Running head: CONCEPT MAP WITH NURSING CARE PLAN AISHA’S CONCEPT MP WITH NURSING CARE PLAN POST CYSTECTOMY BY COURSE TUTOR SCHOOL 1 CONCEPT MAP WITH NURSING CARE PLAN 2 CONCEPT MAP WITH NURSING CARE PLAN 3 Introduction Aisha a 49- year old lady has undergone cystectomy with illeal conduit diversion which involves removal of bladder, urethra, lymph nodes and parts of the vagina and creating a stoma for urine drainage. The post-operative recovery is on track, however, the patient requires health education on discharge, care of the stoma, self-esteem counselling and sexual health education. Aisha’s management is culturally sensitive hence a need to maintain respect for her Islamic culture in planning her care. Question 1. All patients have the right to consent or refuse treatment after a professional advice on the medication has been provided. Nurses are governed by the ethical principles of autonomy which states that the patients have the right to make a decision on their health which should be respected. The ethical principle of nonmaleficence provides for nurses to maintain competency and prevent any arm to their patients. Aisha being an adult, of sound mind, being in a state to make sound decisions and having consented to the surgery, reserves her right to consent or refuse administration of narcotics. Transcultural nursing, however, emphasizes on the importance of respecting cultural values and roles of the patient in achieving holistic care. The role of Aisha’s husband in their religious and culture (Islam) and religion-cultural values is critical in his opposition of narcotic medications. The best approach to address his concerns will be to elaborate to the husband the role of the narcotic analgesics and the dosage ordered for Aisha. Reassuring the husband on the importance of administration of narcotic analgesia for Aisha post operatively will enlighten him CONCEPT MAP WITH NURSING CARE PLAN 4 and enable him to share his concerns about the medication. I would involve the physician in counselling the husband on the safety of the medication and explaining alternative more culturally acceptable analgesics that can be instituted for Aisha, their potency and side effects and allowing them time to make an informed decision of the choice of analgesia. Question 2 The Islamic culture identifies the man as the decision maker in the family while the wife is the care giver (Lawrence and Rozmus, 2001). This cultural set up may impact negatively the post-operative care for Aisha as the husband is tasked to make medical decisions for her which breaches her autonomy as a patient. The health beliefs among the Islamic culture, is based on faith and influences health seeking behaviors and decisions. Abushaikha, (2007) describes the believe that pain endurance is considered as a test of faith, prayer and recitation of the Quran. Such beliefs coupled with the loss of autonomy will impact treatment choices and pain management for Aisha during her post-operative care. The intake of harmful drugs such as narcotics is considered haram in the Islamic culture. Ypinazar et al, (2006) defines the presumption of health within the Islamic culture as absence of actual disease ignoring the psychological and psychosocial being. This culturalreligious assumption will negatively impact on the holistic care which ought to be provided to Aisha after discharge. Healing among her culture is based on the belief of Allah as the healer which tends to either ignore the role of the health provider or viewing health provider as a conduit for healing. Such believes may affect the compliance to discharge instructions and plan for Aisha affecting her care. The Islamic cultural practice of family, community belonging sharing and support is a cultural aspect that will positively impact her post-operative recovery through support from her community and family members. CONCEPT MAP WITH NURSING CARE PLAN 5 Question 3 Adequate nutrition intake is a critical for body requirements is an important aspect contributing to recovery. Ability to resume dietary intake is an essential indicator for recovery post-operatively. Assessment for Aisha’s bowel movements is imperative as the presence of bowel movements allow for initiation of oral food intake for the patient. An assessment for diarrhoea is essential for Aisha. Diarrhoea is reported as a common occurrence for patients post-operatively following cystectomy with illeal conduit diversion (Van der Aa, Joniau, Van Den Branden & Van Poppel, 2011). Assessment for other causes of poor nutrition such as post-operative depression or stress and absence of preferred culturally-sensitive diet is important to establish the cause of Aisha’s refusal for nutritional intake. After assessment, I will in collaboration with other care team members (Nutritionist and physician), identify interventions that will aid in promoting Aisha’s nutritional status. Provision of small frequent culturally acceptable meals, initiating patient counselling for stress and education on the nutritional changes necessary for her recovery are critical nutritional interventions for Aisha. Post cystectomy with illeal conduit diversion patients require a change of dietary intakes to minimize gastrointestinal discomforts while maintaining adequate nutrition and healing. Aisha will need to reduce the intake of spicy foods and fatty foods in her diet as they may irritate the stoma and cause diarrhea due