Textbook of Medical-Surgical Nursing 3e

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Unit 1 Contemporary concepts in nursing

Plan of Nurs ing Care Example of an individualised plan of nursing care ( continued )

CHART 2-8 Nursing interventions

Expected outcomes Discusses lifestyle adjustments with family

Outcomes Excessive involvement in daughters’ school and recreational activities Verbalised plans to make more referrals Identified need to decrease work hours to maximum of 8 h per day Consulted with wife and daughters; will alternate with wife in attending daughters’ activities; all family members supportive Accurately described effects of obesity and caffeine on blood pressure Plans to go to weight loss program; has had success with this in the past Drinks 1 cup of coffee for breakfast; uses decaffeinated coffee at mid- morning, lunch, and dinner; expressed satisfaction with this plan No changes noted in characteristics of skin of lower legs on days 2 and 3 Discussed importance of proper foot care; demonstrated proper technique of foot care; shoes and socks fit well; does not cross legs when sitting

c. Encourage patient to identify adjustments necessary to reduce stress

5. Encourage patient to identify obesity and caffeine as stressors and aggravators of hypertension; request consultation with dietician and reinforce instructions given

Identifies harmful effects of obesity and caffeine Makes plans for losing weight

Makes plans for decreasing caffeine intake

6. Assess for ischaemic leg ulcers; report changes in darkened spots on legs to physician 7. Teach foot care: daily inspection and washing, nail care, avoidance of caustic solutions, lubrication of dry skin, avoidance of heat to feet, well- fitting shoes and socks, avoidance of crossing legs

Absence of changes in skin integrity on lower extremities Describes principles and techniques of proper foot care

symptoms and do not require the assistance of a healthcare team member. The purpose of health promotion is to focus on the person’s potential for wellness and to encourage appropriate alterations in personal habits, lifestyle and environment in ways that reduce risks and enhance health and well-being. Health pro- motion is an active process; that is, it is not something that can be prescribed or dictated. It is up to each person to decide whether to make changes to promote a higher level of wellness. Only the individual can make these choices. Health and wellness Health is viewed as a dynamic, ever-changing condition that enables people to function at an optimal potential at any given time. The ideal health status is one in which people are successful in achieving their full potential, regardless of any limitations they might have. Wellness , a reflection of health, involves a conscious and deliberate attempt to maximise one’s health. Wellness does not just happen; it requires planning and conscious commit- ment and is the result of adopting lifestyle behaviours for the purpose of attaining one’s highest potential for well-being. Wellness is not the same for every person. The person with a chronic illness or disability may still be able to achieve a desir- able level of wellness. The key to wellness is to function at the highest potential within the limitations over which there is no control, such as a lifelong disability or genetic disorders. (For further information on genetic considerations, see Chart 2-1 in the related ancillary file for this chapter.)

present health concern and prevention of any future health issues. Therefore, the following section discusses the use of concepts of health education and promotion. The nurse should ascertain the patient’s current level of knowledge and willing- ness to learn as some patients are extremely well informed and some do not want to know which may then become a targeted issue in the plan of care In Chart 2-9 the use of the nursing process to incorporate these concepts into care is described. Effective health education lays a solid foundation for indi- vidual and community wellness. Although all nursing care is directed towards promoting, maintaining, and restoring health; preventing illness; and helping people adapt to the residual effects of illness, many nursing activities are accomplished Health education and health promotion are linked by a common goal—to encourage people to achieve as high a level of wellness as possible so that they can live maximally healthy lives and avoid preventable illnesses. The call for health pro- motion has become a cornerstone in health policy because of the need to control costs and reduce unnecessary sickness and death. Definition Health promotion may be defined as those activities that assist people in developing resources that maintain or enhance well-being and improve their quality of life. These activities involve people’s efforts to remain healthy in the absence of through patient teaching. Health promotion