Jessica's Therapeutic Relationship
The role of a community nurse is to undertake a wide range of responsibilities that encompass health promotion, disease management, community development and public health activities and deliver high quality nursing care across the lifespan (Arnott, Atherley & Pye, 2012). In order to achieve optimal health and well-being outcomes for the patient, the nurse should ensure that the individual needs and choices of the patient are placed at the centre of the process (Arnott, Atherley & Pye, 2012).
The therapeutic relationship is made up of three core components which include empathy, genuineness and acceptance (Arnott, Atherley & Pye, 2012). Therefore, it is essential that the nurse establish a rapport with Jessica from the initial visit, as if …show more content…
she feel at ease with health professionals she is more likely to answer questions accurately and recall past events (Jevon, Walters, Ng & Cunnington, 2009). This can be achieved through positive initial contact with the patient, by providing privacy, using the patient’s name, ensuring the patient is physically comfortable, ensuring confidentiality and using effective communication skills and appropriate language (Jevon et al., 2009).
The nurse should conduct a comprehensive and thorough assessment of Jessica, in order to gather all the appropriate information to allow for the further planning of her care (Koharchik, Caputi, Robb, & Culleiton, 2015). Vital sign measurement is a core nursing function that provides important information about the condition of an individual’s vital organs (Berman et al., 2012). Therefore, the nurse should undertake a full set of vital signs, including a Blood Glucose Level (BGL) on Jessica. This should be conducted first on the initial visit to Jessica, as it is an objective and non-invasive assessment which allows the nurse to build a rapport with Jessica before moving on to the more subjective assessments (Berman et al., 2012). This would provide a baseline set of vital signs that the nurse could use to monitor for potential alterations in Jessica’s health status and possible clinical deterioration, particularly the BGL which will be useful in assessing the effectiveness of her current diabetes management plan (Berman et al., 2012).
Epilepsy is a chronic condition of the neurological system, which is characterised by repetitive and unpredictable episodes of seizure activity (Bullock & Hales, 2013). An epileptic seizure is the inappropriate electrical discharge of cerebral excitatory and inhibitory cells which results in an electrical storm of excessive neural discharge (Bullock & Hales, 2013; Gurr, 2014). Therefore, the nurse should undertake a thorough neurological assessment on Jessica, including an assessment of her level of consciousness, as well as an examination of the cranial nerves, limbs and cerebellum (Jevon, Walters, Ng & Cunnington, 2009). This will provide the nurse with a baseline neurological snapshot which will allow the nurse to identify any arising neurological deficits in the future, if Jessica’s epilepsy worsens (Berman et al., 2012).
A physical examination is conducted to obtain baseline data about a patient’s health problem, which will assist in the establishment of nursing diagnoses and organising a plan of care (Berman et al., 2012). The nurse should undertake a thorough physical examination of Jessica, including a head-to-toe, and a peripheral vascular assessment (Berman et al., 2012). This is to inspect and palpate for any abnormalities that might indicate that Jessica may be experiencing complications of her diabetes (Berman et al., 2012). The chronic hyperglycaemia and poor glucose control associated with diabetes, leads to the deterioration of the function of the cardiovascular, renal, nervous and visual systems (Bullock & Hales, 2013). This results in microvascular complications such as renal failure and retinopathy; and macrovascular complications such as peripheral vascular disease, cardiovascular disease, and peripheral neuropathy (Bullock & Hales, 2013).
Early onset epilepsy and its underlying pathologies are thought to negatively affect the maturation of the brain and its development (Kellermann, Bonilha, Lin, & Hermann, 2015; Witt & Helmstaedter, 2015). Therefore, the nurse should undertake a cognitive assessment on Jessica, to determine a baseline cognitive level to detect for any future cognitive impairments should Jessica’s epilepsy worsen in the future, as cognitive deficits in epilepsy can be frequent and negatively affect the patient’s daily functioning (Samarasekera, Helmstaedter, & Reuber, 2015; Witt & Helmstaedter, 2015).
A patient’s overall physical and mental well-being is largely associated with their nutritional health (Lewis & Foley, 2011). Therefore, the nurse should undertake a nutritional status assessment on Jessica, this should include a nutrition history, family history, current health and lifestyle practices, in addition to a physical assessment of current weight and height to calculate a Body Mass Index (BMI) and measurements of waist, arm and calf circumferences (Lewis & Foley, 2011). The achievement and maintenance of a healthy body weight is an important management strategy for Jessica’s Type 2 Diabetes Mellitus (T2DM), in order to prevent the progression of her diabetes and arising complications (Rock et al., 2014). Therefore, due to Jessica’s current BMI and high blood pressure, the identification of concerns with Jessica’s diet and nutritional status are vital to ensure the effective management of her diabetes (Carpenito, 2012).
