Case 1: Nursing Care For Patients With Problems Psychosocial Anxiety

NURSING CARE FOR PATIENTS WITH PROBLEMS PSYCHOSOCIAL: ANXIETY Exercise 1 (vignettes, expected tasks and skills) Mrs Y had a hysterectomy operation on April 10 2017. On April 25 2017 Mrs Y was checked into the hospital polyclinic with no medical record. 13.095478. The results of the study showed that: Mrs Y said that after the operation she was afraid that her husband would remarry. Since after the operation was completed, the patient complained of heart palpitations, difficulty sleeping, dry mouth, restlessness, cold sweaty hands, the focus of attention was only on how to be able to act as a good wife. The patient is unable to receive much information from other people and is unable to make good decisions and relies more on her husband in making decisions. Observation results: tense facial expression, narrowed attention span, changes in vital signs (increased pulse and blood pressure), frequent shortness of breath, often startled, decreased attention, often wringing hands and appearing to talk a lot and faster Practice Instructions 1. Make an LP for the case above 2. Create an SP for the above case 3. Carry out an assessment for psychosocial problems according to the existing format 4. Analyze data and nursing problems 5. Make a problem tree 6. Determine the act of virginity 7. Perform a nursing evaluation 8. Perform nursing documentation 9. Do implementation strategy exercises according to the cases above that you often encounter in the clinic Training evaluation instructions 1.Make a preliminary report The first step before you do the practicum, you must make a preliminary report according to a fictional case, as in the format below Instructions for making a preliminary report a. Write down the patient's main complaint b. Complete and create a process for problems occurring from predisposing and precipitating factors in the case.If you have difficulty in making a preliminary report, study the virginity care module for patients with anxiety again. Example of a Chief Complaint Preliminary Report DS : the patient said he was worried after surgery. Complaining of heart palpitations.insomnia DO: Facial expressions are tense, attention span is narrowed, results change in signsvitals (increased pulse and blood pressure), frequent shortness of breath, frequent shocks, decreased attention, often wringing hands and appearing to talk a lot and faster. Dry mouth, restlessness, cold dry hands, focus of attention only after surgery, external stimuli unable to be received, and perception field narrowed. Problem occurrence process There are several theories that can explain the occurrence of anxiety, including: a. Biological Factors The brain contains special receptors for benzodiazepines, which help regulate anxiety. GABA inhibitors also play a major role in the biological mechanism of anxiety as do endorphins. Post cataract and heart patients are different b. Psychological Factors 1) The psychoanalytic view that anxiety is an emotional conflict that occurs between two personality elements, the id-superego. The id represents primitive instincts and impulses, while the superego reflects a person's conscience which is controlled by one's cultural norms. The ego functions to mediate the demands of two conflicting elements and the function of anxiety is to remind people of culture. 2) Interpersonal view. Anxiety arises from fear of interpersonal acceptance and rejection. Post cataract surgery, surgical trauma, fear of separation and loss from the environment of all the people who matter to the patient. c. Behavioral view, anxiety is a product of frustration, namely anything that interferes with a person's ability to achieve desired goals d. Socioculturally, anxiety is something that is commonly found in families. Economic factors and educational background influence the occurrence of anxiety e. Precipitation factor Anxiety precipitation factors are divided into two, namely: 1) Threats to a person's integrity such as inability or decreased physiological function due to illness so that it interferes with the individual carrying out daily living activities such as post cataract surgery 2) Threats to one's self-system. This threat will cause disruption to the individual's self, selfesteem and social functioning .Generalist Nursing Actions for Patients The next step, after you are able to determine the patient's main problem, is to write a nursing action plan according to the patient's problem. You can re-learn nursing care activities for anxious patients. Create nursing care according to the format in the attachment to this module. a. Goal: 1. The patient is able to recognize anxiety 2. Patients are able to overcome anxiety problems through relaxation and distraction techniques 3. The patient is able to demonstrate and use relaxed techniques to overcome anxiety b. Nursing actions 1. Discuss anxiety: causes, process, signs and symptoms, and consequences caused by anxiety 2. Practice physical relaxation, control thoughts and emotions c. Strategy for implementing meeting 1 of anxiety assessment and relaxation exercises: 1. Build a relationship of mutual trust a. Say therapeutic greetings, introduce yourself, call the patient by their preferred nickname b. Explain the purpose of the interaction: practice controlling anxiety so that the healing process is faster 2. Make a contract(informed consent)Twice meetings practice anxiety control 3. Help patients recognize anxiety: a.Help the patient to identify and describe his feelings b. Help the patient recognize the causes of anxiety c. Help clients become aware of anxiety behavior 4. Practice relaxation techniques a. Take a deep breath b. Distraction 5. Maintain patient trust a. Say hello and give motivation b. Reassessment of anxiety and ability to perform relaxation techniques c. Make a contract again: practice controlling anxiety