Dorothea Orem Theory – Self Care Deficit Theory
Every mature person has the ability to meet self care needs, but when a person experiences the inability to do so due to limitations , thus exist a self care deficit. A person benefits from nursing interventions when a health situations inhibits their ability to perform self care or creates a situation where their abilities are not sufficient to maintain own health and wellness. Nursing action focuses on identification of limitations / deficit and implementing appropriate interventions to meet the needs of person. Each person has a need for self care in order to maintain optimal health and wellness.
Each person possesses the abilty and responsibility to care for themselves and dependants. Theory is seperated into three conceptual theories which include : self care, self care degicit and nursing system. Self Care is the ability to perform activities and meet personal needs with the goal of maintaining health And wellness of mind,body and spirit of the client
Self care is a learned behaviour influenced by the metaparadigm of person , environment , health and nursing. Orem viewed man as an integrated whole composed of an internal physical, psychologic, and social nature with varying degrees of self-care ability. He/she has the potential for learning and development as he/she is gifted with rational ability and capacity to reflect on his/her experience and use symbols (ideas and words). Under normal conditions, man is self-reliant, responsible and capable continuous self-care, not only of himself/herself, but also oh his/her dependents.
Orem viewed a patient as an individual with health related limitations that make him/her incapable of continuous self care or dependent care. His/ her self-care requisites or demands are beyond his/her self-care abilities which can be attributed to his/her lack of knowledge, skills, motivation or orientation.
Our patient have a acute myocardial infarction and was adnmitted to Intensive
Care Unit. The patient can not do what she wants to do that’s why she is dependent. She needs help to somebody to meet her needs. That’s why we choose the theory of Dorothea Orem the Self Care Deficit Theory.
MI results from myocardial ischemia and cell death, most often because of an intra-arterial thrombus superimposed on an ulcerated or unstable atherosclerotic plaque. Despite advances in therapy, MI remains the leading cause of death in the United States. MI risk factors include hyperlipidemia, diabetes, hypertension, male gender, and tobacco use. Diagnosis is based on the clinical history, ECG, and blood test results, especially creatine phosphokinase (CK), CK-MB fraction, and troponin I and T levels. Outcome following an MI is determined by the infarct size and location, and by timely medical intervention.
Aspirin, nitrates, and beta blockers are critically important early in the course of MI for all patients. For those with STEMI and for those with new left bundle branch block, coronary angiography with angioplasty and stenting should be undertaken within 90 minutes of arrival at facilities with expertise in these procedures. Fibrinolytic therapy should be used in situations in which early angiographic intervention is not possible. Postdischarge management requires ongoing pharmacotherapy and lifestyle modification. Tests
When a person presents to the emergency room with symptoms of acute coronary syndrome (ACS), it is usually not clear whether the person is having a heart attack or unstable angina, or chest pain due to another cause. A number of tests are available to help evaluate whether a heart attack (AMI) has occurred. Laboratory Tests
Blood tests are usually needed to tell whether a heart attack has occurred. Cardiac biomarkers, proteins that are released when muscle cells are damaged, are frequently ordered to help differentiate ACS from a heart attack. These include: Troponin – the most commonly ordered and cardiac-specific of the markers; will be elevated within a few hours of heart damage and remain elevated for up to two weeks. A series of troponin tests is typically performed over several hours. A rise and/or fall in the series of results indicates a heart attack. CK-MB – one particular form of the enzyme creatine kinase that is found mostly in heart muscle and rises when there is damage to the heart muscle cells. Other tests that may be performed include:
Myoglobin – a protein released into the blood when heart or other skeletal muscle is injured; this test is used less frequently now. BNP or NT-proBNP – released by the body as a natural response to heart failure; increased levels of BNP, while not diagnostic for a heart attack, indicate an increased risk of cardiac problems in persons with acute coronary syndrome. One or more of these tests are usually ordered initially in the ER when a person presents with symptoms of acute coronary syndrome and then a few more times in the next several hours to look at changes in concentrations. If these cardiac biomarkers are normal, then it is much less likely that the symptoms and chest pain are due to heart muscle damage and is more likely that the pain is due to stable angina.
Other more general screening tests may also be ordered to help evaluate the person’s major body organs, electrolyte balance, blood sugar, and red and white blood cells to see whether there are any excesses, deficiencies, or dysfunctions that may be causing or exacerbating the person’s symptoms. These include: Comprehensive Metabolic Panel – a group of usually 14 tests that is used as a broad screening tool to assess the current status of an individual’s kidneys, liver, electrolyte and acid/base balance, blood sugar, and blood proteins. Complete Blood Count – a test used to determine a person’s general health status and to screen for a variety of disorders. Non-laboratory Tests
A range of non-laboratory evaluations and tests are used to assess chest pain and other symptoms. These include: A medical history, including an evaluation of risk factors such as age, CAD, diabetes, and smoking A physical examination
An electrocardiogram (ECG or EKG) – a test that looks at the heart’s electrical activity and rhythm; the diagnosis of a heart attack may be made by changes seen on an electrocardiogram and by a number of blood tests. An ECG is performed within the first few minutes after a person with ACS arrives in the emergency room. It evaluates heart rhythm and can be used to detect changes that prove that a severe heart attack has occurred. Most commonly, the ECG only confirms that the heart is not getting enough blood or has non-specific changes that do not prove that a heart attack has occurred. Continuous ECG monitoring – a person wears a monitor that evaluates heart rhythm over a period of time Based on the findings of these tests, other procedures may be necessary, including: An exercise stress test
Radionuclide imaging – a radioactive compound is injected into the blood to evaluate blood flow and show images of narrowed blood vessels around the heart Echocardiography – ultrasound imaging of the heart
Cardiac catheterization – in this procedure, a thin flexible tube is inserted into an artery in the leg and threaded up to the coronary arteries to evaluate blood flow and pressure in the heart and the status of the arteries in the heart. Coronary angiography – X-rays of arteries using a radiopaque dye to help diagnose CAD; this procedure is performed during cardiac catheterization.
Respiratory alkalosis is the most common acid-base abnormality observed in patients who are critically ill. It is associated with numerous illnesses and is a common finding in patients on mechanical ventilation. Many cardiac and pulmonary disorders can manifest respiratory alkalosis as an early or intermediate finding. When respiratory alkalosis is present, the cause may be minor; however, more serious disease processes should also be considered in the differential diagnosis.
Acid–base homeostasis is the part of human homeostasis concerning the proper balance between acids and bases, also called body pH. The body is very sensitive to its pH level, so strong mechanisms exist to maintain it. Outside the acceptable range of pH, proteinsare denatured and digested, enzymes lose their ability to function, and death may occur. Hypocapnia (hypocapnea, also known as hypocarbia) is defined as a deficiency of carbon dioxide in the arterial blood. Most medical sources define hypocapnia as less than 35 mm Hg for partial CO2 pressure in the arterial blood. The arterial CO2 value for normal breathing at rest is 40 mm Hg (or about 5.3% CO2 partial pressure at sea level).
In medicine, metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due toincreased production of hydrogen by the body or the inability of the body to formbicarbonate (HCO3-) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia. Metabolic acidosis is a condition in which there is too much acid in the body fluids. Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body.
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