Question

CARE PLAN: Mr. M is a 26 year old man who is Moslem. He'd just now being told on this clinic visit that his HIV test was positive after a second test was done. Mr. M is now on the floor, crying, appears devastated. His CD4 count, CBC, CMP, PT/PTT blood work and U/A has been ordered. The LPN is the one collecting his specimen. The nurse stood over him and told him, "we need blood work and your urine, young man." The young man replied, "Oh my, oh my. How am I going to tell my family. They don't even know I'm gay. I'd rather die." The nurse then replied, "Mr. M., I am so sorry to hear that, but we need to get your blood work done now; we have a lot of patient waiting." The young man grabbed a chair and flung it across the other side of the room and yelled, "Forget the other patient, my life is ruined, you don't understand!" The nurse ran out of the room, stating that she'll have to get security. PMH: None Meds: None Allergy: NKA Immunization: Up to date except for HPV; had never had HPV vaccine Occupation: Electrical Engineer Marital Status: Single--has been with the same partner for the last 5 years. Social: Smokes about 5 cigarettes per day; smokes marijuana about 1x/month; drinks socially about every 3 months; denied vaping or other drug use.

1. Using the therapeutic communication tools in the video and in your book (Chapter 4) , how would you deal with this patient.

2. Design a care plan with 2 nursing diagnosis for the patient above, 1 goal, at least 3 subjective & 3 objectives, 6 interventions, and evaluation.

Answer 1

NURSING DIAGNOSIS: Anticipatory grieving related to changes in lifestyle and roles and unfavourable prognosis.

SUBJECTIVE DATA ;

." I'd rather die."
"Forget the other patient, my life is ruined"

OBJECTIVE DATA: * client is unable to cope up his condition

* client wants to die rather than saying the truth to family.

GOAL: the cliet will express giref.

INTERVENTIOS:

The nurse can help the patient in verbalizing the feelings and can help in catharsis.
nurse should explore and identify the support system and mechanism of coping especially when the patient is grieving about anticipated losses.
patient should be encouraged to maintain contact with family, relatives and friends and coworkers.
patient should be encouraged to use the local or national AIDS support system and hotlines.
patient should be encouraged to continue usual activities whenever possible, to improve self esteem.
consultation with a mental health counselor can be useful for patient
EVALUATION: CLIENT STARTED TO EXPRESS THE FEELINGS.

NURSING DIAGNOSIS 2: Social isolation related to stigma of the disease, withdrawal of care, isolation procedures, and fear of telling others.

SUBJECTIVE DATA :

* "How am I going to tell my family. They don't even know I'm gay."

*" Forget the other patient, my life is ruined, "

OBJECTIVE DATA : * Client has fear of disease condition

* withdrawal of procedures.

GOAL: Decreasing sense of isolation and improves self esteem.

INTERVENTIONS:

* Individuals with AIDS are at risk for double stigmatization. People with AIDS may be overwhelmed with emotions such as, anxiety, guilt, rejection, shame, fear etc. nurse is a key position to provide an atmosphere of acceptance and understanding people with AIDS and their families.

* The patient's usual level of social interaction is assessed as early as possible to provide a baseline for monitoring changes in behavior indicative of social isolation.

* Patients should be encouraged to express the feeling of isolation and loneliness with the assurance that these feelings are not unique or abnormal.

* providing information how to protect themseves and others may helps patient avoid social isolation.

* Patient care conferences that addresses the psychosocial issues associated with AIDS may help sensitize the health care team to patient's needs.

* Educating axillary personnel, nurses and other staff will help to reduce factors that might contribute the patients feeling of isolation.

* Patient, family, relatives, must be assures that AIDS is not spread through casual contact.

EVALUATION : Patient statred to involve in self care activities and not avoided procedures.