RUNNING HEAD: Plan of Care 1

Plan of Care Health Assessment

Delaware Technical Community College
Amanda Smith
12/09/2017
Plan of Care 2

Plan of Care Health Assessment

Inadequate Stress Management
During the health assessment interview the patient described being very stressed at this

time. Inadequate stress management can contribute to hypertension, burnout, and decreased

immune function (Pietrangelo & Watson, 2017). Stress is a normal part of life, however, because

of the negative effect inadequate stress management can have on the body it is important to

create a positive system to handle daily stresses.

Stress Management Techniques

There are many proven stress management techniques that the patient can be taught and

will be able to use throughout the day to decrease stress levels. The American Heart Association

(AHA), 2017, has a great article about four steps to managing stress. The four ways to deal with

stress the American Heart Association (2017) suggests are 1) positive self-talk, 2) emergency

stress stoppers, 3) finding pleasure, and 4) daily relaxation. Positive self-talk is a very effective

way to deal with stress, while negative self-talk typically increases stress. Examples of positive

self-talk are telling yourself that you can do it, I can deal with this situation, and I can solve

things one step at a time (AHA, 2017). Emergency stress stoppers are different techniques that

patient can use anywhere to help decrease stress, such as counting to ten, walking away from the

stressful situation, taking several deep breaths, going for a walk, and breaking down problems

into smaller parts (AHA, 2017). Finding pleasure is a natural way to decrease stress, finding

small things in everyday life are ways that this patient can decrease stress. Examples of this are

reading a favorite book or magazine, listening to music, and many more, that idea is to do

something that you know will bring you joy (AHA, 2017). For this patient several ways for her

to find pleasure is to see her horse, take her dogs for a walk, and watching birds eat from a feeder

in her yard. Daily relaxation incorporates the use of meditation to decrease stress. The American
Plan of Care 3

Heart Association (2017) believes meditation is a great way to decrease stress, but most often it

takes practice to use this skill effectively, they suggest taking a class to learn how to do

meditation first.

Patient Goals

Goals for this patient include incorporating stress management techniques into everyday

use, the patient verbalizing a reduction in stress level after using the stress management

techniques, and a possible decrease in pulse and blood pressure because of the lowered stress

level. Yoga is another effective tool of stress management and there are numerous places that

offer beginner classes at a reduced rate so that people may try it. Referrals to give the patient

may include area yoga classes and therapy if they wish to try that. The nurse should make a point

to go over positive stress management techniques and help the patient to create a plan for usage

of these techniques. Making follow up appointments with the primary care physician to discuss

stress and if the stress management techniques are helping to decrease stress levels.

Evaluation

In the evaluation stage the nurse should repeat the previous health questionnaire and

focus on asking the patient what techniques have been working and if there are any revisions

they should make to the plan on care. Does the patient feel they have benefitted from the positive

stress management? Is there one technique that they have been using more than the others and do

they feel like it has worked better for their schedule and situation? When observing the patient do

they seem more relaxed than the last time they came in? Has their blood pressure or heart rate

decreased, which can be a sign of a decrease in stress levels.

Plan of Care 4

Risk for Breast Cancer

When constructing the patients genogram and reviewing family history I noticed a

moderate amount of breast cancer within first degree relatives (mother and older sister), which

places a woman at a higher risk of acquiring breast cancer. Breast cancer has a fairly high death

rate and if prevention or early detection/ treatment can be implemented there is a greater chance

of survival. Which is why understanding if the patient is at a higher risk, and taking steps to

reduce that risk is so important. Breast cancer occurs when malignant cancer cells form in the

tissue of the breast (National Cancer Institute, 2017).

Risk Factors

The National Cancer Institute (NCI), 2017, lists that there are numerous risk factors that

contribute to breast cancer, and many of them are nonmodifiable, such as having dense breast

tissue, increasing age, the presence of the BRCA1 or BRCA2 gene, and the length of exposure to

estrogen made in the body. However, there are protective measures that can be implemented to

reduce cancer risk. Examples of protective measures are maintaining a healthy weight, limiting

alcohol intake, and opting to breast feed (NCI, 2017). My patient maintains a healthy weight and

exercises regularly, does not drink alcohol in excess, and had two children before the age of 35

and breastfed both of them. There are certain surgical options as well to decrease the risk of

breast cancer, two of those options are ovarian oblation and a mastectomy (NCI, 2017). An

ovarian oblation is effective because the ovaries produce much of the estrogen in the body, and

by taking away the highest estrogen producer the breast tissue gets exposed to less estrogen over

time (NCI, 2017). An elective mastectomy is effective because it removes many of the cells in

breast tissue that may become malignant. My patient is best to continue their current lifestyle of

exercising frequently and limiting alcohol intake so her risk of breast cancer does not go up. The
Plan of Care 5

patient currently sees her OBGYN annually and has annual 3D mammograms at the Helen F.

