NURSING CARE PLANName of Patient: PATIENT X Agency/ Area:

Diagnosis: OSTEOSARCOMA Rating:

ASSESSMENTSUBJECTIVE OBJECTIVE

>action are congruent with>expressed feelings & thought>Lact of eye contact>Excessively seeks reassurance

NURSING DIAGNOSISSituational low self esteem related to social role change

SCIENTIFIC EXPLANATION

Development of a negative perception of self-worth in response to a current situation. Although many cancers can be cured and the survival rate in some cancers is good, psychological, social, sexual, and physical dysfunction caused by both the diagnosis and treatment exerts a deleterious impact on the quality of most patients’ lives. Cancer treatment inevitably means a considerable disruption to a patient’s life.Some manage to continue working through the irradiotherapy and chemotherapy, but others require lengthy periods of hospitalization with its associated effects on social, family, sexual, and occupational functioning. After initial therapy, even this has been successful, the months and years of follow-up visits and tests can continue to make it difficult for patients to ever see themselves again in the same way as they did prior to diagnosis.

Source: Oxford Handbookof Oncology by: Cassidyet a

OBJECTIVESLONG-TERM SHORT-TERM

After a week intervention patient will be able to verbalize understanding of individual factors that precipitated the current situation, express positive self-appraisal, demonstrate behaviors to restore positive self-esteem, and participate in treatment regimen to correct factors that precipitated the crisis.

After 4 hours intervention patient will demonstrate behaviors to restore positive self-esteem.

NURSING ACTIONSINTERVENTIONS RATIONALE

1. Assess and consider client’s preparation for and view of amputation.

2. Encourage expression of fears, negative feelings, and grief over loss of body part.

3. Reinforce preoperative information, including type and location of amputation, type of prosthetic fitting if appropriate (i.e., immediate, delayed), and expected postoperative course, including pain control and rehabilitation.

4. Assess degree of support available to client.

5. Discuss client’s perceptions of self, related to change, and how client sees self in usual lifestyle and role functioning.

6. Ascertain individual strengths and identify previous positive coping behaviors.

7. Encourage participation in activities of daily living (ADLs). Provide opportunities to view and care for residual limb, using the moment to point out positive signs of healing.

8. Encourage or provide for a visit by another amputee, especially one who is successfully rehabilitating.

9. Provide open environment for client to discuss concerns about sexuality.

10. Note withdrawn behavior, negative self-talk, use of denial, or overconcern with actual or perceived changes.

1. Research shows that amputation poses serious threats to client’s psychological and psychosocial adjustment. Client who views amputation as life-saving or reconstructive may be able to accept the new self more quickly. Client with sudden traumatic amputation or who considers amputation to be the result of failure in other treatments is at greater risk for disturbances in self-concept.

2. Venting emotions helps client begin to deal with the fact and reality of life without a limb.

3. Provides opportunity for client to question and assimilate information and begin to deal with changes in body image and function, which can facilitate postoperative recovery.

4. Sufficient support by significant other (SO) and friends can facilitate rehabilitation process.

5. Aids in defining concerns in relation to previous lifestyle and facilitates problem-solving. For example, client likely fears loss of independence and ability to work or express sexuality and may experience role and/or relationship changes.

6. Helpful to build on strengths that are already available for client to use in coping with current situation.

7. Promotes independence and enhances feelings of self-worth. Although integration of residual limb into body image can take months or even years, looking at the residual limb and hearing positive comments made in a normal, matter-of-fact manner can help client with this acceptance.

8. A peer who has been through a similar experience serves as a role model and can provide validity to comments and hope for recovery and a normal future.

9. Promotes sharing of beliefs and values about sensitive subject, and identifies misconceptions or myths that may interfere with adjustment to situation.

10. Identifies stage of grief and need for interventions

EXPECTED OUTCOME/ EVALUATION

The patient was able to verbalize understanding of individual factors that precipitated the current situation, express positive self-appraisal, demonstrate behaviors to restore positive self-esteem, and participate in treatment regimen to correct factors that precipitated the crisis.