to malabsorption of fats following bowel resection. An increase in the intake of high protein foods is important as they aid in tissue recovery and recuperation. Increased intake of fluids more so water is important as fluids increase the frequency, flush off CONCEPT MAP WITH NURSING CARE PLAN 6 mucous produced by the illeal loop preventing plugging of the stoma. Vitamin B12 supplementation maybe important in case of resection of the distal ileum where it is normally absorbed. Question 4 According to Modh, Mulhall and Gilbert, (2014), the effects of sexual function in women post cystectomy are due to the narrowing of the vagina, nerve injury, reduced vaginal lubrication which may result in dyspareunia. Aisha’s sexual life is likely to be affected by similar issues following surgery due to the narrowing of vagina secondary to removal of part of the vagina during surgery. Body image and a disturbed self-esteem is another aspect which will affect her sexual life. The presence of a stoma and her inability to voluntarily control urine might reduce her sexual preferences more so as she belongs to a culturally sensitive community. The presence of urine which is in Islamic culture considered unclean, is likely to cause withdrawal of sexual advances from her husband. Aisha’s age (49 years), further compounds the reduction of sexual interest due to onset of menopause marked by reduced libido, vaginal lubrication and inability to bear children. Addressing sexual relationship with Aisha, I would request to conduct a health education session on sexual health for her, in the presence of an older female member of the family. I would educate her on safe sexual practices post discharge such as, avoiding sexual contacts until the surgical site has completely healed and ensuring she empties the pouch prior to sexual activity. I would advise her to share her sexual feelings with her husband and not to assume he is no longer interested in her. In holistically addressing her sexual concerns, I would refer them for further couple counselling in an Islamic sensitive counselling center or by a trusted family or religious leader. 7 CONCEPT MAP WITH NURSING CARE PLAN AISHA’S NURSING CARE PLAN POST CYSTECTOMY AND ON DISCHARGE. Date----/----/2017 Assessment data Nursing diagnosis Goal/expected Intervention Rationale outcome Aisha’s Knowledge deficit verbalisation on related to the surgical her wellbeing process and care post-surgery evidenced by patients Aisha’s husband and relatives inquisitive disapproval of narcotic analgesia In the next 24 hours: The patient will learn - Post surgical care of the stoma -Educate the patient how to take care of the on the procedures of stoma to avoid care for the stoma and infections and injury. urinary pouch. nature on care. ensures a patent and functional stoma, prevents injury and infections which could result in readmissions and improves selfesteem and patient independence. The patient and -Conduct a culturally husband will sensitive health understand the education and importance of narcotic counselling on the analgesia in post- importance of operative pain narcotics use in pain management relieve A culturally sensitive education session will help diffuse the husband’s opposition and allow for the patient and her husband to make an informed decision on continuity of cessation of treatment. Evaluation 8 CONCEPT MAP WITH NURSING CARE PLAN Aisha Risk for altered sexual .-The patient will be Conduct a culturally Sexual changes due to vaginal verbalisations of patterns related to able to understand the sensitive sexual health narrowing, presence of stoma, fears for sexual changes education session with Aisha’ cultural and religious beliefs isolation and her following surgery and the patient and may negatively impact her sexual father’s establish a coping significant other. life. Enlighten on how, when and questioning her mechanism. surgical procedure. importance of further sexual ability to sire counselling will enhance her sexual more children health post-surgery Aisha’s refusal Bowel assessment will indicate her Risk for nutrition -Patient will be able to for dietary imbalance, less than understand importance intake. body requirements of nutrition intake in related to surgical the healing process process evidenced by and dietary changes patient’s refusal to eat. required. Conduct an readiness for feeding. Nutritional assessment of her counselling will help address bowel movements and dietary changes she needs and the nutritional importance on her healing process. counselling. CONCEPT MAP WITH NURSING CARE PLAN 9 References Abushaikha LA,PhD,RN. (2007) Methods of Coping with Labor Pain Used by Jordanian Women .Journal of Transcultural Nursing. 18(1), 35-40. Lawrence P, MSN,RN, & Rozmus C,DSN,RN. (2001) Culturally Sensitive Care of the Muslim Patient. Journal of Transcultural Nursing. 12(3), 228-233. Ypinazar VA, Margolis SA. (2006) Delivering Culturally Sensitive Care: The Perceptions of Older Arabian Gulf Arabs concerning Religion, health, and Disease. Qualitative Health Research. 16(6), 773- 78. Van der Aa, F., Joniau, S., Van Den Branden, M., & Van Poppel, H. (2011). Metabolic Changes after Urinary Diversion. Retrieved 12 January 2017, from Modh, R., Mulhall, J., & Gilbert, S. (2014). Sexual dysfunction after cystectomy and urinary diversion. Nature Reviews Urology, 11(8), 445-453. http://dx.doi.org/10.1038/nrurol.2014.151 Name: Description: ...