1. Include 3–5 pieces of data (subjective, objective, or a combination) that led to a nursing diagnosis.

1. Write two goal statements for each nursing diagnosis. Goals must be patient- and family-focused, measurable, attainable, reasonable, and time-specific.

1. List at least three nursing or collaborative interventions; provide the rationale for each goal and outcome.

• Explain why each intervention is indicated or therapeutic; cite applicable references that support each intervention.

Were the goals met? How would you revise the plan of care according to the patient’s response to the current plan of care? Support your conclusions with outcome measures and professional standards.

Hyperglycemia

• PMH of uncontrolled diabetes
• Overweight due to poor management of disease condition
• Frequent urination secondary to the disease process

• Lower the patient’s BMP blood sugar to 110 mg/dL or less over the next few weeks.
• Reduce chances of additional health complications and emphasize self-care needs.

• Monitor and control blood sugar.
• Identify factors causing glucose instability. 
• Collaborate with a dietitian to create a diabetic diet.

• Frequent monitoring and controlling blood sugar keeps track of daily fluctuations, facilitating better control of diabetes.
• Embracing a diabetic diet with the help of a dietitian will help maximize nutritional intake, manage diabetes, and reduce the risk for cardiovascular illnesses (Sami et al.2017).
• Identifying and working on the causes of instability, such as skipping meals and missing drugs can help control her blood sugar levels.

The goals and outcomes discussed here were manageable and partly met. However, while the nursing interventions helped manage diabetes, it is essential to incorporate other nutritional needs considering that the patient has cancer. 

Obesity

• Hypercholesterolemia 
• Pain and SOB on inspiration due to strain on body secondary to weight 
• Ineffective management of blood pressure secondary to the disease process

• Get the patient to lose some weight (at least 2 pounds per week) through healthy eating and exercising.
• Get and maintain the patient’s blood pressure below 120/80 mmHg, 
• Reduce SOB and fatigue, and 
• Increase oxygen saturation to 95%.

• Educate and engage family members in the patient’s diet formulation.
• Monitor body weight for weight loss every other week.
• Consult with a dietitian on the patient’s caloric and nutritional needs, in an effort to reduce weight and maintain weight lost.
• Light exercise to promote good cadio health.
• Educate patient and family on the need for a low salt diet for the management and reduction of blood pressures

• The patient’s diet should constitute the foods with the right nutrients to help her manage her health condition and meet her nutritional needs (Ridder et al., 2017).
• Periodic weight monitoring allows tracking of the patient’s condition and facilitates necessary adjustments.
• Factors such as age, sex, other health conditions, and desired weight impact nutritional requirements. Consulting with a dietitian helps achieve more effective results (Bleich et al., 2015).

These interventions helped the patient lose weight and feel better. However, weight loss is progressive, and in this case, getting the patient down to an ideal weight may not be realistic since she needs to consume a high-protein diet and supplemental shakes due to her cancer. However, in the future, it may help to increase the patient’s physical exercises to aid in weight management.

Pain-related anxiety

• Low pain tolerance
• Verbal expression of anxiety and fear
• PMH of being on and off of anti-anxiety medication.

• Demonstrate minimal to no psychological symptoms of anxiety by adopting effective mechanisms for dealing with anxiety
• Identify and overcome distinct stressors that cause or heighten anxiety levels.

• Discuss pain management options with the patient
• Explore alternative anxiety management and coping strategies such as aromatherapy.
• Identify and encourage positive reinforcement, including positive self-talk.

• Patient education and information help patients to comprehend the situation and feel more confident (Patrick et al., 2017).
• Alternative anxiety management strategies help reduce anxiety while avoiding other side effects, especially medication-associated ones.
• Positive reinforcement and self-talk fall under cognitive therapies, which focus on changing thoughts. Such reinforcement helps reduce anxiety (Curtiss et al., 2021).

After understanding her pain relief options, some alternative anxiety management strategies that will excuse her from the negative side effects of drugs, and embracing positive reinforcement, the patient’s anxiety reduced significantly. While the goals were ultimately met, it would help further if the care plan involved family members and focused on additional factors in the clinical and home environment that contribute to the patient’s anxiety.

Compromised family coping

• Ineffective family coping secondary to avoiding the needs of a sick family member
• Caregiver role strain secondary to poor understanding of role and lack of effective communication
• Denial of the severity of disease-related complications and risk of death

• Get the patient as much support as possible from the family members.
• Get the family members to express their feelings and help the patient manage her diabetes.
• Family members are able to identify the signs and symptoms of diabetes and intervene accordingly

• Offering valuable feedback and constantly engaging family members.
• Identify available resources and support systems.
• Educate and involve family members in the treatment plan.

• Offering valuable feedback and honoring their contribution motivates them to care for the patient.
• Getting community resources and support systems helps the family interact with others that may offer emotional support and help cope with the situation (Whitehead et al., 2017).
• Family members need to understand the condition to cope with the situation, offer support to the patient, and help administer medication effectively (Jazieh et al., 2018).

The patient’s family, especially Mr. Snyder, has not been very supportive of the patient. They have not helped her embrace a diabetic diet or helped around the house. These interventions have, however, increased their involvement and partly achieved set goals. This care plan would be more effective if it focused on specific disease-related measures.