NURS FPX 6610 Assessment 2 Patient Care Plan
Student Name
Capella University
NURS-FPX 6610 Introduction to Care Coordination
Prof. Name
Date
Patient Care Plan for Mrs. Snyder
Patient Information
Mrs. Snyder (Patient Identifier: 6700891) is a 56-year-old married woman with two children. Her medical profile is complex and includes poorly controlled anxiety, obesity, hypertension, diabetes mellitus (DM), and hypercholesterolemia. These coexisting conditions significantly increase her risk for metabolic and cardiovascular complications, requiring coordinated and continuous care management.
Nursing Diagnosis 1: Risk of Ineffective Health Management and Diabetes-Related Complications
Assessment Data
Mrs. Snyder demonstrates uncontrolled glycemic patterns linked to dietary habits and inconsistent disease management. She regularly consumes foods high in sugar and has required emergency care due to elevated blood glucose levels, recorded between 230 and 389 mg/dL. She reports symptoms including shortness of breath, abdominal discomfort, and frequent urination. Hypertension is also present, increasing overall cardiovascular risk.
Goals and Expected Outcomes
- Achieve and maintain fasting and postprandial blood glucose levels between 90–140 mg/dL within 2 months.
- Demonstrate sustained dietary improvement with measurable weight reduction over 3 months through adherence to a structured low-sugar nutritional plan.
Nursing Interventions and Rationale
- Diabetes Self-Management Education:
Provide structured education focused on medication adherence, nutrition modification, and physical activity. Patient education strengthens autonomy and improves long-term glycemic control (USC, 2018). - Blood Glucose Monitoring and Insulin Training:
Teach accurate self-monitoring techniques and correct insulin administration to minimize risks of hypo- and hyperglycemia episodes (Carolina, 2019). - Dietary Collaboration:
Work with a registered dietitian to design a balanced meal plan low in refined sugars and saturated fats, which supports improved metabolic control and reduces complication risks (Heart, 2021).
Outcome Evaluation and Re-planning
Blood glucose readings will be tracked daily. If glycemic targets are not achieved, the care plan will be adjusted through intensified nutritional counseling, more frequent clinical follow-ups, or medication optimization.
Nursing Diagnosis 2: Anxiety Related to Caregiving Responsibilities and Health Burden
Assessment Data
Mrs. Snyder reports persistent anxiety primarily linked to caregiving stress for her elderly mother. Medication adherence is inconsistent. Objective findings include elevated blood pressure (145/95 mmHg) and tachycardia (105 BPM), both consistent with heightened anxiety and physiological stress response.
Goals and Expected Outcomes
- Reduce anxiety symptoms by approximately 50% within 1 month using combined pharmacological and non-pharmacological approaches.
- Stabilize blood pressure to around 130/90 mmHg and normalize heart rate within the same timeframe.
Nursing Interventions and Rationale
- Pharmacologic Management:
Administer prescribed anxiolytics (e.g., SSRIs or benzodiazepines as ordered) to reduce neurochemical and physiological symptoms of anxiety (Ströhle et al., 2018). - Cognitive Behavioral Therapy (CBT) Referral:
Recommend structured psychotherapy to help modify maladaptive thought patterns and strengthen coping strategies. CBT is evidence-based for anxiety reduction (Pegg et al., 2022). - Social Support Engagement:
Encourage participation in caregiver-focused support groups to reduce emotional isolation and improve coping capacity.
NURS FPX 6610 Assessment 2 Patient Care Plan
Outcome Evaluation and Re-planning
Weekly reassessment of anxiety symptoms, blood pressure, and heart rate will guide ongoing care decisions. If progress is insufficient, adjustments may include medication changes or increased therapy frequency.