In order to gain a holistic overview of the patient, the nurse must determine the patient’s psychosocial developmental level (Lewis & Foley, 2011).
The nurse should undertake a psychosocial assessment on Jessica, including a mini mental exam to provide an overall holistic assessment of Jessica’s life and determine her current quality of life (Falvo, 2008). This is important as Jessica is at risk of developing psychological issues due to ineffective coping related to her chronic diseases of epilepsy and diabetes, such as the demanding self-care regimen of those diseases and the uncertainty of her future while living with these conditions (Carpenito, 2012). In particular, people with epilepsy can experience psychosocial and psychological challenges, such as disabling anxiety over the uncertainty of reoccurring seizures, the associated feelings of embarrassment due to bystander’s misconceptions of a seizure, and experiences of lack of control over one’s life and behaviour (Falvo, …show more content…
2008).
Once the nurse has gathered and processed all the appropriate information about Jessica’s clinical situation, it is then vital to establish some primary goals of care for Jessica, to allow the nurse to develop and implement the appropriate actions (Koharchik et al., 2015). Therefore, the nurse in consultation with Jessica, should determine priorities areas to address in the next visit (Berman et al., 2012).
Firstly, Jessica’s non-adherence to her medications is an important priority area for the nurse to address in the follow up visit. The nurse must first address Jessica’s knowledge of her condition and medications to determine if she has a knowledge deficit (Falvo, 2008). As individuals may be in denial about their condition, and this may manifest as poor adherence with their medications, which may lead to poor seizure control (Falvo, 2008). Also, in Jessica’s case this may also affect for employment potential as she needs to drive for work and has already lost her licence due to recent seizure (Falvo, 2008).
Epilepsy is thought to be caused by an identifiable epileptic focus, which is a group of hyperexcitable cells in the cortex of the brain which are responsible for the seizure activity (Bullock & Hales, 2013). These cells are considerable to be less negative, meaning that their cell membrane potentials are closer to the threshold and therefore can be more easily activated by an incidental electrical signal (Bullock & Hales, 2013). Epilim is used for its ability to reduce the abnormal electrical activity in the brain caused by the epileptic focus, it is also said to increase the action of Gamma-Aminobutyric-acid (GABA) at the inhibitory receptors (Bullock & Hales, 2013).
Due to the potential for serious adverse effects on a fetus or neonate, Epilim is not to be used during pregnancy or lactation unless the benefits to the mother clearly outweigh the risks to the baby (Epstein et al., 2013; Mckenna & Lim, 2012). Although, the discontinuation of anticonvulsant drugs for the treatment of epilepsy should only be done with consultation and approval from the patient’s treating physician (Mckenna & Lim, 2012). This is important for Jessica to understand as her medication Epilim needs to discontinued slowly, as rapid withdrawal of the drug can precipitate absence seizures (Mckenna & Lim, 2012). Therefore, the nurse should initiate that Jessica and her treating physician undertake a medication review, and discuss her current epilepsy medication, and her wishes to become pregnant, and collaboratively come up with a solution to achieve Jessica’s goals (Mckenna & Lim, 2012).
The nurse should include Jessica’s partner Martin in the process, as partners of individuals with epilepsy can sometimes be fearful of the condition due to anxiety and misinformation, which may make him reluctant to support Jessica with her epilepsy needs (Falvo, 2008).
Individuals with DM are at a high risk of non-adherence to their prescribed regimen due to the complexity and chronicity of the condition (Carpenito, 2012).
Jessica’s non-adherence with her current diabetes management plan is also an important concern for the nurse to address in the follow up visit. Jessica’s current self-management of her diabetes is a major concern, as it could be related to a knowledge deficit associated with her condition resulting in the poor self-monitoring of her BGL’s (Carpenito, 2012; Whittemore, 2014).
When patients with DM do not adapt to their condition or fear social isolation due to their condition, they may endeavour to conceal their disease, ignore their dietary restrictions and abandon their management plan (Falvo, 2008). Therefore, It is the nurses role to educate Jessica on the importance of having a firm understanding of her condition, and understanding the importance of the frequency of blood glucose monitoring and the suitable times to ensure her BGL remains within the recommended levels (Bussell,
2014).
