Questionnaire | English homework help

Stephanie Petit-homme

Miami Regional University

Professor: Garcia Mercedes

06/20/2021

I Identifying Data

· Name:

The patient’s name is Mr. R. and his wife’s name is Mrs. R

· Address:

151st Jamaica, Kingstone (FL), 8080.

· Phone number(s):

Not available

Nursing Diagnosis:

Mr. R.:

•Will monitor and record blood glucose levels every morning

•Will accept administration of insulin by Mrs. R

•Will begin range-of-motion and strengthening exercises to promote mobility for eventual transfer of self to chair

•Will communicate to Mrs. R. his ability to take care of any of his own needs as each opportunity arises

•Will demonstrate improved blood glucose levels within 1 month

Mrs. R.:

•Will have her cardiac status evaluated within 2 weeks

•Will self-monitor her health and record her health status for 1 week

•Will decide on one goal to take care of herself within 2 weeks

•Will practice this behavior for 1 month

•Will allow Mr. R. to care for himself when he desires

Mr. and Mrs. R. together:

•Will experience decreased frequency of arguments within 1 month

•Will spend some relaxed time together every evening

The family:

•Will discuss new ways of coping with this situation as a group

•Will try out two behaviors that use different family members within 2 weeks

•Will accept one resource to help within 1 month

· Household members (relationship, gender, age, occupation, education):

Mr. R is an 80 years-old male and is a retired pipe fitter. He is a husband who is diabetic, refusing to accept his wife’s help. Doris is Mr. R’s wife of Mr. R. and is 74 years old. She has been a house maker, has been taking care of her husband, and she has emotional exhaustion and anxiety. Patricia is the eldest daughter of Mr. R. She always keep in touch with her parents. Tom and Ellan are also children of Mr. R. They are not as close to their parents as Patricia is actually with them.

· Financial data (sources of income, financial assistance, medical care; expenditures):

Mr. and Mrs. R are both retired, meanwhile, their children provide financial support.

· Ethnicity:

White Americans.

· Religion:

They are not that quite religious.

· Identified client(s):

Mr. R is the client at the mean time.

· Source of referral and reason:

Mr. is diagnosed with arteriosclerosis and peripheral nephropathy. The family has referred itself to the community nurse because it does not want to sort help outside their community.

II Genogram



· Include household members, extended family, and significant others.

· Age or date of birth, occupation, geographical location, illnesses, health problems, major events

· Triangles and characteristics of relationships

III Individual Health Needs (for each household family member)

· Identified health problems or concerns:

Mr. R. children did not seem to have any concern but their father problem is that he is diagnosed with diabetes, peripheral neuropathy, arteriosclerosis, and impairment of the circulation of the left leg causing amputation below the knee.

· Medical diagnoses:

Experiences arteriosclerotic cardiovascular disease and peripheral neuropathy. Has also Diabetes mellitus in type 2 form (moderate-severe).

· Recent surgery or hospitalizations:

Mr. R.’s left leg has been amputated after 2 months stay in the hospital.

· Medications and immunizations:

Mr. R.’s diabetes is well-controlled by external insulin treatment with diet and exercise.

· Physical assessment data:

Mr. R. appears somewhat drowsy and unkempt. Mr. R faced lack of movement due to knee amputation and was placed in a wheelchair, also he had dark circles under his eyes.

· Emotional and cognitive functioning:

Mr. R is cranky, irritable, and demanding. Mrs. R. looks anxious and tired, her skin color is slightly ashen, and she has circles under her eyes. Patricia, Tom, and Ellen were also experiencing emotional and cognitive problems.

· Coping:

Mr. R. seems to be dependent on his wife for almost all aspects of daily living; He does not care for himself. He has little control over his diabetes and is often confused about what health problems he is experiencing.

· Sources of medical and dental care:

Sources of medical care come from the community nurse during her home visits.

· Health screening practices:

Mr. R will monitor and record blood glucose levels every morning. Also, she will have his cardiac status evaluated within 2 weeks

IV Interpersonal Needs

· Identified subsystems and dyads:

Identified subsystem and dyads: The R. family consists of a nuclear family with a married couple, Doris, and Mr. R., who have three children and four grandchildren. The family is in a state of serious crisis, but you must still assess the family as a whole rather than focusing on just one member or subsystem.

· Prenatal care needed:

Based on the assessment, prenatal care may be needed for Mrs. R., given her age and medical history, and possibly her husband as well since he has diabetes and is obese. A home visit might help the nurse to assess how Mr. R.’s medications are managed to improve his health status.

· Parent–child interactions:

Patricia calls or stops by every week.

· Spousal relationships

In my opinion their spousal relationships were poor. But, the nurse appropriately assessed the relationship dynamics between Mr. and Mrs. R., noting that it was nurturing and supportive, even though Mr. R had diabetes, high blood pressure, obesity, and mobility issues.

· Sibling relationships:

Tom and Ellen have very little communication with the other family members.

· Concerns about older members:

The family is very private to itself.

· Caring for other dependent members:

Mr. R is dependent on Mrs. R.

· Significant others:

There are no significant others in the family.

V Family Needs

· A. Developmental

· Children and ages:

Patricia, Tom, and Helen of whom their ages are not mentioned.

· Responsibilities for other members:

Patricia tries to check up on her father and mother once a week. All three children were responsible for the parent’s financial status.

· Recent additions or loss of members:

There were four grandchildren. Mr. R passes on a few months later.

· Other major normative transitions occurring now:

Mr. and Mrs. R must change their diet and lifestyle all together. Due to Mr. R’s illness he could not proceed on supporting the family.

· Transitions that are out of sequence or delayed:

Mr. R tries to use a walker.

