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This Concept Map, created with IHMC CmapTools, has information related to: Chronic Pain Management, ANEMIA ???? Key Problem # 3 Nutritional Deficit Nursing Diagnosis Imbalanced nutrition: less than body requirements Assessment data Abdominal pain; hyperactive bowel sounds, refusal to eat, lack of information/ misinformation, lack of appetite, chronic pain, establish baseline laboratory values (transferrin, albumin, calories) Interventions Assess and determine motiva)tion for changing eating habits Assess food preferences Identify and addess exacerbating factors to loss of appetite, such as pain Monitor lab values Teach patient about easy to prepare nutritional diets Monitor recorded intake for nutritional content and calories Medication regimen (appetite stimulant) Collaborative activities with dietitian, physician, community outreach programs Create pleasant envirnments for eating/dining Rationale Assessments provide baseline information on nutritional deficits and direct plan of care. Medications (appetite stimulant) increase appetite). Patient education provides accurate information on food nutrients, empowers patient to adequately nourish self. Collaboration with dietitian yields accurate dietary advice. Physician provides accu- rate diagnosis pertaining to condition. Reference Toye, F. & Barker, K.L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response., Key Problem # 3 Nutritional Deficit Nursing Diagnosis Imbalanced nutrition: less than body requirements Assessment data Abdominal pain; hyperactive bowel sounds, refusal to eat, lack of information/ misinformation, lack of appetite, chronic pain, establish baseline laboratory values (transferrin, albumin, calories) Interventions Assess and determine motiva)tion for changing eating habits Assess food preferences Identify and addess exacerbating factors to loss of appetite, such as pain Monitor lab values Teach patient about easy to prepare nutritional diets Monitor recorded intake for nutritional content and calories Medication regimen (appetite stimulant) Collaborative activities with dietitian, physician, community outreach programs Create pleasant envirnments for eating/dining Rationale Assessments provide baseline information on nutritional deficits and direct plan of care. Medications (appetite stimulant) increase appetite). Patient education provides accurate information on food nutrients, empowers patient to adequately nourish self. Collaboration with dietitian yields accurate dietary advice. Physician provides accu- rate diagnosis pertaining to condition. Reference Toye, F. & Barker, K.L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response. MAY WORSEN PERCEPTION OF PAIN Key Problem # 1 Right Knee Pain Nursing Diagnosis Knowledge deficit related to right knee pain management Assessment Data Verbalized pain level 8/10 to right knee, grimacing, warm and swollen knee joint, unsteady gait, irritability, loss of appetite, inadequate sleep, poor body image Interventions Pharmacologic (analgesics, NSAIDs, opioids) Non-pharmacologic (heat, cold application, TENS, acupuncture, massage) Alternative (homeopathy, physiotherapy, spiritual healing) Patient education on pain management Rationale Pharmacokinetics target nociceptors, eliminating the sensation of pain; non-pharmacologic and alternative therapy provide additional relief without drug-related adverse effects; patient education empowers and strengthens the patient's will to manage condition Evaluation Patient verbalized knowledge of alternative measures to relieve pain, stated a pain level maintained at 2/10, resumed previous activity level, demonstrated physical and psychologic well-being, showed enjoyment of leisure activities, maintained good appetite, recognized pain triggers and utilized preventa- tive measures, and used pharmacologic agents appropriately. Reference American Geriatrics Society (1998). The management of chronic pain in older persons., ANOREXIA LEADS TO Key Problem # 3 Nutritional Deficit Nursing Diagnosis Imbalanced nutrition: less than body requirements Assessment data Abdominal pain; hyperactive bowel sounds, refusal to eat, lack of information/ misinformation, lack of appetite, chronic pain, establish baseline laboratory values (transferrin, albumin, calories) Interventions Assess and determine motiva)tion for changing eating habits Assess food preferences Identify and addess exacerbating factors to loss of appetite, such as pain Monitor lab values Teach patient about easy to prepare nutritional diets Monitor recorded intake for nutritional content and calories Medication regimen (appetite stimulant) Collaborative activities with dietitian, physician, community outreach programs Create pleasant envirnments for eating/dining Rationale Assessments provide baseline information on nutritional deficits and direct plan of care. Medications (appetite stimulant) increase appetite). Patient education provides accurate information on food nutrients, empowers patient to adequately nourish self. Collaboration with dietitian yields accurate dietary advice. Physician provides accu- rate diagnosis pertaining to condition. Reference Toye, F. & Barker, K.L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response., Key Problem # 2 Anxiety Nursing Diagnosis Anxiety related to pain Assessment