Diabetes mellitus (DM) is a chronic and incurable condition that involves an imbalance in the secretion and use of insulin, which leaves the body unable to prevent the blood sugar from becoming elevated (Falvo, 2008). T2DM is when the body produces insulin, although there is either an insufficient amount or the body is incapable of using the existing insulin to control BGL’s (Falvo, 2008). The nurse should inform Jessica that she should aim for BGL’s of 4-7mmol/L before meals and less than 8.5mmol/L two hours post meal, and encourage the recording of BGL’s in a diary (Bussell, 2014). The nurse should organise that Jessica get a HbA1c, which is a blood test which measures the amount of glycated haemoglobin in the blood, and result in an average BGL over a three month period (Phillips, 2012).
The management of DM is a lifelong multifaceted process, and can impact individual’s daily lives and futures significantly, particularly if complications of the disease begin to develop (Falvo, 2008). The treatment of T2DM involves patient’s adopting a healthy diet, aiming for an achievable degree of weight loss and undertaking adequate physical activity (Bussell, 2014). These treatment measures help to prevent the progression of non-insulin dependent diabetes mellitus (NIDDM) to insulin dependent diabetes, as well as decreasing the risk of hypertension and heart disease (Bussell, 2014). If glycaemic control is not gained through diet and exercise, individuals will be placed on oral hypoglycaemics such as metformin in Jessica’s case (Falvo, 2008). Metformin is a Biguanide, and its role it to decrease the production and increase the uptake of glucose by the body (Mckenna & Lim, 2012).
The nurse should educate Jessica on the importance of diet and exercise to help normalise her BGL’s (Bussell, 2014; Falvo, 2008). Jessica’s current BMI is also a concern, and the nurse should discuss with Jessica the implementation of an achieveable weight loss plan, as losing weight has been shown to be beneficial in increasing insulin sensitivity and improving glycaemic control, in addition to counteracting the progression of diabetes and possibly reserving it (Bussell, 2014; Carpenito, 2012; Falvo, 2008)
It is vital that nurses undertake comprehensive assessments of their patient’s in order to make accurate conclusions and to prevent assumptions about the patient’s situation and the initiation of interventions that may not be required or even harmful to the patient (Alfaro-LeFevre, 2012; Koharchik et al., 2015). Nurses must value the patient, and plan care based on the patient’s own goals, which will contribute to providing effective person centred care (Arnott, Atherley & Pye, 2012).
The therapeutic relationship is made up of three core components which include empathy, genuineness and acceptance (Arnott, Atherley & Pye, 2012). Therefore, it is essential that the nurse establish a rapport with Jessica from the initial visit, as if …show more content…
she feel at ease with health professionals she is more likely to answer questions accurately and recall past events (Jevon, Walters, Ng & Cunnington, 2009). This can be achieved through positive initial contact with the patient, by providing privacy, using the patient’s name, ensuring the patient is physically comfortable, ensuring confidentiality and using effective communication skills and appropriate language (Jevon et al., 2009).
The nurse should conduct a comprehensive and thorough assessment of Jessica, in order to gather all the appropriate information to allow for the further planning of her care (Koharchik, Caputi, Robb, & Culleiton, 2015). Vital sign measurement is a core nursing function that provides important information about the condition of an individual’s vital organs (Berman et al., 2012). Therefore, the nurse should undertake a full set of vital signs, including a Blood Glucose Level (BGL) on Jessica. This should be conducted first on the initial visit to Jessica, as it is an objective and non-invasive assessment which allows the nurse to build a rapport with Jessica before moving on to the more subjective assessments (Berman et al., 2012). This would provide a baseline set of vital signs that the nurse could use to monitor for potential alterations in Jessica’s health status and possible clinical deterioration, particularly the BGL which will be useful in assessing the effectiveness of her current diabetes management plan (Berman et al., 2012).
Epilepsy is a chronic condition of the neurological system, which is characterised by repetitive and unpredictable episodes of seizure activity (Bullock & Hales, 2013). An epileptic seizure is the inappropriate electrical discharge of cerebral excitatory and inhibitory cells which results in an electrical storm of excessive neural discharge (Bullock & Hales, 2013; Gurr, 2014). Therefore, the nurse should undertake a thorough neurological assessment on Jessica, including an assessment of her level of consciousness, as well as an examination of the cranial nerves, limbs and cerebellum (Jevon, Walters, Ng & Cunnington, 2009). This will provide the nurse with a baseline neurological snapshot which will allow the nurse to identify any arising neurological deficits in the future, if Jessica’s epilepsy worsens (Berman et al., 2012).
