APPLICATION OF BETTY

NEUMANN'S SYSTEMS
MODEL IN NURSING
PRACTICE

Presented By:
Atiqa Ishtiaq
 CASE STUDY
Kiran is a 30 years old lady, a wife of bus driver.
She was admitted in the hospital 2 days ago with
sever hypertension above 200/110 mm Hg
accompanied by chest pain, shortness of breadth.
And insomnia. Patient tells the nurse that her
husband met with the accident 3 days ago and he
was severely injured with other passengers, She is
worried about him as passengers are blaming her
husband for tragedy
Patient is looking anxious and irritable.
 STRESSORS IN THE KIRANS CASE ARE:

1. Anxiety which stemmed from the uncertainty about the fate of

Psychological her husband.
Stressors 2. A sense of guilt because relatives of the passengers are
blaming her husband for the tragedy.
3. Ambivalence in the sense that she would be happy if her
husband survived and at the same time worried too that if he
did survive he would be subjected to court litigation.

Her husband is the breadwinner of the family and in a brood of 5 children,

Financial stressors only one is employed; the rest are still in school.

1. Insomnia
Physical Stressors 2. Elevated blood pressure unresponsive to maintenance medications
3. Persistent chest pains
ASSESSMENT DATA SUGGEST
THAT:

The clients flexible line of defence is compromised here;

she had a hard time in life, irritable and constantly taking
the stress, her nutritional level is also not good and
quantity of stress increases.
Her normal line of defence is also unstable, she is not well
and we can assess she is not as she has blood pressure of
above 200/110 associated with chest pain and shortness of
breath.
And her line of resistance is severely debilitated; as she can
develop heart attack if not properly managed with her
hypertension and stress. Her environment full of talking
relatives also worsen the condition.
 As Betty Neumann's model focuses on Levels of
Prevention for stability of patients line of defence in
Kirans case levels of prevention are applied as:

Primary Preventionwould not be applicable because the

accident causing the stressors has already occurred and the
patient has already developed the reactions/symptoms of
stress.
Secondary Prevention: In this case secondary
preventions will be used for nursing interventions.
Secondary level of prevention is aimed at reducing the
further complexity of Problem
Nursing intervention centered initially on the round the
clock monitoring of the blood pressure and giving of the
ordered anti- hypertensive drugs. Since the EKG showed
myocardial ischemia, the patient was closely watched for
worsening of the pain because of the possibility of a
myocardial infarction.
Nursing Diagnosis
Decreased Cardiac output related to
myocardial ischemia as evidenced by
tachycardia, shortness of breadth and
elevated blood pressure i.e. 200/110
mmHg
Desired Outcomes Outcomes
At the time of discharge Client will:
1. Maintain blood pressure within
individually acceptable range.
2. Demonstrate stable cardiac rhythm
and rate within patients normal
range.
3. Participate in activities that reduce
blood pressure/cardiac workload.
 Nursing Interventions Rational

Monitor BP Measure in both arms/thighs three Comparison of pressures provides a more

times, 35 min apart while patient is at rest, complete picture of vascular involvement/scope
then sitting, then standing for initial evaluation. of problem.
Use correct cuff size and accurate technique.

Bounding carotid, jugular, radial, and femoral

pulses may be observed/palpated. Pulses in the
Note presence, quality of central and peripheral legs/feet may be diminished, reflecting effects of
pulses. vasoconstriction increased systemic vascular
resistance and venous congestion.

Observe skin color, moisture, Presence of pallor; cool, moist skin; and
temperature, and capillary refill time. delayed capillary refill time may be due
to peripheral vasoconstriction or reflect
cardiac decreased output.

Provide calm, restful surroundings, Helps reduce sympathetic stimulation;

minimize environmental activity/noise. promotes relaxation.
Limit the number of visitors and length
of stay.
 Nursing Interventions Diagnosis

Maintain activity restrictions, e.g., Reduces physical stress and tension that
bedrest/chair rest; schedule periods of affect blood pressure and the course of
uninterrupted rest; assist patient with hypertension.
self-care activities as needed.

Instruct in relaxation techniques, guided Can reduce stressful stimuli, produce

imagery, distractions. calming effect, thereby reducing bp.
Instruct and implement to patient This restrictions helpmanage
dietary restrictions in sodium, fat and fluidretention and decreasemyocardial
cholesterol food. workload

Administer medications anxiolytics drugs Medications will help to control the blood
also as indicated pressure
EVALUATION
Goals are achieved:
1) Patient has maintained blood pressure within individual
acceptable range.
2) Demonstrate stable cardiac rhythm and rate within
patients normal range.
 TERTIARY PREVENTION:
If possible to stay in a relatives house for a few weeks
because they were being hounded by media who were
camped outside their home.
Regular monitoring of the patients blood pressure by a
daughter who is a student-nurse who should also monitor
her intake of medications as prescribed by the physician.
Avoid watching TV shows that mention about the tragedy.
Avoid answering the phone.
She should have a close relative with her aside from the
children who will manage their affairs in the meantime.