NURS 110 Introduction to Professional Nursing Assignment

worried about being alone’ suggest that client has poor coping skills. The data cluster is similar to Gordon’s coping-stress tolerance pattern as it defines patient’s coping patterns in the patients (Gordon, 2014). Frankley’s data suggest that the pattern is dysfunctional and he has negative coping style.

Data cluster 3: The third data cluster collected from the analysis of Frankley’s case scenario includes ‘He has the intention to lose weight, but no intention to control her eating habits smoking is a weakness , ‘I don’t plan on quitting’, ‘Eating an entire pizza with coke’. The above data sets clearly exemplified what plans Frankley has regarding improving his health and being healthy. Poor focus on quitting smoking and improving eating habits suggest that he has poor perception about health and well-being. It represents Gordon’s health perception-health management patterns (Gordon, 2014). The pattern is dysfunctional for the patient.

Data cluster 4: The fourth data cluster collected from the analysis of Frankley’s case scenario includes ‘He smokes 2 packs of cigarettes, he is obese but he does not control her eating habits, he was found to have eat an entire pizza pie and coke with his wife during hospital stay’. The data sets defines Frankley’s addiction to cigarette and that he has interest in unhealthy food items like coke and pizza. Eating those foods even during hospital stay is a weak point which suggests he is not serious about his metabolic and nutrient needs. The data resembles Gordon’s nutritional metabolic pattern (Gordon, 2014).

Data cluster 5: The fifth data cluster collected from the analysis of Frankley’s case scenario includes ‘Need ambulatory support while going to the bathroom, he states ‘Its hard for me to get around, I use sticks while walking’. This data set defines patient’s engagement in activity and leisure activity. The pattern is related to Gordon’s activity-exercise pattern and it is dysfunctional (Gordon, 2014). 

Nursing diagnosis or Associated NDx:

The following nursing diagnoses have been identified for patient:

• Breathing difficulty with shortness of breath
• Persistent cought and inabiilty to bring up secretion
• Obesity
• Poor eating habit
• Cigarette smoking
• Difficulty in ambulating
• Poor emotional state
• Poor coping skills 

The cause of each specific nursing diagnosis as per Gordon’s pattern are as follows:

1. Cognitive perception:Acute breathing problem related to cancerous tumor in the left lobe evidenced by shortness of breath, he feels like choking due to breathing difficulty, he is unable to bring up her secretions.
2. Coping-stress tolerance pattern:Poor  coping or stress tolerance related to emotional distress evidenced by ‘he is very distraught and crying’.
3. Nutritional-metabolic pattern:Poor nutritional status evidences related to unhealthy lifestyle evidenced by ‘He smokes 2 packs of cigarettes, he is obese but he does not control her eating habits’.
4. Health perception-health management pattern:Obesity related to poor health perception evidenced by ‘He has the intention to lose weight, but no intention to control her eating habits smoking is a weakness, ‘I don’t plan on quitting’.
5. Activity-exercise pattern:Physical inactivity related to mobility problems evidenced by ‘Need ambulatory support while going to the bathroom, He states ‘Its hard for me to get around, I use sticks while walking’.
6. Each nursing diagnosis was prioritized by dividing patient’s problem into physiological, psychosocial and educational domains. Each domain was analyzed based on risk potential and severity of risk. This helped to prioritize the nursing diagnosis which should be addressed first and the diagnosis which should be prioritized later. Following this pattern, the following table was developed:

	Problem-oriented	Risk/Potential	Health Promotion
Physiological	Physiological problem found in patient includes breathing problem, low pulse rate and persistent cough with problem in bringing up the secretions	Shortness of breath can increase difficulty and chest congestion can increase complication for patient. The patient can be at risk of bleeding while coughing or choking (Polanski et al., 2016).	To promote health, proving high concentration of oxygen and respiratory medications will be important. Suction secretion is also necessary to clear airway blockage (Chatwin et al. 2018).
Psychosocial	Poor emotional states because of cancer diagnosis and inability to cope with mobility problems due to obesity	Impairment in psychosocial state can cause risk in the long term if social isolation and poor emotional state persist for long time. Patient may be at risk of developing depression (Bekh Bradley et al., 2011)	Psycho-education and counseling support is essential to improve thinking pattern and teach positive coping skills to deal with illness and other life stressors (Walker et al., 2013)
Educational	Poor intention to quit smoking and  unhealthy eating habit has been identified as one of the educational problem for patient	Continuing with smoking can further cause problem for Frankeley as he is a patient diagnosed with lung cancer. People who continue to smoke after diagnosis of the cancer doubles their risk of dying (Cataldo, Dubey & Prochaska, 2010).	Smoking cessation is an integral part of treatment and encouraging patient to quit smoking is essential to provide health benefit to patient (Cataldo, Dubey & Prochaska, 2010).

