NURSING CARE PLAN

Name of Patient: PATIENT X Diagnosis: OSTEOSARCOMA ASSESSMENT SUBJECTIVE OBJECTIVE Agency/ Area: Rating:

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

NURSING DIAGNOSIS

Situational 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 patients 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

OBJECTIVES LONG-TERM SHORT-TERM

After a week intervention patient will be able After 4 hours intervention patient will to verbalize understanding of individual demonstrate behaviors to restore positive factors that precipitated the current situation, self-esteem. express positive self-appraisal, demonstrate behaviors to restore positive self-esteem, and participate in treatment regimen to correct factors that precipitated the crisis.
NURSING ACTIONS INTERVENTIONS
1. Assess and consider clients preparation for and view of amputation.

RATIONALE
1. Research shows that amputation poses serious threats to clients 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. Encourage expression of fears, negative feelings, and grief 2. Venting emotions helps client begin to deal with the fact over loss of body part. and reality of life without a limb. 3. Reinforce preoperative information, including type and 3. Provides opportunity for client to question and assimilate location of amputation, type of prosthetic fitting if appropriate information and begin to deal with changes in body image (i.e., immediate, delayed), and expected postoperative course, and function, which can facilitate postoperative recovery. including pain control and rehabilitation. 4. Assess degree of support available to client. 4. Sufficient support by significant other (SO) and friends can facilitate rehabilitation process.

5. Discuss clients perceptions of self, related to change, and 5. Aids in defining concerns in relation to previous lifestyle how client sees self in usual lifestyle and role functioning. 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. Ascertain individual strengths and identify previous positive 6. Helpful to build on strengths that are already available for coping behaviors. client to use in coping with current situation.

7. Encourage participation in activities of daily living (ADLs). 7. Promotes independence and enhances feelings of selfProvide opportunities to view and care for residual limb, using worth. Although integration of residual limb into body image the moment to point out positive signs of healing. can take months or even years, looking at the residual limb and hearing positive comments made in a normal, matter-offact manner can help client with this acceptance.

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

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.

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

10. Note withdrawn behavior, negative self-talk, use of denial, 10. Identifies stage of grief and need for interventions or overconcern with actual or perceived changes.

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: Student Nurses Signature over Printed Name DATE:

Evaluated by: Clinical Instructors Signature over Printed Name DATE: Agency/ Area: Rating: Assessment Nursing Diagnosis Scientific Explanation Objectives Nursing Actions Rationale Expected Outcome/ Evaluation POINTS 25 15 10 10 25 10 5 SCORE

TOTAL: TRANSMUTED GRADE (60% Passing Score):

NURSING CARE PLAN

Name of Patient: PATIENT X Diagnosis: OSTEOSARCOMA ASSESSMENT SUBJECTIVE OBJECTIVE >Reluctance to attempt movement >Impaired coordination >Decreased muscle strength Agency/ Area: Rating:

Impaired physical mobility related to discomfort; perceptual impairment.

NURSING DIAGNOSIS loss of limb particularly

a lower extremity; pain or

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.

OBJECTIVES SHORT-TERM After a week of hospitalization the client will After 4 hours of nursing interventions, the patient will verbalize understanding of individual situation, maintain or increase the strength and functioning of affected compensatory part. 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. LONG-TERM

NURSING ACTIONS INTERVENTIONS

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.

RATIONALE
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. Measure circumference periodically.

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

3. Rewrap residual limb immediately with an elastic bandage, 3. Edema will occur rapidly, thus delaying rehabilitation. 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.

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

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

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

6. Provide trochanter rolls, as indicated.

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

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

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 clients 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.

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.

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: Student Nurses Signature over Printed Name DATE:

Evaluated by: Clinical Instructors Signature over Printed Name DATE:

Rating: Assessment Nursing Diagnosis Scientific Explanation Objectives Nursing Actions Rationale Expected Outcome/ Evaluation

POINTS 25 15 10 10 25 10 5

SCORE

TOTAL: TRANSMUTED GRADE (60% Passing Score):