Student Name
Capella University
NURS-FPX 6610 Introduction to Care Coordination
Prof. Name
Date
Nursing Diagnosis and Care Plan for Mrs. Snyder
Patient Identifier: 6700891
Medical Diagnosis: Poorly controlled anxiety, obesity, hypertension (HTN), diabetes mellitus (DM), and hypercholesterolemia
1. Ineffective Health Management Related to Diabetes and Lifestyle Choices
Mrs. Snyder is a 56-year-old female presenting with multiple chronic conditions, with uncontrolled diabetes mellitus and hypertension being the most significant concerns. Her current dietary pattern includes frequent consumption of high-sugar snacks (e.g., cookies), which has contributed to persistent hyperglycemia. Upon admission to the emergency department, her blood glucose levels ranged between 230–389 mg/dL. She also reported symptoms such as fatigue, lower abdominal discomfort, shortness of breath, and polyuria, all consistent with poor glycemic control. Her condition is further complicated by obesity, hypertension, and unhealthy lifestyle behaviors, which increase her cardiovascular risk profile.
The primary care objectives include achieving stabilized blood glucose and blood pressure levels within one month, along with sustained improvement in dietary behavior, physical activity, and overall self-management within a three-month period (Ramzan et al., 2022). The care plan emphasizes patient empowerment through education, skill development, and self-monitoring strategies.
Nursing Interventions for Diabetes Self-Management
| Intervention | Description | Rationale |
|---|---|---|
| Patient education on lifestyle modification | Provide structured teaching on nutrition, physical activity, hydration, and sleep hygiene | Improves awareness and supports long-term behavioral change essential for glycemic control (USC, 2018) |
| Self-monitoring support | Train patient to use glucometer and maintain food and glucose logs | Encourages self-accountability and early identification of glucose fluctuations (Carolina, 2019) |
| Insulin administration training | Demonstrate correct insulin injection techniques and storage procedures | Enhances adherence, reduces medication errors, and improves treatment effectiveness (Heart, 2021) |
Ongoing evaluation will include regular review of blood glucose records, dietary adherence, and blood pressure trends. If clinical targets are not achieved, adjustments to insulin dosing and dietary planning will be considered, along with intensified diabetes education and follow-up support.
2. Anxiety Intensified by Family and Caregiving Pressures
Mrs. Snyder experiences significant anxiety, largely triggered by her demanding caregiving responsibilities and family stressors. She is the primary caregiver for her ill mother while also managing ongoing interpersonal conflict with her son. These stressors have contributed to physiological symptoms such as elevated blood pressure, tachycardia, and inconsistent adherence to prescribed anxiolytic medications. Her psychological burden is further intensified by financial responsibilities and limited personal support systems.
The primary goals include maintaining blood pressure within 130/90 mmHg and achieving a stable heart rate between 60–100 beats per minute within one month. Additionally, reducing anxiety severity through pharmacological adherence and structured psychotherapy is a key objective (Pegg et al., 2022).
Nursing Interventions for Anxiety Management
| Intervention | Description | Rationale |
|---|---|---|
| Medication adherence support | Ensure timely administration of prescribed anxiolytics and monitor compliance | Helps control physiological manifestations of anxiety (Ströhle et al., 2018) |
| Cognitive Behavioral Therapy (CBT) | Facilitate weekly counseling sessions focusing on thought restructuring and coping strategies | CBT is evidence-based in reducing anxiety symptoms and improving coping skills (Pegg et al., 2022) |
| Community and social support referral | Connect patient with faith-based or community support groups | Enhances emotional resilience and reduces feelings of isolation (Goodtherapy, 2019) |
Progress will be assessed weekly by monitoring anxiety levels, vital signs, and medication adherence. Care plans will be adjusted based on therapeutic response and the patient’s engagement in counseling sessions.
3. Psychosocial Stress Due to Cancer Diagnosis and Caregiver Burden
In addition to chronic conditions, Mrs. Snyder is coping with a recent diagnosis of ovarian cancer, which has significantly increased her emotional distress. Her anxiety is compounded by fear of chemotherapy, ongoing caregiving responsibilities for her mother, and physical symptoms such as abdominal pain and exertional dyspnea. Oxygen saturation levels have been observed to decline during activity, indicating reduced physical tolerance and increased health vulnerability.
Short-term goals include arranging alternative care placement for her mother within 15 days to reduce caregiving burden. Long-term goals focus on improving oxygen saturation levels, physical endurance, and emotional stability over a three-month period.
NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment
Nursing Interventions for Psychosocial and Cancer-Related Stress
| Intervention | Description | Rationale |
|---|---|---|
| Social work referral | Assist in identifying long-term care placement options for her mother | Reduces caregiver burden and allows patient to focus on treatment and recovery (Hoyt, 2022) |
| Pain and symptom monitoring | Conduct regular assessments of pain intensity, respiratory status, and treatment side effects | Ensures timely symptom management and prevents functional decline |
| Non-pharmacological coping strategies | Teach relaxation techniques such as yoga, meditation, and guided imagery | Reduces psychological distress and improves overall quality of life (Sheikhalipour et al., 2019) |
Effectiveness will be evaluated through improvements in oxygen saturation, pain control, emotional well-being, and treatment engagement. As caregiver responsibilities decrease, further refinement of cancer care goals will focus on holistic recovery and quality of life enhancement.
References
Cancer. (2021, October 6). Managing diabetes when you have cancer. Cancer.net. https://www.cancer.net/navigating-cancer-care/when-cancer-not-your-only-health-concern/managing-diabetes-when-you-have-cancer
Carolina, C. M. (2019, October 16). Unlocking the full potential of self-monitoring of blood glucose. Uspharmacist.com. https://www.uspharmacist.com/article/unlocking-the-full-potential-of-selfmonitoring-of-blood-glucose
NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment
Goodtherapy. (2019, September 23). Therapy for self-love, therapist for self-love issues. Goodtherapy.org. https://www.goodtherapy.org/learn-about-therapy/issues/self-love
Heart. (2021, May 6). Living healthy with diabetes. Heart.org. https://www.heart.org/en/health-topics/diabetes/prevention–treatment-of-diabetes/living-healthy-with-diabetes
Hoyt, J. (2022, May 26). Assisted living & senior placement agencies. SeniorLiving.org. https://www.seniorliving.org/placement-agencies/
Pegg, S., Hill, K., Argiros, A., Olatunji, B. O., & Kujawa, A. (2022). Cognitive behavioral therapy for anxiety disorders in youth: Efficacy, moderators, and new advances in predicting outcomes. Current Psychiatry Reports, 24(12). https://doi.org/10.1007/s11920-022-01384-7
Ramzan, B., Harun, S. N., Butt, F. Z., Butt, R. Z., Hashmi, F., Gardezi, S., Hussain, I., & Rasool, M. F. (2022). Impact of diabetes educator on diabetes management: Findings from diabetes educator assisted management study of diabetes. Archives of Pharmacy Practice, 13(2), 43–50. https://doi.org/10.51847/2njmwzsnld
NURS FPX 6610 Assessment 1 Comprehensive Needs Assessment
Sheikhalipour, Z., Ghahramanian, A., Fateh, A., Ghiahi, R., & Onyeka, T. C. (2019). Quality of life in women with cancer and its influencing factors. Journal of Caring Sciences, 8(1), 9–15. https://doi.org/10.15171/jcs.2019.002
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(37), 611–620. https://doi.org/10.3238/arztebl.2018.0611
USC. (2018, January 9). What does self-care mean for diabetic patients? USC Nursing. https://nursing.usc.edu/blog/self-care-with-diabetes/