Prepared by: Evaluated by:

Student Nurse’s Signature over Printed Name

DATE:

Clinical Instructor’s Signature over Printed Name

DATE:

Rating: POINAssessment 25Nursing Diagnosis 15Scientific Explanation 10Objectives 10Nursing Actions 25Rationale 10Expected Outcome/ Evaluation 5

TOTA

TRANSMUTED GRADE (60% Passing Score):

Agency/ Area:

NURSING CARE PLAN

Name of Patient: PATIENT X Agency/ Area:

Diagnosis: OSTEOSARCOMA Rating:

ASSESSMENTSUBJECTIVE OBJECTIVE

>Reluctance to attempt movement

>Impaired coordination

>Decreased muscle strength

NURSING DIAGNOSISImpaired physical mobility related to loss of limb particularly a lower extremity; pain or

discomfort; perceptual impairment.

SCIENTIFIC EXPLANATION

Amputation is the total or partial surgical removal of an extremity or digit.It is done in cases of inadequate tissue perfusion not responsive to other treatments, such as with diabetes mellitus or other peripheral vascular diseases.

OBJECTIVESLONG-TERM SHORT-TERM

After a week of hospitalization the client will maintain or increase the strength and functioning of affected compensatory part.

After 4 hours of nursing interventions, the patient will verbalize understanding of individual situation, treatment regimen and safety measures; Maintain position of function as evidenced by absence of contractures; demonstrate techniques and behaviors that enable resumption of activities; and display willingness to participate in activities.

NURSING ACTIONSINTERVENTIONS RATIONALE

1. Provide residual limb care on a routine basis, for example, inspect the area, clean and dry it thoroughly, and rewrap the residual limb with elastic bandage or air splint. Conversely, apply a “stump shrinker” or heavy stockinette sock for “delayed” prosthesis.

2. Measure circumference periodically.

3. Rewrap residual limb immediately with an elastic bandage, elevate if “immediate or early” cast is accidentally dislodged. Prepare for reapplication of cast.

4. Assist with specified range-of-motion (ROM) exercises for both the affected and unaffected limbs, beginning early in postoperative stage.

5. Encourage active and isometric exercises for upper torso and unaffected limbs.

6. Provide trochanter rolls, as indicated.

7. Instruct client to lie in prone position, as tolerated, at least twice a day with pillow under abdomen and lower-extremity residual limb.

8. Caution against keeping pillow under lower-extremity residual limb or allowing BKA limb to hang dependently over side of bed or chair.

9. Demonstrate/assist with transfer techniques and use of mobility aids such as a trapeze, crutches, or a walker.

10. Help client continue preoperative muscle exercises as able or when allowed out of bed; for example, the client should perform abdomen-tightening exercises and knee bends; hop on foot; and stand on toes while holding on to chair for balance.

1. Provides opportunity to evaluate healing and note complications unless covered by immediate prosthesis. Wrapping residual limb controls edema and helps form residual limb into conical shape to facilitate fitting of prosthesis. Note: Air splint may be preferred because it permits visual inspection of the wound.

2.Measurement is done to estimate shrinkage to ensure proper fit of sock and prosthesis.

3. Edema will occur rapidly, thus delaying rehabilitation.

4. Prevents contracture deformities, which can develop rapidly and could delay prosthesis usage.

5. Increases muscle strength to facilitate transfers and ambulation and promotes mobility and more normal lifestyle.

6. Prevents external rotation of lower-limb residual limb.

7. Strengthens extensor muscles and prevents flexion contracture of the hip, which can begin to develop within 24 hours of sustained malpositioning.

8. Use of pillows can cause permanent flexion contracture of hip; a dependent position of residual limb impairs venous return and may increase edema formation.

9. Facilitates self-care and client’s independence. Proper transfer techniques prevent shearing abrasions/dermal injury related to “scooting.”

10. Contributes to gaining improved sense of balance and strengthens compensatory body parts.

EXPECTED OUTCOME/ EVALUATION

The patient was able to verbalize understanding of individual situation, treatment regimen and safety measures; Maintain position of function as evidenced by absence of contractures; demonstrate techniques and behaviors that enable resumption of activities; and display willingness to participate in activities.

Prepared by: Evaluated by:

Student Nurse’s Signature over Printed Name

DATE:

Clinical Instructor’s Signature over Printed Name

DATE:

Rating: POINTS SCOREAssessment 25Nursing Diagnosis 15Scientific Explanation 10Objectives 10Nursing Actions 25Rationale 10Expected Outcome/ Evaluation 5

TOTAL:

TRANSMUTED GRADE (60% Passing Score):