Care of the Client With Pulmonary Tuberculosis Utilizing orem's theory
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Transcript of Care of the Client With Pulmonary Tuberculosis Utilizing orem's theory
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CARE OF THE CLIENT WITHPULMONARY TUBERCULOSISUTILIZING DOROTHEA
OREMS SELF CARE THEORYo The Philippines is among the 22 highburden countries for tuberculosis. TB is
the 6th leading cause of illness andthe 6th leading cause of deaths
among Filipinos (WHO 2007)
http://doh.gov.ph/node/1452.htmlhttp://doh.gov.ph/node/1452.html -
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oThis clinical research study is proposed todetermine if there is significant effect in thehealth awareness and improvement on self carerequisites of a patient with Pulmonary
Tuberculosis using Orems Self Care Theory whenapplied in the nursing process. The aim is to giveknowledge through education so that patient canperform self care activities to meet needs, and
self care being adhering to treatment.
oNursing has responsibility that focus more
towards health promotion strategies that includea greater emphasis on teaching patients toassume more responsibility toward self-care.
INTRODUCTION
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Is there a significant effect in thehealth awareness and improvementon self care requisites of a patientwith Pulmonary Tuberculosis whenSelf Care Theory by Orem will be
applied in the nursing process?
Statement of the Problem
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CONCEPTUAL/THEORETICAL FRAMEWORK
NOT MET MET
NURSINGINTERVENTION
(NURSING SYSTEMS)
SELF CAREDEFICIT
SELF CAREHEALTH
UNIVERSALSELF CAREREQUISITE
DEVELOPMENTALSELF CAREREQUISITE
HEALTH DEVIATIONSELF CAREREQUISITE
SELF CARE REQUISITES
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METHODOLOGY
The assessment tool was developed within the framework of Orems (1995)self-care requisites. The tool was designed to assess the universal,
developmental, and health deviation self-care requisites of the client. Eachself care requisite category (universal, developmental, and healthdeviation) is broken down into its categorical components.
The tool is entitled the Self-Care Requisite Assessment Tool. For everyquestion, there were 5 responses to choose from and the following weights
were assigned to each response:Response Weight
Always 5
Most of the time 4
Sometimes 3
Seldom 2
Never 1
Clients response to universal self care requisites, developmental self carerequisites and health deviation self care requisites were determined byutilizing the formula to find the mean (average) of each category.
xX =
N
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RESEARCH INSTRUMENT
Self-Care Requisite AssessmentTool
(Adapted from Roque, F. Study onAcute Gastroenteritis with Severe
Dehydration)
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DATA ANALYSIS
Self-care
Requisites
Mean Score of InitialAssessment
Mean Score of FinalAssessment Mean
DifferenceMeanScore
Description Mean Score Description
UniversalSelf care
Requisites3.22 Good 4.05 Very Good 0.83
DevelopmentalSelf-careRequisites
2.50 Fair 3.83 Good 1.33
HealthDeviation Selfcare Requisites
2.20 Fair 4.20 Very Good 2.00
Total 2.89 Fair 4.03 Very Good 1.14
The clients mean difference was obtained by subtracting the clientsoverall mean score of initial assessment and overall means score
from the final assessment results.
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PATIENTS BACKGROUND
Name : Mrs. MG
Age : 46 years oldSex : FemaleCivil Status : MarriedOccupation : HousewifeEducational Attainment : Elementary Graduate
oPatient does not have any regular medical and dentalcheck-ups because of lack of time and financialinsufficiency.oThe patient has an anti-Tuberculosis drug with Fixed-dose Combination for 8 weeks, then Isoniazid/Rifampinfor 16 weeks . For the first 3 weeks, she is compliant withthe treatment regimen. But after few weeks she seemed
to be non-compliant with it.
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NURSING CARE PLAN
ASSESSMENT NURSING
DIAGNOSIS
OBJECTIVES OF
CARE
NURSING INTERVENTIONS/
RATIONALE
EVALUATION/
OUTCOME
Subjective Data
Wala ko kabalo nga
may ara na ko sangbalati-an kay daw okay
man lang akon
pamatyag.
(I dont know that I
already have the disease
because I seemed okay).
Nakuha ko ni siguro sa
mga pagkaon nga gina
kaon ko.
