HEALTH TEACHING

HEALTH PERCEPTION AND MAINTENANCE Provided knowledge that being healthy doesnt only pertains to physical aspect of a person but as well as his mental and emotional well being. Advised to use soft-bristled toothbrush to prevent bleeding gums. Instructed patient to keep fingernails short and smooth to prevent skin excoriation and infection from scratching. NUTRITION AND METABOLIC Encouraged to take nutritious, high-protein diet, if tolerated, supplemented by vitamins of the B complex and others as indicated including vitamin A, C, K and folic acid. Instructed to eat small frequent meals (6per day) than three large meals, because of the abdominal pressure exerted by ascites. Instructed to limit fluid intake of 1Liter per day as ordered by the doctor. Instructed to avoid alcohol consumption and foods rich in Sodium.

ELIMINATION

Encouraged to defecate each time the urge is felt. Provided information that the tea colored urine is due to the present of bile related to his present condition.

ACTIVITY/EXERCISE Advised patient to minimize activity and prolong his rest periods to permit the liver to reestablish its functional ability. It also reduces the demands on the liver and increased the livers blood supply.

Encouraged and assisted in turning side to side, which could help in preventing such problems as pneumonia and pressure ulcers and to promote mobilization of edema.

Encouraged to increase activity gradually within tolerable limit, after nutritional status improves and strength increases. Instructed to ask for assistance to get out of bed. Instructed and assisted family members to perform range of motion exercises to the patient every 4 hours; and elevate the edematous extremities. Instructed patients relatives to make sure that side rails are always up to prevent falls. Instructed to maintain elevation of head of bed at least 30 degrees to reduce abdominal pressure on the diaphragm and permits fuller thoracic excursion and lung expansion.

SELF PERCEPTION Provided information for assessing impact of changes in appearance, sexual function, and role on the patient and family Encouraged to verbalized reactions and feelings about the changes in his physical body. Encouraged and assisted patient in decision making about care.

ROLES AND RELATIONSHIP Encouraged verbalization of feelings to family members. Encouraged family members to always be the client, to provide support and care.

VALUES AND BELIEFS Encouraged to always pray and ask for strength and encouragement. Encouraged to read the bible every start and end of the day.

NURSING THEORIES
INTERPERSONAL ASPECTS OF NURSING THEORY By: Joyce Travelbee According to Travelbee, nursing is accomplished through human-to-human relationships that begin with the original encounter that progresses thorough a series of stages of emerging identities, developing feelings of empathy, and later on, sympathy until such time that the nurse and patient have attained rapport in the final stage. The establishment of a nurse-patient relationship and the experience that is rapport is the end of all nursing endeavor. Rapport is that which is experienced when nurse and patient has progressed through the four interlocking phases preceding rapport and the establishment of a nurse-patient relationship.

Before we started our duty in the clinical area, we were trained and taught on the importance of communication and building of rapport not only to the client, well or ill, but as well as with the family. Therapeutic communication was our vehicle through us, student nurses, and patient relationship were established. We provided positive approach, during our initial interaction with him, since the patient has body malaise and irritable because of his present condition. Proper communication through good listening and proper asking of questions are done so that we were able to identify one another with respect to his condition and for our ability to offer assistance. Rapport was easily built which helped us to gain his cooperation and compliance in providing nursing care to him, and to receive further information about his present condition.

SELF-CARE DEFICIT THEORY OF NURSING By: Dorothea Orem The main focus of this theory is the enhancement of the clients ability for self-care. When individual is unable to meet his own self-care requisites, a self-care deficit occurs. A persons self-care deficits are the result of environmental situations. The appropriate system that exist within nursing practice is the partially compensatory system wherein the student nurse and the patient help each other to perform self-care measures. It is shown below: Partially Compensatory System The nurse is responsible in: Performing some self- care measures for the patient Compensating for self-care limitations of the patient Assisting the patient as required

For the patient to: Performs some self-care measures Regulates self-care agency Accepts care and assistance from nurse

When an individual is unable to meet his own self care requisites, a self care deficit occurs. It is in the duty and obligation of the professional nurse to recognize and identify these deficits in order to define a support modality or intervention.

This theory is applicable to our patient during the time of our 3 days nursing care to him, due to his present condition. As we observed him, hes been a bed ridden for 3 days due to muscle weakness and difficulty of breathing. Self care deficit occurs, because he wasnt able to meet his own self care requisites like eating, bathing, changing clothes, defecating etc. It is our duty and obligation to recognize those deficits in order for us to define a support modality and

interventions. As assigned students nurses to him, it is our responsibility to provide total patient and holistic care to our patient. We performed self-care measures to him like providing bed bath; help him to compensate for self-care limitations through assisting during going to the bathroom to defecate; and assist him in his daily routine. It is clear in this model, the importance of emphasizing on education and supportive measures to our client. We provided health teachings like the importance of withdrawal from alcohol to prevent further liver damageand to increase intake of protein to compensate to the decrease albumin.

HELPING ART OF CLINICAL NURSING By Ernestine Wiedenbach Wiedenbach defined nursing based on her field of maternity nursing. According to her, there are four elements in the art of nursing: philosophy, purpose, practice, and art. She viewed clinical nursing as being directed toward meeting the patients perceived need for help. The following are the major concepts and sub-concepts of her philosophy. 1. Patient- need for help 2. Nurse- purpose, philosophy, practice and art. In order for nurses to fulfill the nurses helping role, they should be able to identify patients need for help through: 1. Observing behavior consistent or inconsistent with their comfort 2. Exploring the meaning of their behavior 3. Determining the cause of their discomfort or incapability 4. Determining whether they can resolve their problems or have a need-for-help In her theory, she believes in the four elements to clinical nursing. In her first element, which is nurses philosophy, it is described as the attitude and belief about life and how that affected reality of them. As female student nurses who are spiritually molded by our institution, we were able to apply nursing care with respect for his dignity and worth as a male patient. Secondly is the nurses purpose. We traditionally visit our patient, a day or hours prior to our

duty, so that we could formulate proper and accurate nursing care plan to him. We set plans or goals on what do we want to accomplish to our patient through our nursing interventions. We planned the activities directed toward the overall good of our patient based on the formulated nursing diagnosis. Next are the practice and art. Practices are the observable nursing actions that are affected by beliefs and feelings while art includes, understanding patients needs and concerns and doing actions to enhance patients ability. We became very sensitive to our patients need during our nursing care. We tried to foresee possible things/complications that could happen to our client so that immediate nursing actions could be establish. We also became his advocate, even though his subjective data didnt match the objective data that we assessed, still we did accurate and proper interventions and referrals to the staff nurses and clinical instructor.