Data Diminished activity, insomnia, restlessness, distress, irritability, worry, facial tension, trembling, tachycardia, increased perspiration, forgetfulness, preoccupation/impaired attention Interventions Anticipatory guidance: Preparation of patient for anticipated episodes of pain that cause anxiety. Calming techniques: Reducing anxiety using effective breathing exercises. Emotional support: Provision of reassurance, acceptance and encouragement during heightened pain. Patient education: Establish realistic goals; provide information about available community resources; teach symptoms of anxiety; teach family support system how to differentiate anxiety attack from symptoms of physical illness; provide factual information about diagnosis, treatment and prognosis. Rationale Administer medication to reduce anxiety. When negative emotions are anticipated patient is better prepared to address source of problem. Calming techniques provide relief and ability to think rationally. Emotional support provides inspiration for effective management of condition. Patient education empowers the patient to seek effective ways, modalities and interventions to address condition. Medication regimen decreases physiologic responses to stressors. Reference Toye, F. & Barker, K. L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response. LEADS TO ANOREXIA, Health Care Need: Chronic Pain Management Medical Diagnosis Right Knee Degenerative Disease Key Assessments Chronic Pain, poor appetite, irritability, anxiety, loss of self-esteem, depression, altered ability to continue previous activities, restlessness, reduced interaction with people RESULTS IN Key Problem # 3 Nutritional Deficit Nursing Diagnosis Imbalanced nutrition: less than body requirements Assessment data Abdominal pain; hyperactive bowel sounds, refusal to eat, lack of information/ misinformation, lack of appetite, chronic pain, establish baseline laboratory values (transferrin, albumin, calories) Interventions Assess and determine motiva)tion for changing eating habits Assess food preferences Identify and addess exacerbating factors to loss of appetite, such as pain Monitor lab values Teach patient about easy to prepare nutritional diets Monitor recorded intake for nutritional content and calories Medication regimen (appetite stimulant) Collaborative activities with dietitian, physician, community outreach programs Create pleasant envirnments for eating/dining Rationale Assessments provide baseline information on nutritional deficits and direct plan of care. Medications (appetite stimulant) increase appetite). Patient education provides accurate information on food nutrients, empowers patient to adequately nourish self. Collaboration with dietitian yields accurate dietary advice. Physician provides accu- rate diagnosis pertaining to condition. Reference Toye, F. & Barker, K.L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response., Health Care Need: Chronic Pain Management Medical Diagnosis Right Knee Degenerative Disease Key Assessments Chronic Pain, poor appetite, irritability, anxiety, loss of self-esteem, depression, altered ability to continue previous activities, restlessness, reduced interaction with people RESULTS IN Key Problem # 1 Right Knee Pain Nursing Diagnosis Knowledge deficit related to right knee pain management Assessment Data Verbalized pain level 8/10 to right knee, grimacing, warm and swollen knee joint, unsteady gait, irritability, loss of appetite, inadequate sleep, poor body image Interventions Pharmacologic (analgesics, NSAIDs, opioids) Non-pharmacologic (heat, cold application, TENS, acupuncture, massage) Alternative (homeopathy, physiotherapy, spiritual healing) Patient education on pain management Rationale Pharmacokinetics target nociceptors, eliminating the sensation of pain; non-pharmacologic and alternative therapy provide additional relief without drug-related adverse effects; patient education empowers and strengthens the patient's will to manage condition Evaluation Patient verbalized knowledge of alternative measures to relieve pain, stated a pain level maintained at 2/10, resumed previous activity level, demonstrated physical and psychologic well-being, showed enjoyment of leisure activities, maintained good appetite, recognized pain triggers and utilized preventa- tive measures, and used pharmacologic agents appropriately. Reference American Geriatrics Society (1998). The management of chronic pain in older persons., Key Problem # 1 Right Knee Pain Nursing Diagnosis Knowledge deficit related to right knee pain management Assessment Data Verbalized pain level 8/10 to right knee, grimacing, warm and swollen knee joint, unsteady gait, irritability, loss of appetite, inadequate sleep, poor body image Interventions Pharmacologic (analgesics, NSAIDs, opioids) Non-pharmacologic (heat, cold application, TENS, acupuncture, massage) Alternative (homeopathy, physiotherapy, spiritual healing) Patient education on pain management Rationale Pharmacokinetics target nociceptors, eliminating the sensation of pain; non-pharmacologic and alternative therapy provide additional relief without drug-related adverse effects; patient education empowers and strengthens the patient's will to manage condition Evaluation Patient verbalized knowledge of alternative measures to relieve pain, stated a pain level