(Maybe I got this disease
from the food Im
eating).
Objective Data-Presence of cough
-Not covering her mouth
and nose when
coughing
-Body weakness
-Poor personal hygiene
and sanitation
Knowledge
Deficit
r/t lack ofinformation and
limited
knowledge about
condition,
prevention and
self-care of
havingTuberculosis as
evidenced by
expressed
misconceptions
and practices
towards health
status.
Within 14 days
of nursing
intervention,Mrs. MG will be
able to:
1. Verbalize
understandingof disease
process/prognos
is and
prevention.
2. Initiate
behaviors/lifestyle changes to
improve general
well-being and
reduce risk of
reactivation of
TB.
Independent
1.Baseline data gathering
about Mrs. MG on the recordsfrom the City Health Office and
Brgy. Health Station. (Baseline
data are essential for
comparison of any significant
changes).
2.Establish rapport with Mrs.
MG by visiting in her house andidentifying the purpose of the
home visit. (To establish trust
and cooperation in the patient.
3.Assess patients ability to
learn, e.g., level of fear,
concern, fatigue, participation
level; best environment inwhich patient can learn; how
much content; best media and
language; who should be
included. (Learning depends on
emotional and physical
readiness and is achieved at an
individual pace).
Within 14
days of
nursingintervention
, Mrs. MG
was be able
to:
1.Verbalized
understandi
ng of the
disease
process and
prevention.
2. Discuss
food choices
and lifestyle
change baseon
individual
needs.
.
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3. Identify
symptoms
requiring
evaluation/inte
rvention.
4. Describe a
plan for
receiving
adequate
follow-up care.
5. Verbalize
understanding
of therapeutic
regimen andrationale for
actions.
4.Provide instruction and specific written
information for patient to refer to, e.g., schedule
for medications and follow-up sputum testing
for documenting response to therapy.(Written
information relieves patient of the burden of
having to remember large amounts ofinformation. Repetition strengthens learning).
5.Emphasize importance of maintaining high-
protein and carbohydrate diet and adequate
fluid intake. (Meeting metabolic needs help
minimize fatigue and promote recovery. Fluids
aid in liquefying/expectorating secretions).
6.Explain medication dosage, frequency of
administration, expected action, and the reason
for long treatment period. Review potential
interactions with other drugs/substances.(
Enhances cooperation with therapeutic regimen
and may prevent patient from discontinuing
medication before cure is truly effected.Stress need to abstain from alcohol while on
INH.( Combination of INH and alcohol has been
linked with increased incidence of hepatitis.)
7.Perform daily home visit to note down
observation in taking her medication and
practices. (To assure patients compliance.)
3. Understand
the need to
report any
untoward drug
reactions.
4. Reports adverse
effects of
medications to
health care
personnel to allowfor early
intervention.
5. Verbalized
individual
treatment regimen
and its purpose.
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FINDINGS1. During initial assessment, the results are as follows: Universal
Self Care Requisites Good, Developmental Self CareRequisites Fair and Health Deviation Self Care Requisites Fair. The clients mean score was 2.89, indicating a Fair levelofclients self care requisites.
2. In the Final assessment, the following are the results:Universal Self Care Requisites Very Good, DevelopmentalSelf Care Requisites Good and Health Deviation Self CareRequisites Very Good. Clients mean score was 4.03, whichshowed a Very Good level ofclients self care requisites.
3. There was an increase of 1.14 noted between the initial andfinal assessment using the same assessment tool. From 2.89it increased to 4.03 which demonstrate an improvement inthe level ofclients self care requisites.
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RECOMMENDATIONS
Nursing Practice. The application ofOrems Self Care Theory
should be used in nursing practice as an effective approachfor the future development programs related to tuberculosiswhich aims in patients education and health promotion in asystematic and holistic way.
Nursing Education. The educators and nursing studentsshould enhance their teaching and learning strategies inorder to have proper knowledge in the application ofOremsSelf Care Theory. This goes in assessing the needs andproviding health education to tuberculosis patients.
Nursing Research. The application of Orems Self CareTheory can also be used in conducting studies for otherdiseases and medical cases. The theory will serve as a guidein patient assessment and intervention to ensure qualitynursing care.