Nursing_Rogerian

Rogerian Narrative Evaluation of Client Patterning The client’s chief concern at time of assessment was pain in her abdomen and middle back. She rated the pain as an ‘8’on the pain scale for her abdomen and a ‘6’ for her middle back. She says that the abdomen pain is from her having chronic pancreatitis. She has a pain pump and is prescribed Lora tab. The client states that both the medications “help a whole lot but there is still residual pain. She was admitted to long term care with her husband and remained here after he passed a year ago. She has inability to care for her apartment and her ADL’s so she would be safer with managed care. Her other diagnoses include hypothyroidism, gastroesophogeal reflux disease, Christian-Weber disease, depression and constipation. With further assessment and patterning I learned that the client is very active physically, mentally and socially despite her condition. She was able to completely dress and groom herself in the morning. She enjoyed conversing with the other residents and with the health staff. She also takes many family vacations; with the next being a cruise in a month. I observed the client eating both her breakfast and lunch although she at 30% of her meals. The client told me that she “has not had an appetite for the last few days because she feels nauseas and her stomach hurts” Objective supportive information to the client’s stomach pain is her current prescription of Loratab and use of a pain pump. The day of care I asked if these medications helped she replied “oh yes, especially after I see the doctor and he refills my pain pump”. When I spoke with her she was a very cognitive individual and was cohesive in her thoughts. She was alert and oriented to person, place and time and had a warm, friendly attitude. When I assessed her circulatory system I did not find any abnormalities, she had strong, equal pulses bilaterally, pulse of 78, and B/P of 138/82. She had clear lungs sounds and a respiratory rate of 20 with no use of accessory muscles. Bowel sounds were present in all four quadrants. With palpation her abdomen was soft in the upper quadrants but there was a hard mass in the lower left quadrant due to Christians Weber’s disease and slight swelling in the right lower quadrant where her pain pump is located. There was pain and tenderness in both lower quadrants upon palpation. Her skin was intact except for a wound on her left hip; I was unable to view the wound due to her appointment with the wound nurse this day. Her skin was pale pink, had delayed recoil, warm skin upon palpation, and was dry with sparse flaky areas on legs and elbows. Other patterning was made apparent through my health assessment of her musculoskeletal system. She had overall slight diminished strength in all areas of the body. She didn’t have any diminished range of motion of the lower and upper extremities except she did have trouble combing the back of her hair. She is allergic to Penicillin and Levaquin according to her medical record. Energy The client told me her height was 5’2” and her weight was documented as 102 lbs. As documented she has lost 8lbs. over the last 6 months due to decreased nutritional input and GI issues. Her energy status fluctuated from high to low throughout the day I spent with her. She did not want to get out of bed in the morning for her appointment and after much encouragement she did get out of bed. She did very well getting herself dressed and ready for her appointment. She joined me in the dining area to eat her breakfast while she waited to leave for her appointment. She was very chipper and had a friendly attitude. When she came back from her appointment she told me all about it very excitedly and then said she was tired and was going to take a nap till lunch. After lunch, she was wide awake again and full of smiles and joined her friends in the dining room. Her energy level troughs may be explained by her decreased nutritional input and chronic abdominal pain. She has high levels of energy when she is interacting with others but otherwise she can be found resting in her bed. She can walk, use the restroom and shower independently which illustrates a high energy level. Although she is tired at times, she instantly ‘perks up’ when someone walks into her room. The client does have adequate finances and insurance to meet her needs. She did tell me that liked being at and takes many vacations with her family. Her next one is a cruise in one month but she has to heal her hip wound first. Openness The client was married but has become a widow just over a year ago. Her and her husband use to have an apartment together in an assisted living facility but when his health declined they moved to Sloan House. A staff member continued to tell me she was depressed for a long time but is doing much better now. She does have children and grandchildren and has many pictures of them in her room. I did see that her daughter had power of attorney and had responsibility for her finances and health decisions. The client is listed as ‘do not resuscitate.’ She told me that she is always in some level of pain. Her most prominent complaint of pain was in her back and abdomen. She has significant back pain with standing and sitting. Her abdomen pain is always present but is managed well with Loratab and her pain pump. The client’s personal space was neat and clean. There were many personal belongings in the room along with many pictures of her friends and family. She had me open her blinds very wide because she loved the sunshine-this lead to a lengthy conversation on the outside weather. She told me “how she loves to go outside and is sad that it’s getting colder.” She did have many blankets-When I assisted her in lying down she wanted three blankets on her. When she went outside of her room she took pride in her appearance. She made sure her hair was brushed and she had nice clothes she wore but she still felt she “looked like crap” but smiled and brushed it off. This client was very willing to interact. I found her to be a very pleasant and kind individual. She was compliant and understanding with the care provided for her. She did have extreme difficulty in taking her morning medications due to nausea but she did take them. When she sat to eat in the dining room she was kind and highly interactive to the fellow residents. This client’s religious preference is Presbyterian. She did not mention that she goes to church or practices her religion actively. Her previous occupation was being a secretary for her husband who was a dentist and then a stay at home wife/mom to five children. Pandimensionality I am using Erikson’s eight stages of development to assess this client. The last stage (Old Age) is Integrity versus despair. This stage is summarized by “many older adults review their lives with a sense of satisfaction even with their inevitable mistakes, whereas others see themselves as failures with their lives marked by despair and regret.” I perceived this client as having a sense of satisfaction despite her deteriorating health situation. The client was not depressed about her situation; she appeared to accept it for what it was. She did not mention any despair or regret she had on the choices she has made in her life. The client does not appear to have notable decline in cognitive abilities. She and I had numerous conversations and she understood and made appropriate evaluations on the issues discussed. She fully understood her medical situation and why she is staying at Meadowlark. She also knew the importance of the care she received and of the medications prescribed to her. She did not like taking her medications but she took them anyways because she understood the significance of the benefits they offered to her. In my opinion she did not fear death (a trait of Integrity) because she opted to be ‘do not resuscitate.” I think that if a person feared death they would want to avoid death and be resuscitated. She has come to terms that she is nearing the end of her life span and accepts this. The client is educated; she has a High School diploma along with a year and a half of college. She smiled as she told me stories about her husband and family, which leads me to believe she has lived a rewarding life so far. The client is aware of her surroundings and interacts coherently and pleasantly with other people. She was alert and oriented times three and had an overall positive attitude (although she was stubborn that morning-I feel this was due to being tired). Her problem solving abilities were still intact. She demonstrated this as her and I discussed her medical condition and why she was receiving her treatments. She was very helpful. She also used her personal rationale to deduce that attending her wound nurse appointments are very important towards her rehabilitation. The Rogerian Principles are Resonancy, Helicy and Integrality. Resonancy: Her wave patterns are high frequency because she has so much energy and positivity although I assume the frequency is not as high as it was before her husband passed away. Helicy: She continues to move forward in life but eventually she will stop because she is of old age, yet it will probably be a long time from now because she is rather spry. Integrality: I would say it is strong because the pt. loves to interact with her environment (the other residents and today with myself-I was also considered part of the environment for today).