Nursing Care Plan


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Medical Diagnoses: Ineffective coping related to depression, Dysfunctional family processes and Alcoholism


1.  Ineffective coping related to depression and feelings of hopelessness as evidenced by alcohol use, patient stating feeling depressed and unsure about future.

Data: Patient states when feels depressed he resorts to drinking

Pt states feels depressed b/c homeless, lost family, hasn’t seen children

Pt states doesn’t feel he has adequate resources to get back on track

Pt states was drinking 2 pints vodka day and beer

2. Dysfunctional family processes: Alcoholism related to alcohol use as evidenced by separation and emergency protective order placed against BG.

Data: Pt states wife was having extra marital affair with his co worker

Pt states was drinking to suppress feelings related to spouse and marriage

Pt states wife took out EPO and is living with boyfriend despite them being married

Pt states hasn’t seen his children in 2 months and spouse said left him b/c of his drinking.

3. Anxiety related to alcohol use and situational crises as evidenced by patient stating feelings of overexcitement, persistent helplessness, uncertainty about future.

Data: pt states worried about discharge b/c is homeless

States has not been given resources that are appropriate to him

Pt had to leave during group session because another patient crying

Pt states feels anxious

4. Dysfunctional grieving related to major life events as evidenced by alcohol dependency to cope.

Data:  patient states is drinking daily because wife and children have left him

Patient states has no family to lean on (sister in prison, mother deceased, father alcoholic, uncle mentally retarded)

Patient states friends are not “real friends” and they give him drugs and alcohol and use themselves

Pt said married but legally separated and wife has new boyfriend

Pt stated wife took cars, money, and moved leaving him homeless

Patient not employed

30 Male

 

Current Illness: Alcohol dependence and Depression   

Previous History: no reports of mental illness         Assessments: Monitor BP, HR
signs of depression
suicidal thoughts
changes in mental status 

changes in behavior

5. Hopelessness related to abandonment and deteriorating physiologic condition as evidenced by anxiety, lack of initiation, and alcohol use.

Data: pt states is homeless and unemployed so unsure how he can “start again with no starting point”

Says doesn’t have place to shower so doesn’t feel good about himself so can’t interview, attempt to see children

Pt states halfway house is $100/week and doesn’t have it

Pt states homeless shelter is 3 week waiting period

Pt states doesn’t want to “look like this” (unkept, unclean, not having shaved)

6. Risk for injury related to substance abuse and alcohol dependence as evidenced by patient verbalizing uses other people’s prescription drugs  including Xanax, uses marijuana, and drinks to excess.

Data: pt states has been drinking regularly and reason for wife leaving

Pt states drinking heavily in past few days (a gallon of vodka on day of admission)

Pt states used marijuana 5 days prior

7. Situational Low Self-Esteem related to loss and current living situation as evidenced by patient stating doesn’t feel good about himself, doesn’t want to “look like this”, and expressing feelings of helplessness.

Data: pt states doesn’t want to not be able to shower, get hair cut or shave

Pt states doesn’t want to feel like this or be sick

Pt states wants to work and get life together

Pt feels as if no where to start because has been left with nothing and doesn’t feel he has resources

8. Loneliness related to social isolation and affectional deprivation as evidenced by marital problems, homelessness, and lack of family and social support.

Data: pt states wife left with children and marriage has ended

Pt states no other family to rely on for help

Pt states friends aren’t “real friends”

Pt states occasionally staying in friends basement but can only go late at night when friend’s wife is asleep b/c she doesn’t like him


NANDA Diagnostic Statement:  Ineffective coping related to depression and feelings of hopelessness as evidenced by alcohol use, patient stating feeling depressed and unsure about future.

Behavioral Outcome / Goal:  Client will consistently acknowledge personal consequences associated with alcohol use.  Client will commit to alcohol use control strategies.  Client will consistently demonstrate effective coping strategies. Client will seek treatment for depression after discharge; seeking out resources prior to discharge. 


Nursing Interventions:

 

 

1. Determine history of alcohol use.

 

2. Assist the patient to identify and explore specific situations that are creating stress and possible alternatives for dealing with the situation.

