What This Document Is
This is a Geriatric Care Plan completed as part of the NUR 330 Gerontological Nursing course at Indiana Wesleyan University. It represents a student’s assessment of a client (initials R.S.) and the development of prioritized nursing diagnoses based on that assessment. The care plan focuses on identifying the client’s strengths, stressors, and relevant history to formulate appropriate nursing interventions.
Why This Document Matters
This type of document is crucial for nursing students learning to apply theoretical knowledge to real-world patient scenarios. It’s used during clinical rotations and coursework to develop critical thinking skills in geriatric care. Completed care plans demonstrate a student’s ability to synthesize assessment data, identify patient needs, and begin to formulate a plan of care. This specific example is valuable for students seeking a model of how to structure a geriatric assessment and nursing diagnosis process.
Common Limitations or Challenges
This document represents a *snapshot* in time and a student’s initial assessment. It does not reflect ongoing care, changes in patient condition, or the full implementation of interventions. It’s a starting point for a comprehensive care plan, not a finished product. Users should not rely on this as a complete or definitive guide to treating any patient.
What This Document Provides
This preview includes:
* A client’s identified strengths and stressors across developmental, cultural, psychosocial, and physiological domains.
* Relevant client history, including age, living situation, family contact, and medical diagnoses.
* Three prioritized nursing diagnoses in PES (Problem, Etiology, Signs/Symptoms) format, including definitions from Ackley & Ladwig (2011). These diagnoses address impaired walking, risk for loneliness, and deficient knowledge/risk for spiritual distress.
* Key assessment findings, including vital signs, lab results (INR, PTT, HDL, Cholesterol), and physical assessment observations.
* Information regarding the client’s nutritional status and activity/mobility limitations.
This preview *does not* include a complete plan of care with specific interventions, rationales, or evaluation criteria. It also does not include a full medical history or a comprehensive list of medications.