· Tasks that need to be accomplished:

Mr. R.:

•Will monitor and record blood glucose levels every morning

•Will accept administration of insulin by Mrs. R

•Will begin range-of-motion and strengthening exercises to promote mobility for eventual transfer of self to chair

•Will communicate to Mrs. R. his ability to take care of any of his own needs as each opportunity arises

•Will demonstrate improved blood glucose levels within 1 month

Mrs. R.:

•Will have her cardiac status evaluated within 2 weeks

•Will self-monitor her health and record her health status for 1 week

•Will decide on one goal to take care of herself within 2 weeks

•Will practice this behavior for 1 month

•Will allow Mr. R. to care for himself when he desires

Mr. and Mrs. R. together:

•Will experience decreased frequency of arguments within 1 month

•Will spend some relaxed time together every evening

The family:

•Will discuss new ways of coping with this situation as a group

•Will try out two behaviors that use different family members within 2 weeks

•Will accept one resource to help within 1 month

· Daily health-promotion practices for nutrition, sleep, leisure, child care, hygiene, socialization, transmission of norms and values:

Doris has made changes in food preparation and her lifestyle adjustments.

· Family planning used:

Mr. and Mrs. R should use family planning methods to prevent occurrence of pregnancy now.

· B. Loss or Illness

· Nonnormative events or illnesses:

Mr. R.’s hyperglycemia is noted.

Mrs. R.’s cardiac status is to be assessed.

· Reactions and perceptions of ability to cope:

No member has consistently been a problem or has failed to fulfill her or his role. The adult children are not acting in their age-appropriate roles of support to parents. This status seems to reflect the family style but can possibly be modified.

· Coping behaviors used by individuals and family unit:

The children have started helping and being concerned about the family.

· Meaning to the family:

This has been of great help to the family because the children have started helping.

· Adjustments family has made:

Mr. R. is having a controlled with diet.

· Roles and tasks being assumed by members:

Doris has become Mr. R’s “watchdog” since she schedules his physician appointments, buys his medical supplies, and administers his insulin.

· Any one individual bearing most of responsibility:

Doris, Mr. R’s Wife

· Family idea of alternative coping behaviors available:

Mr. R has started learning how to use a cane.

· Level of anxiety now and usually:

Mr. and Mrs. R look anxious because of the nurse visit.

· C. Resources and Support

· General level of resources and economic exchange with community:

It is poor because the family is so restrained and private.

· External sources of instrumental support (money, home aides, transportation, medicines, etc.):

The community nurse has been coming over to help offer home based care.

· Internal sources of instrumental support (available from family members):

Mr. R moves with the help of a wheelchair.

· External sources of affective support (emotional and social support, help with problem solving):

The community has tried helping the family but the family s so restrained to itself.

· Internal sources of affective support (who in family is most helpful to whom?):

Doris is most helpful to her husband Mr. R.

· Family more open or closed to outside?

The family is more closed to the outside.

· Family willing to use external sources of support?

The family is unwilling to use external sources of support.

· D. Environment

· Type of dwelling:

The family mostly dwells at home

· Number of rooms, bathrooms, stairs; refrigeration, cooking: *

The cooking is diet based because of Mr. R’s condition.

· Water and sewage:

Mr. R should drink a lot of water because of his condition.

· Sleeping arrangements:

The family should manage to get enough sleep.

· Types of jobs held by members: *

All the children offer support including Mrs. R.

· Exposure to hazardous conditions at job:

They are all retired hence not subjected to hazardous conditions.

· Level of safety in the neighborhood:

The neighborhood safety is above average.

· Level of safety in household:

The household safety is also above average.

· Attitudes toward involvement in community:

The family does not want to be involved in anything from the neighborhood.

· Compliance with rules and laws of society:

The society maintains that anyone with an issue in the society should be seen by the community nurse.

· How are values similar to and different from those of the immediate social environment?

That the family does not like getting involved with the community.

· E. Internal Dynamics

· Roles of family members clearly defined?

Doris schedules his physician appointments, buys his medical supplies, and administers his insulin.

· Where do authority and decision making rest?

From both Mr. and Mrs. R.

· Subsystems and members:

Everyone in the family is part of the care program.

· Hierarchies, coalitions, and boundaries:

There are no hierarchies and boundaries in the family.

· Typical patterns of interaction:

The family gets along very well.

· Communication, including verbal and nonverbal:

The communication is a bit off since Mr. R is so irritable.

· Expression of affection, anger, anxiety, support, etc.:

Mrs R is anxious and angry about her husband’s behavior.

· Problem-solving style:

The family solves problems as a team.

· Degree of cohesiveness and loyalty to family members:

The bonds of the wife to his husband is strong but that of the children is weak.

· Conflict management:

The family does not possess conflict management skills at all.

VI Analysis

· Identification of family style:

The family style is extended.

· Identification of family strengths:

The family-style of functioning is identified as “supportive” and “responsible.” Within the family strong supports are provided by the mother

· Identification of family functioning:

Even though the family is currently stressed, long-term functioning is fairly healthy. No one member has consistently been a problem or has failed to fulfill her or his role. The adult children are not acting in their age-appropriate roles of support to parents. This status seems to reflect the family style but can possibly be modified.

· What are needs identified by family?

The outstanding needs are those of Mr. R of mobility and care.

· What are needs identified by community/public health nurse?

Mr. R needs to accept help from his wife, and Mrs. R should go for a cardiac checkup.

References

Smith, F.M. C. Community/Public Health Nursing Practice. [VitalSource Bookshelf]. Retrieved

from https://online.vitalsource.com/#/books/978-1-4557-0762-1/

Maurer, F. & Smith, C. (2013). Community/Public Health Nursing Practice: Health for families and populations (5th ed.). St. Louis, MO: Elsevier Mosby.

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