NURS FPX 6610 Patient Care Plan Paper Example
NURS FPX 6610 Assessment 2 Patient Care Plan
NURS FPX 6610 Patient Care Plan Paper Assignment Brief
Course: NURS-FPX6610 Introduction to Care Coordination
Assignment Title: NURS FPX 6610 Assessment 2 Patient Care Plan
Assignment Overview
In this assessment, you will engage in an interactive simulation involving interviews with a patient, family members, and experienced healthcare workers. From the insights gained, you will craft a proactive and patient-centered care plan for the individual, focusing on care coordination and aligning with national care coordination initiatives.
Understanding Assignment Objectives
Your primary objective is to develop a comprehensive care plan that addresses the patient’s holistic needs while incorporating principles of care coordination. You will apply nursing assessments to identify patient needs, formulate nursing diagnoses aligned with assessment data, and devise appropriate interventions in collaboration with other healthcare professionals. Moreover, you will evaluate the outcomes of care coordination efforts and revise the care plan as necessary, ensuring adherence to professional standards and guidelines.
The Student’s Role
As a nursing student, your role in this assignment is that of a care coordinator responsible for developing and implementing a patient-centered care plan. You will leverage your understanding of patient assessments, nursing diagnoses, and evidence-based interventions to promote optimal health outcomes for the individual.
Competencies Measured
This assessment aims to evaluate your proficiency in the following course competencies:
- Competency 1: Develop patient assessments: Assess a patient’s condition from a coordinated-care perspective and develop nursing diagnoses aligned with assessment data.
- Competency 3: Evaluate care coordination plans and outcomes: Evaluate care coordination outcomes according to measures and standards.
- Competency 4: Develop collaborative interventions: Determine appropriate nursing or collaborative interventions and explain the rationale for each intervention.
- Competency 5: Communicate effectively: Write clearly and concisely, supporting main points with credible evidence and correctly formatting citations and references using APA style.
You Can Also Check Other Related Assessments for the NURS-FPX6610 Introduction to Care Coordination Course:
NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment Example
NURS FPX 6610 Patient Care Plan Paper Example
Patient Medical Diagnosis: Diabetes
Nursing Diagnosis: Hyperglycemia
Assessment Data:
- Patient has a past medical history (PMH) of uncontrolled diabetes.
- Overweight due to poor management of the disease condition.
- Experiences frequent urination secondary to the disease process.
Goals and Outcome:
- Lower the patient’s BMP blood sugar to 110 mg/dL or less over the next few weeks.
- Reduce chances of additional health complications and emphasize self-care needs.
Nursing Interventions:
- Monitor and control blood sugar.
- Identify factors causing glucose instability.
- Collaborate with a dietitian to create a diabetic diet.
Rationale:
- Frequent monitoring and controlling blood sugar facilitate better control of diabetes.
- A diabetic diet with the help of a dietitian maximizes nutritional intake, manages diabetes, and reduces the risk for cardiovascular illnesses (Sami et al., 2017).
- Identifying and addressing factors contributing to glucose instability aids in controlling blood sugar levels.
Outcome Evaluation and Re-planning:
The goals and outcomes were partially met. Incorporating additional nutritional needs due to the patient’s cancer diagnosis is essential for a more comprehensive care plan.
Nursing Diagnosis: Obesity
Assessment Data:
- Patient presents with hypercholesterolemia.
- Experiences pain and shortness of breath on inspiration due to strain on the body secondary to weight.
- Ineffective management of blood pressure secondary to the disease process.
Goals and Outcome:
- Get the patient to lose some weight (at least 2 pounds per week) through healthy eating and exercising.
- Maintain the patient’s blood pressure below 120/80 mmHg.
- Reduce shortness of breath and fatigue.
- Increase oxygen saturation to 95%.
Nursing Interventions:
- Educate and engage family members in the patient’s diet formulation.
- Monitor body weight for weight loss every other week.
- Consult with a dietitian on the patient’s caloric and nutritional needs.
- Encourage light exercise to promote good cardiovascular health.
- Educate patient and family on the need for a low salt diet for blood pressure management.
Rationale:
- The patient’s diet should contain the right nutrients to manage her health condition and meet her nutritional needs (Ridder et al., 2017).