A physical examination is conducted to obtain baseline data about a patient’s health problem, which will assist in the establishment of nursing diagnoses and organising a plan of care (Berman et al., 2012). The nurse should undertake a thorough physical examination of Jessica, including a head-to-toe, and a peripheral vascular assessment (Berman et al., 2012). This is to inspect and palpate for any abnormalities that might indicate that Jessica may be experiencing complications of her diabetes (Berman et al., 2012). The chronic hyperglycaemia and poor glucose control associated with diabetes, leads to the deterioration of the function of the cardiovascular, renal, nervous and visual systems (Bullock & Hales, 2013). This results in microvascular complications such as renal failure and retinopathy; and macrovascular complications such as peripheral vascular disease, cardiovascular disease, and peripheral neuropathy (Bullock & Hales, 2013).
Early onset epilepsy and its underlying pathologies are thought to negatively affect the maturation of the brain and its development (Kellermann, Bonilha, Lin, & Hermann, 2015; Witt & Helmstaedter, 2015). Therefore, the nurse should undertake a cognitive assessment on Jessica, to determine a baseline cognitive level to detect for any future cognitive impairments should Jessica’s epilepsy worsen in the future, as cognitive deficits in epilepsy can be frequent and negatively affect the patient’s daily functioning (Samarasekera, Helmstaedter, & Reuber, 2015; Witt & Helmstaedter, 2015).
A patient’s overall physical and mental well-being is largely associated with their nutritional health (Lewis & Foley, 2011). Therefore, the nurse should undertake a nutritional status assessment on Jessica, this should include a nutrition history, family history, current health and lifestyle practices, in addition to a physical assessment of current weight and height to calculate a Body Mass Index (BMI) and measurements of waist, arm and calf circumferences (Lewis & Foley, 2011). The achievement and maintenance of a healthy body weight is an important management strategy for Jessica’s Type 2 Diabetes Mellitus (T2DM), in order to prevent the progression of her diabetes and arising complications (Rock et al., 2014). Therefore, due to Jessica’s current BMI and high blood pressure, the identification of concerns with Jessica’s diet and nutritional status are vital to ensure the effective management of her diabetes (Carpenito, 2012).
In order to gain a holistic overview of the patient, the nurse must determine the patient’s psychosocial developmental level (Lewis & Foley, 2011).
The nurse should undertake a psychosocial assessment on Jessica, including a mini mental exam to provide an overall holistic assessment of Jessica’s life and determine her current quality of life (Falvo, 2008). This is important as Jessica is at risk of developing psychological issues due to ineffective coping related to her chronic diseases of epilepsy and diabetes, such as the demanding self-care regimen of those diseases and the uncertainty of her future while living with these conditions (Carpenito, 2012). In particular, people with epilepsy can experience psychosocial and psychological challenges, such as disabling anxiety over the uncertainty of reoccurring seizures, the associated feelings of embarrassment due to bystander’s misconceptions of a seizure, and experiences of lack of control over one’s life and behaviour (Falvo, …show more content…
2008).
Once the nurse has gathered and processed all the appropriate information about Jessica’s clinical situation, it is then vital to establish some primary goals of care for Jessica, to allow the nurse to develop and implement the appropriate actions (Koharchik et al., 2015). Therefore, the nurse in consultation with Jessica, should determine priorities areas to address in the next visit (Berman et al., 2012).
Firstly, Jessica’s non-adherence to her medications is an important priority area for the nurse to address in the follow up visit. The nurse must first address Jessica’s knowledge of her condition and medications to determine if she has a knowledge deficit (Falvo, 2008). As individuals may be in denial about their condition, and this may manifest as poor adherence with their medications, which may lead to poor seizure control (Falvo, 2008). Also, in Jessica’s case this may also affect for employment potential as she needs to drive for work and has already lost her licence due to recent seizure (Falvo, 2008).
Epilepsy is thought to be caused by an identifiable epileptic focus, which is a group of hyperexcitable cells in the cortex of the brain which are responsible for the seizure activity (Bullock & Hales, 2013). These cells are considerable to be less negative, meaning that their cell membrane potentials are closer to the threshold and therefore can be more easily activated by an incidental electrical signal (Bullock & Hales, 2013). Epilim is used for its ability to reduce the abnormal electrical activity in the brain caused by the epileptic focus, it is also said to increase the action of Gamma-Aminobutyric-acid (GABA) at the inhibitory receptors (Bullock & Hales, 2013).
