Rozanski, A., Bavishi, C., Kubzansky, L. D., & Cohen, R. (2019). Association of optimism with

cardiovascular events and all-cause mortality: a systematic review and meta-analysis.

JAMA network open, 2(9), e1912200-e1912200.

Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the

treatment of obesity in adults. American psychologist, 75(2), 235.

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Weidinger, S., Nosbaum, A., Simpson, E., & Guttman, E. (2022). Good practice intervention for

clinical assessment and diagnosis of atopic dermatitis: Findings from the atopic

dermatitis quality of care initiative. Dermatologic Therapy, 35(3), e15259.