b.Whether problems are present or not, nurses
must look for evidence of risk factors, and if
identified, aim to reduce or control them,
thereby preventing the problems themselves.
c. In all situations, nurses must encourage behaviors
that promote optimum function, independence,
and a sense of well-being.- a.Mr. Klinetob, aged 86, has been seriously
depressed since the death of his wife of 52 years,
6 months ago. Although he suffers from degener-
ative joint diseaseand has talked for years about
having “just a touch of arthritis,” this never kept
him from being up and about. Recently, however,
he spends all day sitting in a chair and seems to
have no desire to engage in self-care activities.
He tells the visiting nurse that he doesn’t get
washed up anymore because he’s “too stiff” in
the morning to bathe and “I just don’t seem to
have the energy.” The visiting nurse notices that
his hair is matted and uncombed, his face has
traces of previous meals, and he has a strong
body odor. His adult children have complained
that their normally fastidious father seems not
to care about personal hygiene any longer.
Nursing Diagnosis: Bathing/Hygiene Self-
Care Deficit, related to decreased strength and
endurance, discomfort, and depression, as
evidence by matted and uncombed hair, new
beard, food particles on face, and strong body
odor
b.Miss Adams sustained a right-sided cerebral
infarct that resulted in left hemiparesis(paralysis
on left side of body) and left “neglect.” She
ignores the left side of her bodyand actually
denies its existence. When asked about her left
leg, she stated that it belonged to the woman in
the next bed—this while she was in a private
room. This patient was previously quite active:
she walked for 45 to 60 minutes four or five
times a week and was an avid swimmer. At pres-
ent, she cannot move either her left arm or leg.
Nursing Diagnosis: Body Image Disturbance,
related to left hemiparesis (paralysis), as evidenced
by her ignoring the left side of her body follow-
ing her inability to move it
c. After trying to conceive a child for 11 years, Ted
and Rosemary Hines sought the assistance of a
fertility specialist who was highly recommended
by a friend. It was determined that Ted’s sperm
was inadequate, and Rosemary was inseminated
with sperm from an anonymous donor. The cou-
ple was told that the donor was healthy and that
he was selected because he resembled Ted. Rose-
mary became pregnant after the second in-vitro
fertilization attempt and delivered a healthy
baby girl named Sarah.
Sarah is now 7 years old, and Ted and Rosemary
have learned from blood tests that their fertility
specialist is the biologic father of their child. It
seems that he lied to some couples about using
sperm from anonymous donors and deceived
others into thinking the wives had become
pregnant when he had simply injected them
with hormones. Ted and Rosemary have joined
other couples in pressing charges against this
physician. Rosemary tells the nurse in her
pediatrician’s office that she is concerned about
how all this is affecting her family. “Ted and I
both love Sarah and would do nothing to hurt
her, but I’m so angry about this whole situation
that I’m afraid I may be taking it out on her,”
she says. Questioning reveals that Rosemary has
found herself yelling at Sarah for minor disobedi-
ences and spanking her, something she rarely did
before. Both Ted and Rosemary had commented
before about Sarah’s striking physical resemblance
to the fertility specialist but attributed this to
coincidence. Rosemary says, “Whenever I see her
now I can’t help but see Dr. Clowser and every-
thing inside me clenches up and I want to
scream.”Both Ted and Rosemary express great
remorse that Sarah, who is innocent, is bearing the
brunt of something that is in no way her fault.
Nursing Diagnosis: Parental Role Conflict
related to unexpected discovery about their
daughter’s biologic father, as evidenced by
parental concern about increased incidence of
parental yelling and spanking and the anger
the child evokes in her parents because of her
physical resemblance to the fertility specialist
who deceived them.
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing diagnosis would be appropriate for
Mr. Prescott? How might the nurse advocate for
Mr. Prescott to ensure that he gets tested for colon
cancer?
Nursing Diagnosis: Anxiety related to constipation
and possible bowel alterations
Mr. Prescott would benefit from patient teaching/
counseling regarding the need for stool testing.
After checking with the primary care provider, the
nurse could schedule a colonoscopy if ordered to
check for colon cancer. The nurse should address
the patient’s constipation and check with the
primary care provider about scheduling a consult
with a gastroenterologist.
2.What would be a successful outcome for this
patient?
Mr. Prescott states the warning signs of colon
cancer and agrees to schedule a colonoscopy
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:344 ANSWER KEY
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