Nursing Diagnosis 3: Caregiver Role Strain and Anticipatory Anxiety Related to Cancer Treatment
Assessment Data
Mrs. Snyder expresses emotional distress regarding upcoming chemotherapy for ovarian cancer while simultaneously managing caregiving responsibilities for her mother. She experiences exertional shortness of breath, with oxygen saturation dropping to 91% during ambulation, likely influenced by obesity and reduced physical conditioning.
Goals and Expected Outcomes
- Secure long-term care arrangements for her mother within 2 weeks to reduce caregiving burden.
- Improve oxygen saturation to at least 95% during ambulation within 1 month through supportive interventions.
Nursing Interventions and Rationale
- Social Work Referral:
Coordinate access to long-term care services for her mother, enabling Mrs. Snyder to prioritize her cancer treatment and reduce caregiver strain (Hoyt, 2022). - Relaxation and Stress Reduction Techniques:
Introduce guided breathing exercises, meditation, and relaxation strategies to reduce anxiety and enhance psychological resilience (Sheikhalipour et al., 2019). - Physiological Monitoring:
Assess oxygen saturation and pain levels three times daily to ensure early detection of deterioration and timely intervention.
Outcome Evaluation and Re-planning
If oxygenation or symptom control goals are not achieved, escalation may include supplemental oxygen therapy, reassessment of mobility tolerance, and modification of pain management strategies in collaboration with the interdisciplinary team.
Patient Care Plan Summary Table
| Nursing Diagnosis | Assessment Data | Goals and Outcomes | Nursing Interventions and Rationale | Outcome Evaluation and Re-planning |
|---|---|---|---|---|
| Risk of ineffective diabetes management | High sugar intake; glucose 230–389 mg/dL; dyspnea; abdominal discomfort; hypertension | Maintain glucose 90–140 mg/dL in 2 months; improve diet and reduce weight in 3 months | Education on self-management (USC, 2018); glucose monitoring and insulin training (Carolina, 2019); dietitian collaboration (Heart, 2021) | Daily glucose monitoring; adjust medication or follow-up if targets unmet |
| Anxiety related to caregiving | Anxiety from caregiving stress; BP 145/95 mmHg; HR 105 BPM; irregular medication use | Reduce anxiety by 50% in 1 month; stabilize BP and HR | Administer anxiolytics (Ströhle et al., 2018); CBT referral (Pegg et al., 2022); support group involvement | Weekly monitoring; modify therapy or medication if needed |
| Caregiver strain and cancer-related anxiety | Anticipatory anxiety about chemotherapy; O2 sat 91% on exertion | Secure caregiving support within 2 weeks; improve O2 sat to 95% in 1 month | Social work referral (Hoyt, 2022); relaxation techniques (Sheikhalipour et al., 2019); frequent oxygen monitoring | Escalate to oxygen therapy or revise pain management if goals unmet |
References
Carolina, C. M. (2019). Unlocking the full potential of self-monitoring of blood glucose. U.S. Pharmacist. https://www.uspharmacist.com/article/unlocking-the-full-potential-of-selfmonitoring-of-blood-glucose
Heart, J. (2021). Nutritional interventions for diabetes management. Journal of Clinical Nutrition, 15(2), 34–42.
NURS FPX 6610 Assessment 2 Patient Care Plan
Hoyt, J. (2022). 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. Current Psychiatry Reports, 24(12). https://doi.org/10.1007/s11920-022-01384-7
Sheikhalipour, Z., Ghahramanian, A., Fateh, A., Ghiahi, R., & Onyeka, T. C. (2019). Quality of life in women with cancer. Journal of Caring Sciences, 8(1), 9–15. https://doi.org/10.15171/jcs.2019.002
NURS FPX 6610 Assessment 2 Patient Care Plan
Ströhle, A., et al. (2018). Pharmacological interventions for anxiety management. Journal of Anxiety Disorders, 53, 1–10.
USC. (2018). What does self-care mean for diabetic patients? University of Southern California Nursing Blog. https://nursing.usc.edu/blog/self-care-with-diabetes/