Application of Orem
Application of Orem
Application of Orem
theory
This page was last updated on September 9, 2013
OBJECTIVES
PATIENT PROFILE
Age 56 year
Gender Female
Health state Disability due to health condition,
therapeutic self care demand
Development state Ego integrity vs despair
Sociocultural orientation No formal education, Indian, Hindu
Health care system Institutional health care
Family system Married, husband working
Patterns of living At home with partner
Environment Rural area, items for ADL not in easy
reach, no special precautions to
prevent injuries
resources Husband, daughter, sister’s son
T. Valus SR OD
T. Pan 40 mg OD
T. Tramazac 50 mg OD
T. Recofix Forte BD
T. Shelcal BD
Syp. Heamup 2tsp TID
Air
Water
Food
Elimination
Activity/ Rest
Solitude/ Interaction
Prevention of hazards
Promotion of normalcy
Maintain a developmental environment.
Prevent or manage the developmental threats
Maintenance of health status
Awareness and management of the disease process.
Adherence to the medical regimen
Awareness of potential problem.
modify self image
Adjust life style to accommodate health status changes and MR
Thus in the patient Mrs. X the areas that need assistance were…
Air
Water
Food
Elimination
Activity/ Rest(2)
Solitude/ Interaction
Prevention of hazards(2)
Promotion of normalcy
Maintain a developmental environment.
Prevent or manage the developmental threats
Maintenance of health status
Awareness and management of the disease process.
Adherence to the medical regimen
Awareness of potential problem.
modify self image
Adjust life style to accommodate health status changes and medical regimen
NURSING DIAGNOSIS
a. Outcome:
Improved nutrition
Maintenance of a balanced diet with adequate iron supplementation.
supportive educative
d. Method of helping:
guidance
support
Teaching
Providing developmental environment
IMPLEMENTATION
Mutually planned and identified the objectives and the patient were made to
understand about the required changes in the behaviour to have the
requisites met.
EVALUATION
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NURSING DIAGNOSIS
a. Outcome:
improved self-care
maintain the ability to perform the toileting and dressing with modification as
required.
d. Method of helping:
1. Guidance:
Assess the various hindering factors for self care and how to tackle them.
2. Support:
Provide all the articles needed for self care, near to the patient and ask the
family members also to give the articles near to her.
Provide passive exercises and make to perform active exercises so as to
promote the mobility of the joint.
Make the patient use commodes or stools to perform toileting and insist on
avoidance of squatting position
Provide assistance whenever needed for the self care activities
Provide encouragement and positive reinforcement for minor improvement in
the activity level.
Initiate the pain relieving measures always before the patient go for any of
the activities of daily living
Make the patient to use loose fitting clothes which will be easy to wear and
remove.
3. Teaching:
Teach the family members the limitation in the activity level the patient has
and the cooperation required
Teach the family and help them to practice how to help the patient according
to her needs
IMPLEMENTATION
Mutually planned and identified the objectives and the patient was made to
understand about the required changes in the behaviour to have the
requisites met.
EVALUATION
Patient was performing some of the activities and she practiced toileting
using a commode in the hospital.
She verbalized an improved comfort and self care ability.
She performed the dressing activities with minimal assistance
Patient verbalized that she will perform the activities as instructed to get her
ADL done.
The partly compensatory system was useful for Mrs. X
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C. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PAIN CONTROL
NURSING DIAGNOSIS
a. Outcome:
d. method of helping:
Guidance:
Explore the past experience of pain and methods used to manage them.
Ask the client to report the intensity, location, severity, associated and
aggravating factors.
Support:
Teaching:
Teach the non – pharmacological method to the patient once the pain is a
little reduced.
Discuss with the patient the necessity to maintain a pain diary with all
information regarding episodes of pain and refer to that periodically
Enquire from the health team, the need for opioid analgesics or other
analgesics and get a prescription for the patient.
IMPLEMENTATION
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EVALUATION
Patient still has pain over the joints and she agreed that she will use the
measures for pain relief that is told to her.
The pain scale score was 6 after the measures were provided to the patient.
She demonstrated slight reduction in the pain behaviours.
The supportive educative system was useful for Mrs. X
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NURSING DIAGNOSIS
a. Outcome:
Goal: prevent the falls and injury and to maintain a good body mechanics.
d. method of helping:
Support
IMPLEMENTATION
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EVALUATION
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E. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: PREVENTION OF
HAZARDS.
NURSING DIAGNOSIS:
Goal: Maintain the skin integrity and take measures to prevent skin impairment.
d. method of helping:
Support:
Assess the skin regularly for any excoriation or loss of integrity or colour
changes. Keep the skin clean always
Avoid stress or pressure over the area of edema by providing extra cushions
or padding
Monitor the lab values as well as the patient for any signs and symptoms of
renal failure.
Encourage the patient to use slippers while walking and that should not be
tight fitting.
Assess the edema for its degree, pitting or non pitting and continue the
assessment daily.
Provide a leg end elevated position or elevation of the leg on a pillow if no
cardiac abnormalities are identified.
Explain the patient the need for taking care of the edematous parts
Explain the patient to report the symptoms like decreased urine output,
palpitations, increased edema etc. to the health team
IMPLEMENTATION
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EVALUATION
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F. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: AWARENESS OF
THE DISEASE PROCESS AND MANAGEMENT
NURSING DIAGNOSIS
a. Outcome:
Goal: Improve the knowledge of the patient about the disease process and the
complications.
supportive educative
d. Methods of helping:
Guidance
Teaching
Promoting a developmental environment
IMPLEMENTATION
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EVALUATION
Patient got adequate information regarding the disease
She verbalized what she understood about the disease and its management.
Patient has cleared her doubts regarding the medication actions and the side
effect
The supportive educative system was useful for Mrs. X
The theory of self-care deficit when applied could identify the self care requisites of
Mrs. X from various aspects. This was helpful to provide care in a comprehensive
manner. Patient was very cooperative. the application of this theory revealed how well
the supportive and educative and partly compensatory system could be used for
solving the problems in a patient with rheumatoid arthritis.
REFERENCES