- Periodic weight monitoring allows for tracking of the patient’s condition and facilitates necessary adjustments.
- Consulting with a dietitian helps achieve more effective results in weight management (Bleich et al., 2015).
Outcome Evaluation and Re-planning:
While the interventions helped the patient lose weight and feel better, considering her cancer diagnosis and need for a high-protein diet, increasing physical exercises may aid in weight management in the future.
Nursing Diagnosis: Pain-related Anxiety
Assessment Data:
- Patient exhibits low pain tolerance.
- Verbalizes anxiety and fear.
- PMH of being on and off anti-anxiety medication.
Goals and Outcome:
- Demonstrate minimal to no psychological symptoms of anxiety.
- Identify and overcome distinct stressors that cause or heighten anxiety levels.
Nursing Interventions:
- Discuss pain management options with the patient.
- Explore alternative anxiety management and coping strategies such as aromatherapy.
- Identify and encourage positive reinforcement, including positive self-talk.
Rationale:
- Patient education helps comprehend the situation and increases confidence (Paterick et al., 2017).
- Alternative anxiety management strategies help reduce anxiety without medication-associated side effects (Curtiss et al., 2021).
- Positive reinforcement and self-talk aid in reducing anxiety by focusing on changing thoughts (Curtiss et al., 2021).
Outcome Evaluation and Re-planning:
The interventions significantly reduced the patient’s anxiety. In future care plans, involving family members and addressing additional factors contributing to anxiety in the clinical and home environment may enhance effectiveness.
Nursing Diagnosis: Compromised Family Coping
Assessment Data:
- Ineffective family coping due to avoidance of the needs of a sick family member.
- Caregiver role strain due to poor understanding of the role and lack of effective communication.
- Denial of the severity of disease-related complications and risk of death.
Goals and Outcome:
- Obtain as much support as possible from family members.
- Encourage family members to express their feelings and assist the patient in managing her diabetes.
- Ensure family members can identify signs and symptoms of diabetes and intervene accordingly.
Nursing Interventions:
- Offer valuable feedback and constantly engage family members.
- Identify available resources and support systems.
- Educate and involve family members in the treatment plan.
Rationale:
- Offering valuable feedback motivates family members to care for the patient.
- Community resources and support systems help families interact with others for emotional support (Whitehead et al., 2017).
- Family members understanding the condition aids in effective support and medication administration (Jazieh et al., 2018).
Outcome Evaluation and Re-planning:
While these interventions increased family involvement, further focus on specific disease-related measures and addressing the lack of support from family members, especially Mr. Snyder, would enhance the effectiveness of the care plan.
References
Bleich, S. N., Bandara, S., Bennett, W. L., A., C. L., & Gudzune, K. A. (2015). Enhancing the role of nutrition professionals in weight management: A cross-sectional survey. Obesity, 23(2), 454-460.
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders. Focus, 19(2), 184-189.
Jazieh, A. R., Volker, S., & Taher, S. (2018). Involving the Family in Patient Care: A Culturally Tailored Communication Model. Global Journal on Quality and Safety in Healthcare, 1(2), 33–37.
Paterick, T. E., Patel, N., Tajik, A., & Chandrasekaran, K. (2017). Improving health outcomes through patient education and partnerships with patients. Baylor University Medical Center Proceedings, 30(1), 112–113.
Ridder, D. d., Kroese, F., Evers, C., Adriaanse, M., & Gillebaart, M. (2017). Healthy diet: Health impact, prevalence, correlates, and interventions. Psychology & Health, 32(8), 907-941.
Sami, W., Ansari, T., Butt, N., & Hamid, M. (2017). Effect of diet on type 2 diabetes mellitus: A review. International Journal of Health Sciences, 65-71.
Whitehead, L., Jacob, E., Towell, A., Abu-Qamar, M., & Cole-Heath, A. (2017). The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review. Journal of Clinical Nursing, 27(1-2), 22-30.
Detailed Assessment Instructions for the NURS FPX 6610 Patient Care Plan Paper Assignment
Description
Assessment 2 Instructions: Patient Care Plan Paper Assignment
- Complete an interactive simulation that includes interviews of a patient, family members, and experienced health care workers. Then, develop a care coordination strategy and a care plan for the patient based on the information gathered from the interviews.