Due to the potential for serious adverse effects on a fetus or neonate, Epilim is not to be used during pregnancy or lactation unless the benefits to the mother clearly outweigh the risks to the baby (Epstein et al., 2013; Mckenna & Lim, 2012). Although, the discontinuation of anticonvulsant drugs for the treatment of epilepsy should only be done with consultation and approval from the patient’s treating physician (Mckenna & Lim, 2012). This is important for Jessica to understand as her medication Epilim needs to discontinued slowly, as rapid withdrawal of the drug can precipitate absence seizures (Mckenna & Lim, 2012). Therefore, the nurse should initiate that Jessica and her treating physician undertake a medication review, and discuss her current epilepsy medication, and her wishes to become pregnant, and collaboratively come up with a solution to achieve Jessica’s goals (Mckenna & Lim, 2012).
The nurse should include Jessica’s partner Martin in the process, as partners of individuals with epilepsy can sometimes be fearful of the condition due to anxiety and misinformation, which may make him reluctant to support Jessica with her epilepsy needs (Falvo, 2008).
Individuals with DM are at a high risk of non-adherence to their prescribed regimen due to the complexity and chronicity of the condition (Carpenito, 2012).
Jessica’s non-adherence with her current diabetes management plan is also an important concern for the nurse to address in the follow up visit. Jessica’s current self-management of her diabetes is a major concern, as it could be related to a knowledge deficit associated with her condition resulting in the poor self-monitoring of her BGL’s (Carpenito, 2012; Whittemore, 2014).
When patients with DM do not adapt to their condition or fear social isolation due to their condition, they may endeavour to conceal their disease, ignore their dietary restrictions and abandon their management plan (Falvo, 2008). Therefore, It is the nurses role to educate Jessica on the importance of having a firm understanding of her condition, and understanding the importance of the frequency of blood glucose monitoring and the suitable times to ensure her BGL remains within the recommended levels (Bussell,
2014).
Diabetes mellitus (DM) is a chronic and incurable condition that involves an imbalance in the secretion and use of insulin, which leaves the body unable to prevent the blood sugar from becoming elevated (Falvo, 2008). T2DM is when the body produces insulin, although there is either an insufficient amount or the body is incapable of using the existing insulin to control BGL’s (Falvo, 2008). The nurse should inform Jessica that she should aim for BGL’s of 4-7mmol/L before meals and less than 8.5mmol/L two hours post meal, and encourage the recording of BGL’s in a diary (Bussell, 2014). The nurse should organise that Jessica get a HbA1c, which is a blood test which measures the amount of glycated haemoglobin in the blood, and result in an average BGL over a three month period (Phillips, 2012).
The management of DM is a lifelong multifaceted process, and can impact individual’s daily lives and futures significantly, particularly if complications of the disease begin to develop (Falvo, 2008). The treatment of T2DM involves patient’s adopting a healthy diet, aiming for an achievable degree of weight loss and undertaking adequate physical activity (Bussell, 2014). These treatment measures help to prevent the progression of non-insulin dependent diabetes mellitus (NIDDM) to insulin dependent diabetes, as well as decreasing the risk of hypertension and heart disease (Bussell, 2014). If glycaemic control is not gained through diet and exercise, individuals will be placed on oral hypoglycaemics such as metformin in Jessica’s case (Falvo, 2008). Metformin is a Biguanide, and its role it to decrease the production and increase the uptake of glucose by the body (Mckenna & Lim, 2012).
The nurse should educate Jessica on the importance of diet and exercise to help normalise her BGL’s (Bussell, 2014; Falvo, 2008). Jessica’s current BMI is also a concern, and the nurse should discuss with Jessica the implementation of an achieveable weight loss plan, as losing weight has been shown to be beneficial in increasing insulin sensitivity and improving glycaemic control, in addition to counteracting the progression of diabetes and possibly reserving it (Bussell, 2014; Carpenito, 2012; Falvo, 2008)
It is vital that nurses undertake comprehensive assessments of their patient’s in order to make accurate conclusions and to prevent assumptions about the patient’s situation and the initiation of interventions that may not be required or even harmful to the patient (Alfaro-LeFevre, 2012; Koharchik et al., 2015). Nurses must value the patient, and plan care based on the patient’s own goals, which will contribute to providing effective person centred care (Arnott, Atherley & Pye, 2012).