maintained at 2/10, resumed previous activity level, demonstrated physical and psychologic well-being, showed enjoyment of leisure activities, maintained good appetite, recognized pain triggers and utilized preventa- tive measures, and used pharmacologic agents appropriately. Reference American Geriatrics Society (1998). The management of chronic pain in older persons. ???? ANOREXIA, Key Problem # 1 Right Knee Pain Nursing Diagnosis Knowledge deficit related to right knee pain management Assessment Data Verbalized pain level 8/10 to right knee, grimacing, warm and swollen knee joint, unsteady gait, irritability, loss of appetite, inadequate sleep, poor body image Interventions Pharmacologic (analgesics, NSAIDs, opioids) Non-pharmacologic (heat, cold application, TENS, acupuncture, massage) Alternative (homeopathy, physiotherapy, spiritual healing) Patient education on pain management Rationale Pharmacokinetics target nociceptors, eliminating the sensation of pain; non-pharmacologic and alternative therapy provide additional relief without drug-related adverse effects; patient education empowers and strengthens the patient's will to manage condition Evaluation Patient verbalized knowledge of alternative measures to relieve pain, stated a pain level maintained at 2/10, resumed previous activity level, demonstrated physical and psychologic well-being, showed enjoyment of leisure activities, maintained good appetite, recognized pain triggers and utilized preventa- tive measures, and used pharmacologic agents appropriately. Reference American Geriatrics Society (1998). The management of chronic pain in older persons. TRIGGERS Key Problem # 2 Anxiety Nursing Diagnosis Anxiety related to pain Assessment Data Diminished activity, insomnia, restlessness, distress, irritability, worry, facial tension, trembling, tachycardia, increased perspiration, forgetfulness, preoccupation/impaired attention Interventions Anticipatory guidance: Preparation of patient for anticipated episodes of pain that cause anxiety. Calming techniques: Reducing anxiety using effective breathing exercises. Emotional support: Provision of reassurance, acceptance and encouragement during heightened pain. Patient education: Establish realistic goals; provide information about available community resources; teach symptoms of anxiety; teach family support system how to differentiate anxiety attack from symptoms of physical illness; provide factual information about diagnosis, treatment and prognosis. Rationale Administer medication to reduce anxiety. When negative emotions are anticipated patient is better prepared to address source of problem. Calming techniques provide relief and ability to think rationally. Emotional support provides inspiration for effective management of condition. Patient education empowers the patient to seek effective ways, modalities and interventions to address condition. Medication regimen decreases physiologic responses to stressors. Reference Toye, F. & Barker, K. L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response., Key Problem # 2 Anxiety Nursing Diagnosis Anxiety related to pain Assessment Data Diminished activity, insomnia, restlessness, distress, irritability, worry, facial tension, trembling, tachycardia, increased perspiration, forgetfulness, preoccupation/impaired attention Interventions Anticipatory guidance: Preparation of patient for anticipated episodes of pain that cause anxiety. Calming techniques: Reducing anxiety using effective breathing exercises. Emotional support: Provision of reassurance, acceptance and encouragement during heightened pain. Patient education: Establish realistic goals; provide information about available community resources; teach symptoms of anxiety; teach family support system how to differentiate anxiety attack from symptoms of physical illness; provide factual information about diagnosis, treatment and prognosis. Rationale Administer medication to reduce anxiety. When negative emotions are anticipated patient is better prepared to address source of problem. Calming techniques provide relief and ability to think rationally. Emotional support provides inspiration for effective management of condition. Patient education empowers the patient to seek effective ways, modalities and interventions to address condition. Medication regimen decreases physiologic responses to stressors. Reference Toye, F. & Barker, K. L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response. MAY LEAD TO Key Problem # 4 Loss of Self-Esteem Nursing Diagnosis Risk for situational low self-esteem Assessment Data Self evaluation of inability to deal with chronic illness, presence of chronic pain, loss of interest in life events, lack of eye contact Interventions Hope instillation, mood management, self-esteem enhancement, values clarification Patient education on chronic disease process and interventions Rationale Hope instillation will develop positive outlook in the event of pain (chronic). Mood management provides for safety, stabilization, recovery and maintenance in depressive mood related to chronic pain. Self- esteem enhancement will assist patient to increase personal judgment of self-worth despite debilitating chronic condition. Values clarification assists patient in looking at his own values to facilitate effective decision making. Patient education provides information for patient and family support system that teaches behavioral skills. Goals Patient will demonstrate self esteem through verbalization of self-acceptance, will maintain eye contact when communicating, will acknowledge personal strengths, will maintain grooming and hygiene, will participate in decision making regarding plan of care and set realistic goals for pain management. Reference Stevenson, F. & Higgs, P. (2011). 