Health and healing

1 Nursing Care Plan

Kelly Savage, Rosemary Orumwense, Twinkle Twinkle, Jasmeen Jasmeen, Bhumika Katuwal

Institute of Applied Health Sciences at McMaster Campus

Hlth, Healing & Nrsng Proc II - NRSG-10162

Prof. Karen Massey

3/14/2024

2 Nursing Care Plan

Relevant Client Assessment Data

Identified Concerns with Rationale and

Evidence

Nursing Diagnosis SMART Goal Nursing/Collaborative Interventions with

Rationale and Evidence

Evaluation

• Helen Hill, 35 years

old, Female

• Irish Canadian,

Single, Graphic

Designer

• Diagnosed with

Graves' Disease 1 year

ago

• Suffers from anxiety

• Hypertension

• High-stress career,

genetic predisposition

• HR: 110 bpm;

• BP: 152/90 mmHg

(Health history

evidence client’s BP

range from 128/90 -

135/95)

• Visible goiter,

Exophthalmos

• Height: 1.68 m

• Past Weight: 58 kg;

Current Weight: 48 kg

Priority Concern 1

and Rationale:

Helen lost a lot of

weight, marked by

significant

unintentional weight

loss from 58 kgs to 48

kgs

critical due to its

extensive impact on

her physical and

mental well-being.

This weight loss,

stemming from

Graves' Disease's

effect of accelerating

the metabolic rate,

can lead to severe

health complications

if not addressed.

(Tyerman et al., 2023)

Priority Level: High

Rationale:

Nursing

Diagnosis 1:

Risk for

Imbalanced

Nutrition: Less

than Body

Requirements

related to

increased

metabolic rate as

evidenced by

unintentional

weight loss and

underweight BMI

caused due to

Grave’s Disease

(Flynn &

Martinez-Kratz,

2023, p686-691)

SMART Goal 1:

Within the next

eight weeks, Helen

will achieve a

weight gain of 5-6

kgs, improving her

BMI to a healthier

range of 19.8- 20.5,

through a structured

nutrition plan

tailored to her

increased metabolic

demands, supervised

by a dietitian.

• Nursing/Collaborative

Intervention 1 for concern

#1:

The nurse will assess the

client’s readiness to be

referred to a dietitian to be

recognized as at risk for

malnutrition and receive

a complex nutritional

assessment and

intervention.

Level of Priority:

High

Rationale: Immediate and

comprehensive nutritional

assessment by a dietitian is

critical for managing

malnutrition and improving

Helen’s health outcomes.

Understanding Helen's

readiness is essential for

effective intervention. It

ensures that

recommendations are

Evaluation #1:

Schedule regular weigh-

ins and malnutrition

assessments with a nurse

and dietitian respectively

to monitor Helen's weight

gain progress towards the

goal of attaining 5-6 kgs

in eight weeks. This

includes a review of her

dietary log to ensure

adherence to the

nutritional plan.

Adjustments to her

dietary plan will be made

by the dietician based on

her progress, preferences,

and any nutritional

deficiencies identified.

The dietitian's reports and

Helen's feedback will

guide the ongoing

customization of her

nutritional strategy to

effectively address her

3 •BMI change from

21.3 to 17.6 indicating

significant weight loss

• Hand tremors,

fluctuating vision

• Severe fatigue, night

sweats

• Irregular menstrual

cycle, increased

appetite, heat

intolerance

• Isolation due to

physical changes

• Withdrawal from

social activities

• Active in online

support groups

• Volunteers graphic

design skills to local

non-profits

• Currently on

Medications:

Methimazole – 20 mg,

Propranolol – 80 mg,

Lisinopril – 5 mg,

SSRI – 2 tabs for

anxiety

(Tyerman et al., 2022)

• Alternative medicine

interest: Supplements,

dietary changes, yoga

“Imbalanced

Nutrition: less than

body requirement" is

a high priority

because malnutrition

can lead to critical

complications,

including weakened

immune function and

decreased muscle

strength, directly

impacting recovery

and overall health.

(Tyerman et al., 2023)

Evidence Based:

As evidenced by the

increasing thyroid

hormone, Grave’s

Disease causes an

increase in

metabolism, which

can lead to

unexpected weight

loss (Flynn &

Martinez, 2023,

p686).

timely and align with her

willingness to engage in

lifestyle changes, enhancing

the success rate of

nutritional interventions.

Evidence Based: As related

to the ‘Nutrition and

Deictics and the American

Society of Parental and

Enteral Nutrition’, at least

two of the listed are

recommended to aid

insufficient nutrition:

inadequate intake of energy,

losing substantial weight,

atrophy, confined and

localized accumulation of

fluid, and decreased in

functional status” (White,

Guenter, and Jensen, 2012).

