CHAPTER 42 / Stress and Coping 1075
NURSING CARE PLAN Ineffective Coping
ASSESSMENT DATA NURSING DIAGNOSIS DESIRED OUTCOMES*
Nursing Assessment
Ruby Smithson is a 55-year-old mother of four children who is
hospitalized with breast cancer. She is scheduled for a modified
radical mastectomy. Ruby was relatively healthy until she found a
lump in her right breast 1 week ago. She and her husband are ex-
tremely anxious about the surgery. Ruby confides to the admitting
nurse that “I can’t stand the idea of having one of my breasts cut
off; I don’t know how I’m going to be able to even look at myself.”
Mr. Smithson informs the nurse that Ruby has been abusing alco-
hol since her diagnosis and neglecting her responsibilities as a
mother. She is tearful and doesn’t see how she will be able to
continue her work as a dress designer.
Ineffective Coping related to
personal vulnerability secondary
to mastectomy (as evidenced
by verbalization of inability to
cope, substance abuse, inability
to meet role expectations)
Coping [1302], as evidenced
by often demonstrating ability
to
■Identify effective and inef-
fective coping patterns
■Verbalize sense of control
■Report decrease in negative
feelings
■Modify lifestyle as needed
Social Support [1504], as evi-
denced by substantial reports of
■Willingness to call on others
for help
■Emotional assistance pro-
vided by others
NURSING INTERVENTIONS*/SELECTED ACTIVITIES RATIONALE
Coping Enhancement [5230]
Provide an atmosphere of acceptance.
Provide factual information concerning the diagnosis, treatment,
and prognosis.
Appraise Ruby’s adjustment to changes in body image.
Arrange situations that encourage her autonomy. Give her as
many opportunities as possible to make decisions/choices for
herself.
Explore with her previous methods of dealing with life problems.
Encourage verbalization of feelings, perceptions, and fears.
Encourage Ruby to identify her own strengths and abilities.
Establishing rapport is essential to a therapeutic relationship and
supports the client in self-reflection. Recognizing problems and
sharing feelings is best brought about in an atmosphere of
warmth and trust.
Factual information serves as a foundation for Ruby to explore
feelings and alternative coping strategies. Stressed clients often
misunderstand facts and require frequent clarification so that ap-
propriate conclusions can be drawn. Having valid information
helps relieve stress.
Alteration in body image may be a major issue for Ruby and
should be explored to facilitate therapeutic intervention. Coping
strategies often change with a reappraisal of the situation.
Enhances a sense of control, personal achievement, and
self-esteem.
Present and past coping status assists both Ruby and her hus-
band in capitalizing on successful methods, identifying ineffective
strategies, and developing new skills more appropriate to the
present situation. Also determines risk for inflicting self-harm.
Open, nonthreatening discussions facilitate the identification of
causative and contributing factors.
Assists Ruby to develop appropriate strategies for coping based
on personal strengths and previous experiences. Improves self-
concept and sense of ability to manage stress.
Physical Examination
Height: 164 cm (5′5′′)
Weight: 58 kg (158 lb)
Temperature: 37ºC (98.6ºF)
Pulse rate: 88 BPM
Respirations: 16/minute
Blood pressure: 142/88 mm Hg
Diagnostic Data
Chest x-ray negative, CBC, and
urinalysis within normal limits
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