Thai female 79 years old
Anxiety
1. Impaired Gas
Exchange/Oxygenation and risk
for respiratory failure from
COVID-19 infection
Assessment : tested positive for
COVID a runny nose, a dry cough,
dyspnea , Day1 oxygen was
desaturated (SpO2 = 93%).
Goal: Maintain oxygenation
Outcome: Patient cooperates
with RT, uses oxygen, and
breathing remains nonlabored
Nursing intervention
1.Record and monitor V/S as usual
2. Monitor respiratory response to
activity Monitor SpO2 : Record oxygen
saturation at room air once a shift
(except during sleeping) and every time
the patient has dyspnea, and if the
SpO2 is < 95%, please notify
3. Instruct and assist client using
conscious, controlled breathing
technique
3.Auscultate breath sound, rate depth
& patterns every hour.
4. Perform 6 MWT every morning
(record SpO2 before and after 6
minutes) if drop >/=3%, please notify
3.
U/D: Type II DM, DLP, CKD, HTN, Assessment: Day 1 She asked the nurse if she would die, and
glaucoma in the right eye, and would she be able to return home after hospitalization?
cataracts on both sides. Day 4-5 d difficulty sleeping. She said she had not given food
offerings to Buddhist monks for several days. she missed
2. Risk for hypo-hyperglycemia home and her grandchildren very much.
Assessment : Hx. poor control, day
2DTX in the evening and before Day 3 Her face looked unhappy. She said she felt lonely and
bedtime were 329 and 391 mg%,, missed her grandchildren
day 3 11:00 AM it was 72 mg% Goal: Decrease anxiety
Goal: DTX inrange, no sign of Outcome: Patient verbalizes concerns
hypo-hyperglycemia
Outcome: DTX inrange, can
4. Constipation Nursing intervention
control by herself
Assessment: constipation 1.Guided imagery
Goal: constipation resoving 2. Therapeutic communication,
especially, empathy, distraction
Nursing intervention Outcome: feces q 3 day
3. Comfort touch, active listening
1. Observe sign of Hypo-
hyperglycemia 4. Teach slow deep-breathing
2. Diabetic diet
3. F/U DTX and give medication as
order
Nursing intervention
1. promote mobilize
2. give the med Milk of
5.Promote more effective breathing patterns through magnesia 60 ml Sig 30 cc
optimal positioning, pursed-lip breathing, and use
@ stat
abdominal muscle. High Fowler’s position promotes lung 3. observe elimination
expansion, turning side to side promote aeration of lung
6.Administer humidified O2
7.Schedule nursing care to provide rest and minimize fatigue
(inappropriate activity can increase hypoxia).
8.Give the medication as order
Utilizing the concepts of holistic health, managing clinical outcomes, nursing theories,
empirical evidence, continuing care, local wisdom, integrated and alternative health,
Philosophy of Sufficiency Economy, multiculturalism,

Holistic Approach in Nursing

Holistic nurses may integrate complementary care/ alternative modalities (CAM) into clinical
practice to treat people’s physiological, psychological and spiritual needs. Does not negate the
validity of conventional medicine therapies but serve to complement, broaden, and enrich the
scope of nursing practice and to help individuals assess their greatest healing potential (Burkhardt
& Deveneau, 2016: 409).

Mosby’s Dictionary of Complementary and Alternative Medicine, prayer is a “communication

with the spiritual or ultimate reality, which may be understood as transcendent or immanent, and
described in theistic or nontheistic terms.” This means prayer can be for the religious or
nonreligious, and although it may be tied to a religion, it isn’t prejudiced toward any faith, but all-
inclusive.

In terms of CAM, prayer is often viewed as a mind-body therapy to “focus on the relationships
among the brain, mind, body, and behavior, and their effect on health and disease” and “often
implemented by patients because of the low physical and emotional risk, the relatively low cost,
and [its] ability to allow patients to take a more active role in their treatment.” Understanding
prayer’s role in CAM is essential to gathering information about its effects.

From this case belief in Buddhist religion: used “Prayer” play Buddhist chants, invite the
monk to sprinkle the holy water and pray bedside.
Issues for discussion:

1. Identify the nursing problems of the client, including the physical, mental, psychosocial, and spiritual aspects, with supporting information. Then, put
these into a concept mapping by linking connections between each problem.

>>nursing-focused assessment was performed using Gordonʼs functional health

the physical

mental, psychosocial

spiritual aspects

2. Develop a nursing care plan that is holistic and appropriate for this client and her family, both during hospitalization and in the long term after hospital
discharge, using nursing theories, evidence-based nursing, continuing care, local wisdom, integrated and alternative health care, as well as the philosophy of
sufficiency economy. By:

2.1 Indicate nursing objectives or goals, both in short-term and long-term care, for each nursing problem of the client.

2.2 Identify indicators or desired clinical outcomes, both in short-term and long-term care, for each nursing problem of the client.
2.3 Recommend nursing interventions under the concepts of nursing theories, evidence-based nursing, continuing care, local wisdom, integrated and alternative
health care, as well as the philosophy of sufficiency economy.

3. Identify the ethical dilemmas that may arise in delivering care to this client and propose managements of choice for these indicated ethical dilemmas