CASE STUDY-4 (IMPI EMENTATION OF THE NURSING PROCESS) The following information was obtained in the initial/admission diagnosis of Mrs. Akkaya, who applied to the polyclinic. Mrs. Akkaya is a 65-year-old, 155 cm tall, 80 kg illiterate housewife who gave birth five times but lost four of her children in their infancy due to various reasons. Mrs. Akkaya lost her husband two months ago and moved in with her son. The house they live in is in a slum; They meet their water needs from a pump (well) in the garden in this house with two rooms , a stove, no water in its toilet and kitchen. In this house , Mrs. Akkaya lives with his son ,daughter-in-law and two grandchildren, aged 8 and 14. After the death of her husband, some health problems of Mrs. Akkaya began to emerge. She applied to the health institution with excessive thirst, frequent urination, sweating, feeling of faintness, dryness in the mouth and the smell she felt in his breath. As a result of the examinations made with the financial support of her acquaintances, she was diagnosed with diabetes mellitus (Type II Diabetus Mellitus). Mrs. Akkaya cannot take her medications regularly and go to her checkups because she and her son do not have any health insurance and are experiencing financial difficulties. Therefore, their complaints continue. Mrs. Akkaya spends her days helping her son in gardening. However,while doing these works, cracks and abrasions may occur on her feet and hands from time to time and she usually noticed later. In her spare time, she knits sweaters and socks for her grandchildren. In addition, many changes in his life, such as having to give up her favorite food habits due to his diabetes diet, and interrupted sleep due to frequent urination at night made her more sensitive. At the same time, she does not feel rested during the day, has difficulties in her daily work and cannot go to visit her neighbors in her old neighborhood, although she misses them. Mrs. Akkaya often makes statements to those around her, "I will no longer be able to get rid of this disease". She feels restricted, alone, and her view on life becomes pessimistic day by day. In line with the information above, make the nursing diagnosis of Mrs. Akkaya. 1. Formulate the following nursing diagnoses. 2. Plan your care considering these diagnoses.

1. Nursing Diagnoses:<br /><br />a. Impaired Skin Integrity related to cracks and abrasions on feet and hands from gardening, as evidenced by visible lesions and patient's reports of pain and discomfort.<br /><br />b. Ineffective Health Maintenance related to financial difficulties and lack of health insurance, as evidenced by irregular medication and checkup attendance, and patient's verbal expressions of feeling overwhelmed and unable to manage diabetes.<br /><br />c. Disturbed Sleep Pattern related to frequent urination at night, as evidenced by patient's reports of interrupted sleep and feeling unrested during the day.<br /><br />d. Social Isolation related to physical and emotional limitations imposed by diabetes, as evidenced by patient's inability to visit neighbors and feelings of loneliness and pessimism.<br /><br />2. Care Plan:<br /><br />a. For Impaired Skin Integrity:<br />- Educate Mrs. Akkaya on proper foot care, including daily inspection for cracks and abrasions, keeping feet clean and dry, and wearing protective shoes.<br />- Provide instructions on wound care and prevention of infection.<br />- Encourage regular hand hygiene and use of gloves while gardening to prevent abrasions.<br />- Schedule regular follow-up appointments to monitor skin integrity and address any concerns.<br /><br />b. For Ineffective Health Maintenance:<br />- Assist Mrs. Akkaya in exploring available resources for financial assistance and health insurance options.<br />- Develop a realistic and achievable diabetes management plan, including medication schedule, diet, and exercise recommendations.<br />- Provide education on the importance of regular checkups and self-monitoring of blood sugar levels.<br />- Offer emotional support and counseling to help Mrs. Akkaya cope with the financial and emotional burden of diabetes.<br /><br />c. For Disturbed Sleep Pattern:<br />- Educate Mrs. Akkaya on strategies to manage nocturia, such as limiting fluid intake in the evening, emptying the bladder completely, and waking up to use the bathroom.<br />- Encourage regular sleep hygiene practices, such as maintaining a consistent sleep schedule, creating a restful sleep environment, and avoiding caffeine and heavy meals before bedtime.<br />- Provide relaxation techniques, such as deep breathing exercises or guided imagery, to help Mrs. Akkaya fall asleep and stay asleep.<br /><br />d. For Social Isolation:<br />- Encourage Mrs. Akkaya to engage in social activities and maintain connections with friends and family, even if it's through phone calls or video chats.<br />- Assist Mrs. Akkaya in identifying local resources and support groups for individuals with diabetes.<br />- Provide emotional support and counseling to help Mrs. Akkaya cope with feelings of loneliness and pessimism.<br />- Encourage Mrs. Akkaya to set realistic goals and develop a plan to gradually increase her social interactions and participation in daily activities.