Case Study # 2
PN Program
LaGuardia Community College
Spring I 2007
Name: Anaise Ikama
Date: May 21, 2007
Al and Louise are couple in their mid-seventies. They have been married for 38 years. In the last three years
Louise suffered a mild heart attack and has had repeated hospitalizations about every month. She is diabetic but is non compliant with her medication and diet regime. She now self-administers her own insulin, Lantus, every evening. Her kidneys are mildly dysfunctional and she is on antibiotics for seven weeks for a UTI. She is severely depressed but states her antidepressant ran out last week. She is now shaky and teary-eyed and asking the nurse next door to come over and help her administer her SC epogen.
Al, on the other hand, has had palladium seeds implanted in his scrotum as a result of a prostate cancer diagnosed three months ago. He is quite able-bodied, still drives and shows no ill effects from the treatment.
Al and Louise are getting divorced because Louise cannot stand Al and they argue all the time. They are in the midst of selling their house and each will move into their own apartment. The closing date is fast approaching.
The nurse administers Louise’s SC epogen in the right mid-lateral thigh, and sits and listens for an hour to
Louise.
On a separate sheet please type your responses to these questions and turn in with this page on the top. Make sure your name is on both pages. Place one staple in the top left corner. You may consult one another, and any text. However, your submitted work must be your own. Make sure what your paper states is what YOU yourself would choose to do.
1.
Identify as many NANDA bases as you can for Louise, and list them out. (At least 5)
2.
List the diagnosis in order according to Maslow’s Hierarchy of Needs
3.
Looking at your whole list, what are the three most important problems you feel should be addressed right now?
4.
List at least three nursing interventions with rationales (cite your references) that you would perform to assist with each of the three problems you identified.

Answer to Questions in Case Study # 2
1. Identify as many NANDA bases as you can for Louise, and list them out (at least 5).
- Activity Intolerance
- Ineffective health maintenance
- Impaired Urinary elimination
2.
- Ineffective family coping
- Risk for Ineffective Therapeutic Regiment Management
List the diagnosis in order according to Maslow’s Hierarchy of needs
5. Ineffective family coping (Love and Belonging Needs)
4. Risk for Ineffective Therapeutic Regiment Management (Physiological Needs)
3. Ineffective health maintenance (Safety and Security Needs)
2. Impaired Urinary elimination (Physiological Needs)
1. Activity Intolerance (Physiological Needs)
3. now?
Looking at your whole list, what are the three most important problems you feel should be addressed right
The three most important problems that should be addressed right now are: Activity Intolerance, Impaired Urinary elimination and Ineffective health maintenance.

4. List at least three nursing interventions with rationales (cite your references) that you would perform to assist
with each of the three problems you identified.
Nursing Diagnosis Nursing Interventions Rationales
I- Activity Intolerance related to insufficient oxygen for activities of daily living (Handbook of
Nursing Diagnosis 11Ed).
As evidenced by repeated hospitalization.
1. Assess the client daily for appropriateness of activity and bed rest orders (Ackley J. Betty and Gail B.
Ladwig. Nursing Diagnosis Handbook.
7 Ed. Page 149)
1. Inappropriate prolonged bed rest orders may contribute to activity intolerance (Ackley J. Betty and Gail B.
Ladwig. Nursing Diagnosis Handbook. 7
Ed. Page 149)
2.If mainly on bed rest, minimize cardiovascular deconditioning by positioning the client in an upright position several times daily (Ackley J.
Betty and Gail B. Ladwig. Nursing
Diagnosis Handbook. 7 Ed. Page 149).
2. Deconditioning of the cardiovascular system occurs within days and involves fluids shifts, fluid loss, decreased cardiac output, decreased peak oxygen uptake, and increased resting heart rate (Ackley J.
Betty and Gail B. Ladwig. Nursing
Diagnosis Handbook. 7 Ed. Page 149)
3.When appropriate, gradually increase activity, allowing the client to assist with positioning, transferring, and selfcare as possible. Progress from sitting in bed to dangling, to standing, to ambulation… (Ackley J. Betty and Gail
B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 149)
3.Always have the client dangle at the bedside before trying standing to evaluate for postural hypertension.
Watch the client closely for dizziness during increased activity.

II- Impaired urinary elimination related to mildly dysfunctional kidney as evidenced by abdominal discomfort, pain and urgency
1. Assess the client for readiness for improving urine elimination patterns, focusing on need for physical assistance to access toilet, cognitive awareness of sensation indicating readiness for urine elimination and current continence atatus (Ackley J. Betty and Gail B.
Ladwig. Nursing Diagnosis Handbook.
7 Ed. Page 1262).
2. Complete a bladder diary of diurnal and nocturnal urine elimination pattern and patterns of urinary leakage (Ackley
J. Betty and Gail B. Ladwig. Nursing
Diagnosis Handbook. 7 Ed. Page 1262).
3. Ensure that toileting opportunities are offered both daytime hours and during hours of sleep (Ackley J. Betty and Gail B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 1262).
1. Definition of urinary continence and incontinence applied to ambulatory adults must be modified for the frail, elder client who is homebound or who resides in a long term care setting (Ackley
J. Betty and Gail B. Ladwig. Nursing
Diagnosis Handbook. 7 Ed. Page 1262).
2. A bladder diary provides a more objective verification of urine elimination patterns than a history (Ackley J. Betty and Gail B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 1262).
3. Certain clients who are homebound or reside in a long-term care facility have the potential for continence but experience urine loss because they lack adequate physical assistance needed to access the toilet, remove clothing, and redress after toileting is finished (Ackley J. Betty and
Gail B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 1262).

III- Ineffective health maintenance r/t deficient knowledge regarding care of diabetic condition (Ackley J.
Betty and Gail B. Ladwig.
Nursing Diagnosis Handbook. 7
Ed. Page 54).
1. Assess the client’s feeling, values, and reasons for not following the prescribed plan of care (Ackley J. Betty and Gail B.
Ladwig. Nursing Diagnosis Handbook.
7 Ed. Page 605).
2. Assess for family patterns, economic issues, and cultural patterns that influence compliance with a given medical regimen (Ackley J. Betty and
Gail B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 605).
3. Meet with the client following completion of the proposed actions to review the contract and determine the next course of action. Do this until the client is able to initiate and follow through independently (Ackley J. Betty and Gail B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 608).
1. A factor to assess when examining client responsibility is the level of dissatisfaction with current lifestyle and readiness for change (Ackley J. Betty and
Gail B. Ladwig. Nursing Diagnosis
Handbook. 7 Ed. Page 605)
2. Responsiveness to clients enables the nurse to gain an understanding of clients’ lives and to cultivate their connections to a responsive community, encouraging clients to avoid getting into ‘“reviving”’ behaviors (Ackley J. Betty and Gail B.
Ladwig. Nursing Diagnosis Handbook. 7
Ed. Page 605).
3. Successful completion of contracts promotes improved self-esteem and positive coping (Ackley J. Betty and Gail
B. Ladwig. Nursing Diagnosis Handbook.
7 Ed. Page 608).