Graham Cancer Center. Both of those visits are very important detection tools for breast cancer

and are encouraged. The patient does plan to increase her mammogram frequency to every six

months as her age advances.

Patient Goals

Goals for this patient are to maintain or decrease her risk for breast cancer and continue

practicing preventative measures. I would like this patient to be able to perform self-breast

checks with greater frequency and to be more comfortable with doing self-breast exams. The

patient should verbalize steps they can do now to prevent breast cancer. The patient should see

her primary care physician annually and discuss how mammograms and preventative steps are

going. The patient may need referral to a geneticist at some point if she would like to get testing

for the BRCA1 and BRCA2 gene. Quest Diagnostics in Middletown, DE does have a genetic

testing specific for cancer available called the Watson Genomic test. The code for the test is

readily available for the primary care physician to enter and may provide information that was

unknown before.

Evaluation

Evaluation of this patient should occur annually, if not more. Does the patient still

exercise regularly? Has the patient gotten more comfortable with self-breast examination and

does she do it regularly? Has the patient gained weight? Is the patient still menstruating or has

she reached menopause? Does the patient still get annual 3D mammograms and visit her

OBGYN? Has the patient done genetic testing and what was the result? A positive finding of the

BRCA1 and/ or BRCA2 gene increases her risk of breast cancer. If the result is positive do other

measures, such as surgical options, need to be discussed more readily? Frequently evaluating
Plan of Care 6

where the patient stands with risk factors and lifestyle is important to staying up to date and

allowing changes to be made to prevent breast cancer.

Risk for Heart Disease

When constructing the patients genogram and reviewing family history I noticed a

moderate amount of hypertension and high cholesterol that can lead to heart disease. Heart

disease makes a person more prone to stroke and heart attack. Prevention is key when there is a

risk of heart disease and being aware of a higher risk of heart disease early can prompt

preventative behavior sooner (AHA, 2017). Committing to yearly physicals and visits with a

primary care physician are important steps to staying on top of indicators of heart disease.

Having routine blood pressure checks and blood work done to check cholesterol are just some of

the things a primary care physician will use to monitor a healthy heart and lifestyle. A low fat

diet and routine exercise are also both major factors at controlling heart disease.

Patient Goals

Goals for this patient are early detection and treatment if indicators of heart disease are

found. The patient is not currently taking any medications for heart disease, if medications are

prescribed in the future adherence to taking them is a crucial part of managing heart disease. The

major goal for an at risk for health condition is preventing the disease for as long as possible.

Referrals that may assist this patient keep to their goals may be a nutritionist to discuss diet,

exercise coach (or their primary care physician) to get good advice on heart healthy exercises

that are age appropriate. Many YMCAs and gyms offer classes that target heart healthy

exercises that are not high impact, like swimming and cycling.

Evaluation
Plan of Care 7

During visits the patient should be assessed on the continuing adherence of a heart

healthy lifestyle. What exercises do they do and with what frequency? How are they contributing

to eating a low-fat/ heart healthy diet? Do they have any concerns for their heart health, any

episodes of chest pain or shortness of breath? Are their cholesterol levels within normal limits?

Is their blood pressure within an acceptable range? Does the patient have any extra goals for

themselves that they would like to add to prevent heart disease? The evaluation stage is a crucial

part of determining if the plan in place right now is working or if anything needs to be revised to

keep the patent on track for short and long term goals and the prevention of heart disease.
Plan of Care 8

References

American Heart Association. (2017, May 2nd). Four ways to deal with stress. Retrieved from

http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/FourWaystoDeal

WithStress/Four-Ways-to-Deal-with-Stress_UCM_307996_Article.jsp#

American Heart Association. (2017, Nov. 16th). Understand your risks to prevent a heart attack.

Retrieved from

http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskstoPrev

entaHeartAttack/Understand-Your-Risks-to-Prevent-a-Heart-

Attack_UCM_002040_Article.jsp#.Why_7kqnE2w

National Cancer Institute. (2017, August 18th). Breast cancer prevention. Retrieved from

https://www.cancer.gov/types/breast/patient/breast-prevention-pdq#section/_4

Pietrangelo, A., & Watson, S. (2017, June 5th). The effects of stress on your body. Retrieved from

https://www.healthline.com/health/stress/effects-on-body