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      Mrs. X came to the hospital with complaints of pain over all the joints, stiffness which is more in the morning and reduces by the activities. She has these complaints since 5 years and has taken treatment from local hospital. The symptoms were not reducing and came to --MC, Hospital for further management.  Patient was able to do the ADL by herself but the way she performed and the posture she used was making her prone to develop the complications of the disease. She also was malnourished and was not having awareness about the deficiencies and effects.


DATA COLLECTION ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT:

1. BASIC CONDITIONING FACTORS

Age:
56 yo
Gender:
Female
Health State:
Disability due to health condition, therapeutic self care demand
Development State:
Ego integrity vs despair
Socio-cultural Orientation:
No formal education, Indian, Hindu
Healthcare 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: Nephew

2. UNIVERSAL SELF-CARE REQUISITES





Air:
Breaths without difficulty, no pallor cyanosis
Water:
Fluid intake is sufficient. Edema present over ankles.
Turgor:
Normal for the age
Food:
Hb – 9.6gm%, BMI = 14. Food intake is not adequate or the diet is not nutritious.
Elimination:
Voids and eliminates bowel without difficulty.
Activity/Rest:
Frequent rest is required due to pain; Pain not completely relieved; Activity level has come down; Deformity of the joint secondary to the disease process and use of the joints.
Social Interaction:
Communicates well with neighbors and calls the daughter by phone; Need for medical care   is communicated to the daughter.
Prevention of Hazards:
Need instruction on care of joints and prevention of falls. Need instruction on improvement of nutritional status. Prefer to walk bare foot.
Promotion of Normalcy:
Has good relation with daughter

3. DEVELOPMENTAL SELF-CARE REQUISITES





Maintenance of developmental environment:
Able to feed self; Difficult to perform the dressing, toileting etc
Prevention/ Management of the conditions threatening the normal development:
Feels that the problems are due to her own behaviors and discusses the problems with husband and daughter.

4. HEALTH DEVIATION SELF CARE REQUISITES





Adherence to medical regimen:
Report the problems to the physician when in the hospital;
Cooperates with the medication
Not much aware about the use and side effects of medicines
Awareness of potential problem associated with the regimen:
Not aware about the actual disease process;
Not compliant with the diet and prevention of hazards;
Not aware about the side effects of the medications
Modification of self image to incorporates changes in health status:
Has adapted to limitation in mobility;
The adoption of new ways for activities leads to deformities and progression of the disease;
Adjustment of lifestyle to accommodate changes in the health status and medical regimen:
Adjusted with the deformities.

Pain tolerance not achieved

5. MEDICAL PROBLEM AND PLAN





Physician’s perspective of the condition:
Diagnosed with rheumatoid arthritis and is on the following medications:
ü  T. Valus SR OD

ü  T. Pan 40 mg OD

ü  T. Tramazac 50 mg OD

ü  T. Recofix Forte BD

ü  T. Shelcal BD

ü  Syp. Heamup 2tsp TID
Medical Diagnosis:
Rheumatoid arthritis
Medical Treatment:
Medication and physical therapy

AREAS OF PRIORITY:





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

NURSING CARE PLAN ACCORDING TO OREM’S THEORY OF SELF CARE DEFICIT:
  • Nursing diagnosis (diagnostic operations) 
  • Outcome and plan (prescriptive operations) 
  • Implementation (control operations) 
  • Evaluation (regulatory operations)
APPLYING THE OREM’S THEORY OF SELF-CARE DEFICIT, NURSING CARE PLAN FOR MRS. X COULD BE PREPARED AS FOLLOWS:

1. THERAPEUTIC SELF CARE DEMAND: DEFICIENT AREA: ACTIVITY
ADEQUACY OF SELF CARE AGENCY: INADEQUATE
NURSING DIAGNOSIS



Outcome:
Goal:
Objectives:
Design of the nursing system:

improved self-care
maintain the ability to perform the toileting and dressing with modification as required.

to achieve optimal levels of ability for self care.

Mrs. X will be able to:
perform the dressing activities within limitations
utilize the alternative measures available for improving the toileting
perform the other activities of daily living with minimal assistance.

Partly compensatory






Method of helping:
Implementation:
Evaluation:
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


4. Promoting a developmental environment


·         Teach the family and help them to practice how to help the patient according to her need

        Mutually planned and identified the objectives and the patient was made to understand about the required changes in the behavior to have the requisites met.

       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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