 

 

3. Identify with client those factors that relate and contribute to alcohol use.

 

 

4. Assist client to identify negative effects of chemical dependency.      

 

5. Sit with the client multiple times daily to hear and discuss concerns and feelings.

 

 

 

6. Identify support groups in community for long term substance use treatment.

 

 

7. Initiate referral to psychiatric clinical nurse specialist or other specialist as needed.

Rationale:

 

1. Identifies high risk situations (Varcarolis, Carson, & Shoemaker, 2006). 

 

2. Identification of problem area is the first step in problem solving and promotes creative problem solving (Newfield, Hinz, Tilley, Sridaromont, &Maramba, 2007).

 

3. Emphasis on alcoholism as a disease can lower guilt and increase self esteem (Varcarolis, Carson, & Shoemaker, 2006). 

 

4. Begins to decrease denial and increase problem solving (Varcarolis, Carson, & Shoemaker, 2006). 

 

5. Communication of concerns in a supportive environment can facilitate the development of adaptive coping behaviors.  Continues the development of a trusting relationship (Newfield, Hinz, Tilley, Sridaromont, &Maramba, 2007).

 

6. Alcohol dependence requires long term treatment; AA is effective (Varcarolis, Carson, & Shoemaker, 2006). 

 

7. Specialist skills may be needed to intervene in significant problem areas (Newfield, Hinz, Tilley, Sridaromont, &Maramba, 2007).

Client Response:

 

1. BG stated his father was an alcoholic.  He stated he hasn’t always drank but stress and feeling depressed triggers his drinking.

2. BG identifies that his marital problems, wife seeing a coworker of his, and separation from his kids are situations that cause him great stress.  Being homeless and unemployed are also key factors that contribute to his alcohol use.

3. BG stated he uses alcohol just as something to do.  He stated if he had somewhere to live and shower, he would feel good about himself and wouldn’t need to drink.  He also states because he is unkept he can’t find work. 

4. BG is well aware how alcohol is affecting him.  He is very clear about not wanting to use alcohol as his support system but feels he has no one else to turn to and no outlet.  BG stated he was going to try to make contact with his old boss and see about working again once he is discharged.

5. BG warmed up very quickly and shared his concerns about the future.  He also described his marital situation and how it has affected him.  He said he hadn’t talked to any professionals during his stay other than a social worker for 5 minutes.  He said she gave him a halfway house and told him the cost involved.  He stated he didn’t feel he had received help. He did seem happy that he had someone to talk to.  He smiled often during the conversation but didn’t laugh.

6. Patient states was given half way house contact and has looked into homeless shelters.  Patient aware of AA services.  Patient states drinking became out of control when wife left, and he was left homeless.  BG states drinks out of boredom and loneliness.

7. BG expressed that hadn’t been referred or helped with resources other than half way house.  I spoke with clinical instructor and she provided some helpful ideas and suggestions and stated she would share with BG the following week before discharge. 

Summarize impressions of client progress toward outcomes / problem resolution: More time is needed to evaluate interventions and to determine if goals are met and with BG being discharged 3-5 days after admission, I’m not sure it’s possible for him to complete these tasks.  BG will need a social worker or case manager in order to manage his care and evaluate and adjust interventions and goals.  BG was able to discuss his history of alcohol abuse, identify situations causing him stress and making him feel as if he needs to use alcohol, and identify negative effects of alcohol abuse.  BG does have a hard time coming up with solutions and alternatives to drinking, primarily because he feels as if he has no way out because he is unemployed and homeless at this time.  BG stated several times if he “had a place to go, he wouldn’t be doing this”, this being drinking.  BG did open up when I sat and had a discussion with him and stated he hadn’t spoke to a professional for more than 5 minutes since he’d been there (3 days).  He did express that he felt resources were limited in terms of the resources he could utilize.  I think a case manager or social worker who could work with him and help him come up with a plan that is productive and he can comply with would be beneficial.  BG expressed he wants to not use drinking as his outlet but his concern of not having a place to live and shower is overwhelming.  He stated his appearance was important to him and not being able to shower, shave, and get a haircut is preventing him from applying himself.  He stated he didn’t want his kids to “see him like this”, referring to being unshaven and not having showered.  BG stated is welcome to suggestions and will utilize resources if available. 


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