'Ageing Well': Competing discourses and tensions in the management of knee pain., Health Care Need: Chronic Pain Management Medical Diagnosis Right Knee Degenerative Disease Key Assessments Chronic Pain, poor appetite, irritability, anxiety, loss of self-esteem, depression, altered ability to continue previous activities, restlessness, reduced interaction with people RESULTS IN Key Problem # 2 Anxiety Nursing Diagnosis Anxiety related to pain Assessment Data Diminished activity, insomnia, restlessness, distress, irritability, worry, facial tension, trembling, tachycardia, increased perspiration, forgetfulness, preoccupation/impaired attention Interventions Anticipatory guidance: Preparation of patient for anticipated episodes of pain that cause anxiety. Calming techniques: Reducing anxiety using effective breathing exercises. Emotional support: Provision of reassurance, acceptance and encouragement during heightened pain. Patient education: Establish realistic goals; provide information about available community resources; teach symptoms of anxiety; teach family support system how to differentiate anxiety attack from symptoms of physical illness; provide factual information about diagnosis, treatment and prognosis. Rationale Administer medication to reduce anxiety. When negative emotions are anticipated patient is better prepared to address source of problem. Calming techniques provide relief and ability to think rationally. Emotional support provides inspiration for effective management of condition. Patient education empowers the patient to seek effective ways, modalities and interventions to address condition. Medication regimen decreases physiologic responses to stressors. Reference Toye, F. & Barker, K. L. (2008). Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response., ANOREXIA ???? ANEMIA, Health Care Need: Chronic Pain Management Medical Diagnosis Right Knee Degenerative Disease Key Assessments Chronic Pain, poor appetite, irritability, anxiety, loss of self-esteem, depression, altered ability to continue previous activities, restlessness, reduced interaction with people RESULTS IN Key Problem # 4 Loss of Self-Esteem Nursing Diagnosis Risk for situational low self-esteem Assessment Data Self evaluation of inability to deal with chronic illness, presence of chronic pain, loss of interest in life events, lack of eye contact Interventions Hope instillation, mood management, self-esteem enhancement, values clarification Patient education on chronic disease process and interventions Rationale Hope instillation will develop positive outlook in the event of pain (chronic). Mood management provides for safety, stabilization, recovery and maintenance in depressive mood related to chronic pain. Self- esteem enhancement will assist patient to increase personal judgment of self-worth despite debilitating chronic condition. Values clarification assists patient in looking at his own values to facilitate effective decision making. Patient education provides information for patient and family support system that teaches behavioral skills. Goals Patient will demonstrate self esteem through verbalization of self-acceptance, will maintain eye contact when communicating, will acknowledge personal strengths, will maintain grooming and hygiene, will participate in decision making regarding plan of care and set realistic goals for pain management. Reference Stevenson, F. & Higgs, P. (2011). 'Ageing Well': Competing discourses and tensions in the management of knee pain., Key Problem # 4 Loss of Self-Esteem Nursing Diagnosis Risk for situational low self-esteem Assessment Data Self evaluation of inability to deal with chronic illness, presence of chronic pain, loss of interest in life events, lack of eye contact Interventions Hope instillation, mood management, self-esteem enhancement, values clarification Patient education on chronic disease process and interventions Rationale Hope instillation will develop positive outlook in the event of pain (chronic). Mood management provides for safety, stabilization, recovery and maintenance in depressive mood related to chronic pain. Self- esteem enhancement will assist patient to increase personal judgment of self-worth despite debilitating chronic condition. Values clarification assists patient in looking at his own values to facilitate effective decision making. Patient education provides information for patient and family support system that teaches behavioral skills. Goals Patient will demonstrate self esteem through verbalization of self-acceptance, will maintain eye contact when communicating, will acknowledge personal strengths, will maintain grooming and hygiene, will participate in decision making regarding plan of care and set realistic goals for pain management. Reference Stevenson, F. & Higgs, P. (2011). 'Ageing Well': Competing discourses and tensions in the management of knee pain. ???? ANOREXIA