care of the client with pulmonary tuberculosis utilizing orem's theory

7/28/2019 Care of the Client With Pulmonary Tuberculosis Utilizing orem's theory

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CARE OF THE CLIENT WITHPULMONARY TUBERCULOSISUTILIZING DOROTHEA

OREMS SELF CARE THEORYo The Philippines is among the 22 highburden countries for tuberculosis. TB is

the 6th leading cause of illness andthe 6th leading cause of deaths

among Filipinos (WHO 2007)
http://doh.gov.ph/node/1452.htmlhttp://doh.gov.ph/node/1452.html


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oThis clinical research study is proposed todetermine if there is significant effect in thehealth awareness and improvement on self carerequisites of a patient with Pulmonary

Tuberculosis using Orems Self Care Theory whenapplied in the nursing process. The aim is to giveknowledge through education so that patient canperform self care activities to meet needs, and

self care being adhering to treatment.

oNursing has responsibility that focus more

towards health promotion strategies that includea greater emphasis on teaching patients toassume more responsibility toward self-care.

INTRODUCTION


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Is there a significant effect in thehealth awareness and improvementon self care requisites of a patientwith Pulmonary Tuberculosis whenSelf Care Theory by Orem will be

applied in the nursing process?

Statement of the Problem


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CONCEPTUAL/THEORETICAL FRAMEWORK

NOT MET MET

NURSINGINTERVENTION

(NURSING SYSTEMS)

SELF CAREDEFICIT

SELF CAREHEALTH

UNIVERSALSELF CAREREQUISITE

DEVELOPMENTALSELF CAREREQUISITE

HEALTH DEVIATIONSELF CAREREQUISITE

SELF CARE REQUISITES


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METHODOLOGY

The assessment tool was developed within the framework of Orems (1995)self-care requisites. The tool was designed to assess the universal,

developmental, and health deviation self-care requisites of the client. Eachself care requisite category (universal, developmental, and healthdeviation) is broken down into its categorical components.

The tool is entitled the Self-Care Requisite Assessment Tool. For everyquestion, there were 5 responses to choose from and the following weights

were assigned to each response:Response Weight

Always 5

Most of the time 4

Sometimes 3

Seldom 2

Never 1

Clients response to universal self care requisites, developmental self carerequisites and health deviation self care requisites were determined byutilizing the formula to find the mean (average) of each category.

xX =

N


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RESEARCH INSTRUMENT

Self-Care Requisite AssessmentTool

(Adapted from Roque, F. Study onAcute Gastroenteritis with Severe

Dehydration)


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DATA ANALYSIS

Self-care

Requisites

Mean Score of InitialAssessment

Mean Score of FinalAssessment Mean

DifferenceMeanScore

Description Mean Score Description

UniversalSelf care

Requisites3.22 Good 4.05 Very Good 0.83

DevelopmentalSelf-careRequisites

2.50 Fair 3.83 Good 1.33

HealthDeviation Selfcare Requisites

2.20 Fair 4.20 Very Good 2.00

Total 2.89 Fair 4.03 Very Good 1.14

The clients mean difference was obtained by subtracting the clientsoverall mean score of initial assessment and overall means score

from the final assessment results.


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PATIENTS BACKGROUND

Name : Mrs. MG

Age : 46 years oldSex : FemaleCivil Status : MarriedOccupation : HousewifeEducational Attainment : Elementary Graduate

oPatient does not have any regular medical and dentalcheck-ups because of lack of time and financialinsufficiency.oThe patient has an anti-Tuberculosis drug with Fixed-dose Combination for 8 weeks, then Isoniazid/Rifampinfor 16 weeks . For the first 3 weeks, she is compliant withthe treatment regimen. But after few weeks she seemed

to be non-compliant with it.


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NURSING CARE PLAN

ASSESSMENT NURSING

DIAGNOSIS

OBJECTIVES OF

CARE

NURSING INTERVENTIONS/

RATIONALE

EVALUATION/

OUTCOME

Subjective Data

Wala ko kabalo nga

may ara na ko sangbalati-an kay daw okay

man lang akon

pamatyag.

(I dont know that I

already have the disease

because I seemed okay).

Nakuha ko ni siguro sa

mga pagkaon nga gina

kaon ko.

