Case study-Nursing Care Plan: Stress & Coping
Case study-Nursing Care Plan: Stress & Coping
Directions: Complete the following case study using this template. Identify at least two
problems for this family. Determine if the family is coping, (no right or wrong answers) and tell
me why you feel that way (use your assessment skills). Write at least 3 goals and expected
outcomes for each. Make sure they are written as SMART goals and outcomes. Use Nursing
Intervention Classifications and provide the rationale for why you chose that intervention.
Create at least 3 interventions (one for each goal). Explain what you did as the nurse, how the
patient/spouse responded (expected response) and describe whether or not you achieved your
expected outcome. Evaluate your interventions. As this is not being done in person your
evaluation will be hypothetical and assumes that you actually met with the couple and were able
to apply your interventions so your evaluation will assume that your goals were or were not met
(your choice).
Assessment:
Sandra and john have been married only three years; they are both 55 years old. This is a late
marriage for both of them; neither was previously married. They both work and plan on retiring
at age 66. Last month John was diagnosed with stage 3 pancreatic cancer. Presently Jon and
Sandra are in the early phase of treatment options. At this point in time they are both working.
They are at the Cancer Center today to decide on some treatment options. When you greet the
couple, you notice that they both look tired, Sandra is disheveled, and John is clean shaven and
well groomed. John states that he is worried about Sandra as she appears “just worn out,” and he
is afraid that she will not be able to help him through this medical crisis.
ASSESSMENT ACTIVITIES
Ask Sandra how she feels about John’s
diagnosis
Ask Sandra what she remembers about John’s
treatment options
Ask John and Sandra about their support
network
Ask Sandra to identify people she can turn to
for help
FINDINGS/DEFINING
CHARACTERISTICS
Sandra states, “There’s so much. I just feel
inadequate and overwhelmed. I don’t even
know how I feel. I know I feel very alone.”
She states, “I can’t really remember anything
but stage 3 pancreatic cancer. I got on the
internet so I know this is a bad cancer.”
Both are only children and have no other
family; they moved to the NW last year for
new jobs. They both work for the same
company but state that they have a few close
friends
Sandra sobs and feels that she doesn’t have
anyone locally to whom she can turn. They
are active in the church. On further
discussion Sandra mentions a close friend
from the Midwest.
Case study-Nursing Care Plan: Stress & Coping
Ask Sandra about sleep and nutrition patterns.
Assess Sandra’s mood and affect by asking
how she is feeling.
She can’t get to sleep easily and awakens 34x per night. States, “Appetite is poor; I’m
just not hungry. I think I’ve lost weight
because my clothes are loose, but I don’t
know.
She states, “I feel very tired. Everything feels
overwhelming.”
What are some problems that you have identified for this family?
Fear and anxiety around John’s diagnosis AEB Sandra’s disheveled appearance and her inability
to recall treatment options regarding his condition. She is also using the internet as a source of
information. Additionally, the stress of dealing with this alone could be a problem. Sandra states
that she does not have anyone to turn to.
Is this family coping? Why or why not?
John and Sandra are not coping very well as they seem to be trying to manage this stress on their
own. Sandra’s own health could be at risk as she is now not eating or sleeping well. John states
that he is unsure that his wife can help him.
Nursing Diagnosis: What nursing dx have you identified?



Compromised family coping
Ineffective Health Maintenance
Fear/Anxiety
Planning: What are some goals and expected outcomes identified for this family based on the
chosen nursing dx? Goals and expected outcomes are specific, measurable, attainable, realistic,
and times.
GOALS
Example goal statement: Patient will
ambulate independently in 3 days
Sandra and John will reach out to a church
member, the close Midwest friend, or a
support group by John’s next appointment
John and Sandra will express ways they can
cope with stress and anxiety by next
appointment
Sandra will express ways to focus on herself
and manage her self-care by next meeting
EXPECTED OUTCOMES (nursing
outcomes classification)
Example outcome statement: Patient
ambulates in the all 3 times a day by 4/22.
Sandra and John will be more relaxed by next
meeting.
Sandra and John will have various ways to
cope thereby being more able to focus on
John’s treatment options.
Sandra will appear well groomed and she will
also have begun to gain weight back.
Case study-Nursing Care Plan: Stress & Coping
Sandra And John will express ways to get
information on John’s condition other than
the internet by end of the appointment
Sandra and John will utilize the Cancer
Center and EBP resources to help stay better
informed.
Interventions: Identify nursing intervention classifications
INTERVENTIONS (nursing intervention
classifications)
Use Therapeutic communication, activelistening, acknowledgment, nonverbal, silence
to assess and help Sandra and John express
their feelings
Reinforce and help provide teachings on
diseases process and reinforce providers
information on treatment options. Provide
factual information
Observe and discuss any strengths that Sandra
and John have such as the church for support
Give information on groups or other support
systems.
Offer to set up a home health visit for
palliative care
RATIONALE
This will help the couple deal with this
situation and express what they may need
This provides Sandra and John correct
information, and they may not search the
internet
This will help identify where they are doing
well and how they are managing successfully
Sandra and John may also need outside
support such as others in their situation
This can further evaluative the needs of
Sandra and John and help identify any further
assistance
Evaluation:
NURSING ACTIONS
Set up palliative care
Discussed supportive options
Discussed Sandra’s decline in
health
PT RESPONSE
ACHIEVEMENT OF
OUTCOME
Sandra and John decided to
Sandra and John have hired a
enlist more help in their home housekeeper to alleviate
Sandra’s stress
The couple joined a cancer
They have set aside Wed
group each Wed
evenings as a “Cancer date
night”
Sandra is taking yoga classes John is able to focus on his
own treatment.
Case study-Nursing Care Plan: Stress & Coping
References
Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care. (n.d.).
https://online.vitalsource.com/#/books/9780323322249/. https://online.vitalsource.com/