Page 367 - alligood 8th edition_Neat

348 UNIT III Nursing Conceptual Models

n Eliminative: The patient is able to urinate with- n Set: It is evident that the patient is accustomed
out difficulty in a urinal but prefers walking to to making his own decisions and being a
the bathroom. He becomes constipated easily leader. It is also evident that he is accustomed
due to decreased fluid and food intake. to conferring with his wife to ensure that she
n Sexual: There are changes in the patient’s is comfortable with decisions being made.
sexual relationship with his wife due to pain, n Choice: Although the patient agrees to the
limited use of his right side, and fatigue. diagnostic tests, he is no longer in pain and
has had no bleeding since his hospitalization.
Environmental Assessment Therefore, he is more focused on achieving his
The assessment of internal and external environ- rehabilitation goals. He initiates activities and
mental factors indicates that several are creating seeks assistance from his family in walking to
tension and threatening the balance and stability the bathroom, walking in the hall, and com-
of the behavioral system. This hospitalization and pleting his ADLs.
diagnostic testing adds additional stress to the n Actions: The patient socializes with visitors
already weakened biological and psychological and family by actively participating in conver-
stability of the behavioral system. The stroke pro- sations. He requests assistance as needed for
duced several physical and cognitive impairments physical and cognitive needs. He asks for
that affect independence, self-care, learning, mat- prayers from his family and friends for spiri-
uration, and socialization. Hospitalization at this tual guidance in managing his illness.
time can delay or decrease the prognosis of the
patient’s physical and speech rehabilitation. He Functional Requirements
will need assistance to move safely in the hospital The patient needs outside assistance for all three
environment. functional requirements including protection, nur-
The patient and his wife are active in their turance, and stimulation. His inability to feel his
church and participate in many social activities. right side and his impaired mobility increase his
The patient taught classes in Sunday school. The potential for injury. Protective devices such as hand
recent illnesses, hospitalizations, and fatigue have bars and a shower chair can be used. The patient
decreased his ability to participate in previous ac- needs assistance with preparing meals but has
tivities. Although he has adapted to his right-sided adapted to using his left hand for eating and drink-
weakness and decreased motor function by per- ing. Socialization and performance expectations at
forming his ADLs with his left hand and walking the outpatient rehabilitation facility are important
with a cane, he still needs assistance. The patient methods of providing stimulation for the patient.
and his wife live in a suburban neighborhood. Stimulation is also provided by friends and family
Family members installed a ramp to facilitate ac- who visit the patient. Continued social stimulation
cess to the home. His wife states that neighbors is vital for this patient, because he has difficulty
watch the house when she is away and watch for understanding other forms of stimulation such as
her return to be sure she is safe. radio, television, and reading.

Structural Components Nursing
n Drive or goal: The patient seems motivated to Nursing actions are external regulatory forces that
complete the diagnostic tests and return home. should protect, stimulate, and nurture to preserve
He is eager to get back into his outpatient re- the organization and integration of the patient’s
habilitation program. It seems equally impor- behavioral system. Nursing actions for this patient
tant for him to decrease stress on his wife. His should focus on providing explanation of diagnos-
wife provides positive encouragement and tic tests to be performed and the results of the
support for him. He looks to her for assistance tests. Identification of favorite foods and encour-
with decisions. agement of small, frequent meals with sufficient