(Maybe I got this disease

from the food Im

eating).

Objective Data-Presence of cough

-Not covering her mouth

and nose when

coughing

-Body weakness

-Poor personal hygiene

and sanitation

Knowledge

Deficit

r/t lack ofinformation and

limited

knowledge about

condition,

prevention and

self-care of

havingTuberculosis as

evidenced by

expressed

misconceptions

and practices

towards health

status.

Within 14 days

of nursing

intervention,Mrs. MG will be

able to:

1. Verbalize

understandingof disease

process/prognos

is and

prevention.

2. Initiate

behaviors/lifestyle changes to

improve general

well-being and

reduce risk of

reactivation of

TB.

Independent

1.Baseline data gathering

about Mrs. MG on the recordsfrom the City Health Office and

Brgy. Health Station. (Baseline

data are essential for

comparison of any significant

changes).

2.Establish rapport with Mrs.

MG by visiting in her house andidentifying the purpose of the

home visit. (To establish trust

and cooperation in the patient.

3.Assess patients ability to

learn, e.g., level of fear,

concern, fatigue, participation

level; best environment inwhich patient can learn; how

much content; best media and

language; who should be

included. (Learning depends on

emotional and physical

readiness and is achieved at an

individual pace).

Within 14

days of

nursingintervention

, Mrs. MG

was be able

to:

1.Verbalized

understandi

ng of the

disease

process and

prevention.

2. Discuss

food choices

and lifestyle

change baseon

individual

needs.

.


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3. Identify

symptoms

requiring

evaluation/inte

rvention.

4. Describe a

plan for

receiving

adequate

follow-up care.

5. Verbalize

understanding

of therapeutic

regimen andrationale for

actions.

4.Provide instruction and specific written

information for patient to refer to, e.g., schedule

for medications and follow-up sputum testing

for documenting response to therapy.(Written

information relieves patient of the burden of

having to remember large amounts ofinformation. Repetition strengthens learning).

5.Emphasize importance of maintaining high-

protein and carbohydrate diet and adequate

fluid intake. (Meeting metabolic needs help

minimize fatigue and promote recovery. Fluids

aid in liquefying/expectorating secretions).

6.Explain medication dosage, frequency of

administration, expected action, and the reason

for long treatment period. Review potential

interactions with other drugs/substances.(

Enhances cooperation with therapeutic regimen

and may prevent patient from discontinuing

medication before cure is truly effected.Stress need to abstain from alcohol while on

INH.( Combination of INH and alcohol has been

linked with increased incidence of hepatitis.)

7.Perform daily home visit to note down

observation in taking her medication and

practices. (To assure patients compliance.)

3. Understand

the need to

report any

untoward drug

reactions.

4. Reports adverse

effects of

medications to

health care

personnel to allowfor early

intervention.

5. Verbalized

individual

treatment regimen

and its purpose.


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FINDINGS1. During initial assessment, the results are as follows: Universal

Self Care Requisites Good, Developmental Self CareRequisites Fair and Health Deviation Self Care Requisites Fair. The clients mean score was 2.89, indicating a Fair levelofclients self care requisites.

2. In the Final assessment, the following are the results:Universal Self Care Requisites Very Good, DevelopmentalSelf Care Requisites Good and Health Deviation Self CareRequisites Very Good. Clients mean score was 4.03, whichshowed a Very Good level ofclients self care requisites.

3. There was an increase of 1.14 noted between the initial andfinal assessment using the same assessment tool. From 2.89it increased to 4.03 which demonstrate an improvement inthe level ofclients self care requisites.


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RECOMMENDATIONS

Nursing Practice. The application ofOrems Self Care Theory

should be used in nursing practice as an effective approachfor the future development programs related to tuberculosiswhich aims in patients education and health promotion in asystematic and holistic way.

Nursing Education. The educators and nursing studentsshould enhance their teaching and learning strategies inorder to have proper knowledge in the application ofOremsSelf Care Theory. This goes in assessing the needs andproviding health education to tuberculosis patients.

Nursing Research. The application of Orems Self CareTheory can also be used in conducting studies for otherdiseases and medical cases. The theory will serve as a guidein patient assessment and intervention to ensure qualitynursing care.

care of the client with pulmonary tuberculosis utilizing orem's theory

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