• Nursing/Collaborative

Intervention 2 for

Concern #1:

The nurse will aid Helen in

the formulation of her self-

management system, that

encompass the self-

monitoring of weight and

BMI, the establishment of

realistic goals, the action

development plans aimed at

malnutrition and improve

her overall health status.

(Tyerman et al.,2023)

4

the betterment of dietary

habits and physical activity

enhancement, as well as the

documentation of dietary

intake and exercise.

Level of Priority:

Medium

Rationale: Moderate

priority compared to

immediate dietary

assessment and addressing

client readiness but

essential for long-term

success. Empowering Helen

with tools for self-

monitoring and goal setting

supports sustained dietary

improvements and

complements initial dietary

interventions.

Evidence Based: Self-

monitoring is one of the key

components in weight

management and

maintenance (Thomason et

al, 2016).

5

Priority Concern 2

and Rationale:

Another concern is

unstable blood

pressure due to

Helen's Graves'

Disease and pre-

existing hypertension

as it directly impacts

cardiovascular health,

increasing the risk of

heart diseases.

Graves’ Disease

accelerates the heart

rate, potentially

destabilizing blood

pressure. (Whelton et

al, 2017).

Priority Level:

Medium

Rationale:

"Risk for unstable

blood pressure" is

considered a slightly

lower priority

because, while

fluctuations can lead

to significant health

events, they can often

be more immediately

Nursing

Diagnosis 2:

Risk for

Unstable Blood

Pressure related

to

hyperthyroidism

as evidenced by

high blood

pressure due to

Grave’s Disease

(Flynn &

Martinez, 2023,

p171-175).

SMART Goal 2:

Over the next 6

weeks, Helen will

maintain her blood

pressure within the

target range of

130/90 mmHg to

135/95 mmHg

through dietary and

medication

adjustments, regular

physical activity,

plus self- monitoring

blood pressure.

• Nursing/Collaborative

Intervention 1 for

Concern #2:

The nurse will review

current medications of the

client, both prescribed

medications and OTC, with

the healthcare team to make

necessary adjustments.

Level of Priority:

High

Rationale: Reviewing

medications to determine

any required dosage

adjustments of

antihypertensives could aid

in stabilizing the blood

pressure to the desired

range.

Evidence Based:

Unstable blood pressure is

an ongoing symptom that

Grave’s Disease patients

may struggle with due to

their hyperthyroidism.

Current guidelines for

Grave’s Disease treatment

include prescribing

antithyroid and

antihypertensives and

increasing those dosages as

needed. If increasing

Evaluation #2:

Factors such as

medication adherence,

effectiveness, side effects,

and Helen's engagement

with recommended

lifestyle changes will be

closely monitored.

Regular consultations

with her healthcare

provider will ensure that

any necessary

adjustments to her

treatment plan are made

promptly, aiming to

stabilize her blood

pressure and mitigate any

risks associated with her

hypertension and Graves’

Disease.

(Tyerman et al.,2023)

6

managed or

monitored with

medication

adjustments and

lifestyle interventions.

The rationale for

prioritization

emphasizes

immediate health

risks and the

foundational role of

nutrition in

supporting all other

aspects of health

management.

(Tyerman et al., 2023)

Evidence Based: As

evidenced by the

Clinical Practice

Guidelines for the

management of adults

with hypertension

(2017) states that

blood pressure of over

130/80mmHg causes

the risk

of various

cardiovascular

diseases including

myocardial infarction

antithyroid and

antihypertensive medication

does not help a client, the

client may need more

treatment such as

Radioactive Iodine therapy.

(Andrade et al, 2021)

The treatment with Anti-

hypertensive medications

can be affected by OTC

supplements and certain

medications (Gumprecht et

al, 2019).

• Nursing/Collaborative

Intervention 2 for

Concern #2:

Nurse will deliver tailored

health education teachings

to client emphasizing the

critical role of a healthful

lifestyle in minimizing the

risks and complications

associated with

hypertension.

Level of Priority:

Medium

Rationale: Moderate

priority compared to

immediate clinical

interventions but crucial for

long-term management.

7

or stroke. (Li et al.

2017)

Lifestyle changes have a

profound impact on

managing hypertension and

reducing cardiovascular

risks, supporting Helen's

overall well-being, and

supporting medical

interventions.

Evidence Based: A low-

sodium diet, weight

management, and exercise

can help to manage the high

blood pressure of the client

and reduce the risk of any

cardiovascular diseases.

(Whelton et al, 2017).

8

References

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