6. The nursing diagnosis related to acute breathing problem was identified as the most important to address. This was identifying by analyzing the consequence of persistent breathing problems and its impact on respiratory system of patient. As patient is at risk of choking and even dying due to breathing problem, this nursing problem can cause immediate risk to patient (Ignatavicius & Workman, 2015). Hence, addressing breathing problem was prioritized first.
7. Poor nutritional status is the second important nursing diagnosis because Frankley takes 2 packs cigarette and this can increase his risk of dying earlier than without smoking. Smoking cessation can yield both immediate and long-term health benefits (Amato et al., 2015).
8. Poor mobility is least important to address as when client will modify his lifestyle patterns and lose weight, the problem can be eliminated.

Nursing process:

1. As the priority problem is reducing acute breathing problem, the goal of care is as follows:

• To have a clear and effective airway and respiratory pattern
• To reduce mucus secretion and breathing difficult
• To promote comfort and ease of breathing
• To improve patients ability to take part in physical activities.

2. The nursing interventions that can help to address the goals include the following:

• Assessment of respiratory rate and ABG level to detect signs of respiratory compromise
• Assessment of breathing patterns
• Providing respiratory medication and oxygen  to relax airway smooth muscles
• Use suction secretion to clear airway blockage
• Maintain proper body alignment and support patient to do deep breaths to promote deep inspiration (Mudd & Sloand, 2015).

3. Evaluation of outcome:

To understand whether client has met the goal, the evaluation of outcome will be done by evaluating patients respiratory pattern. Other expected outcomes include:

• Stable physiological parameters of breathing and respiratory rate
• Achieve healthy lifestyle

Reference:

Amato, K. A. D., Hyland, A., Reed, R., Mahoney, M. C., Marshall, J., Giovino, G., ... & Nwogu, C. (2015). Tobacco cessation may improve lung cancer patient survival. Journal of Thoracic Oncology, 10(7), 1014-1019.

Bekh Bradley, D., DeFife, J. A., Guarnaccia, C., Phifer, M. J., Fani, M. N., Ressler, K. J., & Westen, D. (2011). Emotion dysregulation and negative affect: association with psychiatric symptoms. The Journal of clinical psychiatry, 72(5), 685.

Cataldo, J. K., Dubey, S., & Prochaska, J. J. (2010). Smoking Cessation: An Integral Part of Lung Cancer Treatment. Oncology, 78(5-6), 289–301.

Chatwin, M., Toussaint, M., Gonçalves, M. R., Sheers, N., Mellies, U., Gonzales-Bermejo, J., ... & Nygren-Bonnier, M. (2018). Airway clearance techniques in neuromuscular disorders: A state of the art review. Respiratory medicine, 136, 98-110.

Gordon, M., 2014. Manual of nursing diagnosis. Jones & Bartlett Publishers.

Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing-E-Book: Patient-Centered Collaborative Care. Elsevier Health Sciences.

Mudd, S. S., & Sloand, E. D. (2015). Lower Respiratory Disorders. Pediatric Nurse Practitioner Certification Review Guide, 137.

Polanski, J., Jankowska-Polanska, B., Rosinczuk, J., Chabowski, M., & Szymanska-Chabowska, A. (2016). Quality of life of patients with lung cancer. OncoTargets and therapy, 9, 1023.

Walker, J., Sawhney, A., Hansen, C. H., Symeonides, S., Martin, P., Murray, G., & Sharpe, M. (2013). Treatment of depression in people with lung cancer: a systematic review. Lung Cancer, 79(1), 46-53.