Note: Each assessment in this course builds on your work from the preceding assessment; therefore, complete the assessments in the order in which they are presented.
Whether designing care plans directed by patients’ needs and preferences, educating patients and their families at discharge, or doing their best to facilitate continuity of care for patients across settings and among providers, registered nurses use accredited health care standards to realize coordinated care. This assessment provides an opportunity for you to explore health care standards with respect to the quality of care, investigate opportunities and challenges in care coordination, and develop a proactive, patient-centered care plan.
The National Strategy for Quality Improvement in Health Care (2011) focuses on improving patient care, maximizing health resources, and reducing preventable hospital readmissions. Care coordinators reduce readmissions of those suffering from chronic conditions (such as congestive heart failure, pneumonia, asthma, and diabetes) and are responsible for providing quality care in a fiscally responsible manner. While this may seem a reasonable task, shifting the way we use health care resources can be a challenge. Consequently, you must be cognizant of effective strategies for reducing preventable readmissions and understand the barriers that nurses face when coordinating care for patients with chronic illnesses.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:- Competency 1: Develop patient assessments.
- Assess a patient’s condition from a coordinated-care perspective.
- Develop nursing diagnoses that align with patient assessment data.
- Competency 3: Evaluate care coordination plans and outcomes according to performance measures and professional standards.
- Evaluate care coordination outcomes according to measures and standards.
- Competency 4: Develop collaborative interventions that address the needs of diverse populations and varied settings.
- Determine appropriate nursing or collaborative interventions.
- Explain why each intervention is indicated or therapeutic.
- Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
- Write clearly and concisely, using correct grammar and mechanics.
- Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style.
- Reference
Agency for Healthcare Research and Quality. (2011). 2011 report to Congress: National strategy for quality improvement in health care. Retrieved from https://www.ahrq.gov/workingforquality/reports/2011-annual-report.html
Competency Map
CHECK YOUR PROGRESSUse this online tool to track your performance and progress through your course.
- Competency 1: Develop patient assessments.
- Toggle DrawerResources
- Asssessment InstructionsNote: Complete the assessments in this course in the order in which they are presented.
Preparation
To prepare for this assessment, complete the following simulation:- Vila Health: Care Coordination Scenario I.
- In this simulation, you will obtain the information needed to develop a care coordination strategy for Mrs. Snyder and her family. You may use an intervention developed as part of your first assessment. Locate applicable current standards and benchmarks as you determine the best way to develop this strategy.
Note: Remember that you can submit all or a portion of your draft to Smarthinking for feedback before you submit the final version of this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Requirements
Develop a proactive, patient-centered care plan for the patient, using the information gained from your simulated interviews. Focus on care coordination and national care coordination initiatives.
Care Plan Format
Use the Patient Care Plan Template [DOCX] provided.
Supporting Evidence
Cite 3–5 sources of scholarly or professional evidence to support your plan.
Developing the Care Plan
The requirements outlined below correspond to the grading criteria in the scoring guide. Be sure that your care plan addresses each point, at a minimum. Read the Patient Care Plan Scoring Guide to better understand how each criterion will be assessed. - Assess a patient’s condition from a coordinated-care perspective.
- Consider the full scope of the patient’s needs.
- Include 3–5 pieces of data (subjective, objective, or a combination) that led to a nursing diagnosis.
- Develop nursing diagnoses that align with patient assessment data.
- Write two goal statements for each diagnosis.
- Ensure goals are patient- and family-focused, measurable, attainable, reasonable, and time-specific.
- Consider the psychosociocultural aspect of care.
- Determine appropriate nursing or collaborative interventions.
- List at least three nursing or collaborative interventions.
- Provide the rationale for each goal or outcome.
- Explain why each intervention is indicated or therapeutic.
- Cite applicable references that support each intervention.
- Evaluate care coordination outcomes according to measures and standards.
- Indicate if the goals were met. If they were not met, explain why.
- Describe how you would revise the plan of care based on the patient’s response to the current plan.
- Support conclusions with outcome measures and professional standards.
- Write clearly and concisely, using correct grammar and mechanics.
- Express your main points and conclusions coherently.
- Proofread your writing to minimize errors that could distract readers and make it difficult to focus on the substance of your plan.
- Support main points, claims, and conclusions with credible evidence, correctly formatting citations and references using APA style.
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