Problem/Need Intervention Outcome Actual Start and End Dates
Purposeless and involuntary vomiting ·         Create rapport and make the patient comfortable.


·         Assess the pattern of vomiting, timing and amount.



·         Assess the patient’s social history and the familial support.



·         Assess prior remedies tried and drugs used before.

·         This makes the patient comfortable to give consent and share information.

·         To be able to rule out other vomiting problems with similar manifestations(Young & Dietrich 2014).


·         Sometimes rumination is associated with family-related stress and neglect in childhood and infancy

·         To ascertain the entry level of the patient and the need and depth for health education.

By 1 week
Ineffective nutrition (less than body requirement) ·         Relate vomiting to nutritional requirement by age/sex

·         Assess the patient’s weight changes over time.


·         Assess the nutrition status of the patient.



·         Progressively provide alternative nutrition such as parenteral nutrition and supplementation.

·         To identify the existing nutritional deficiency related to rumination.


·         To discover the effects of rumination on positive weight gain.


·         To ascertain the existence of deficiency and come up with a solution.

·         To ensure adequate nutritional support and cover the deficiency(Berman et al. 2011).

2-3 weeks
Retarded growth and development ·         Assess patients milestones and relate to age and sex ·         To discover the effects of rumination on growth and development. 3 weeks
Negative Social image ·         Assess the social support of the patient.



·         Provide psychological counselling to the patient and involve the family(Berman et al. 2011).



·         Conduct a comprehensive health education on patient and family

·         To discover the effects of rumination on the socialisation and life of the patient.

·         To help the patient recover his or her image after the disease and ensure family and social support

·         To allay anxiety and create an informed understanding from the family and the society(Young & Dietrich 2014).

2-3 weeks

Nursing Care Plan Rumination

 Nursing Care Plan Worthlessness and Hopelessness

Problem/Need Intervention Outcome Actual Start and End Dates
Low self-Esteem ·         Introduce self and others

·         Create rapport and an environment of understanding.

·         Allow the patient to express self without interruption.


·         Helps the client feel valued and comfortable to share important information.


·         A listening person encourages the client to share. Further, it assists in making the feel valued and understood(Delaney & Barrere 2012).

1 week
Feeling of Worthlessness ·         Help patient to recognise life achievement however small.


·         Help patient to focus on positives in his or her life



·         Create a list of positives and negatives in life and help the patient compare.

·         Little achievements may be easily forgotten but are important in creating self-worth(Verkaik, Francke, Van Meijel, et al. 2011).

·         Excess focus on negatives and failures leads to low self-esteem. Focusing on positives counters this feeling

·         Having a list of positives makes the feeling of self-worth reinforced and makes it appear real.

2 weeks
Inability to find pleasure in activities ·         Encourage socialisation and participation in activities.


·         Provide psychosocial support.

·         Socialisation and sharing helps reduce negatives in life and mind.

·         Supportive frameworks encourage the ability to interact and be happy

2 weeks
Feeling of lost hope ·         Encourage patient to find pleasure in small things.



·         Help patient regain hope in self, humanity and life.

·         Small positive feelings encourage hope and helps the patient look forward for tomorrow.


·         Regained self-worth, hope in self and others makes the patient anticipate activities, people and events(Verkaik, Francke, van Meijel, et al. 2011).

2 weeks

 The Story

Mrs T. is a midwife. On a fateful evening, she was hurrying home after a normal day’s work at the hospital. Just a few meters from her house, Mrs T. was attacked by two robbers who hit her twice on the head with a hammer and took her purse leaving her unconscious. Fortunately, a teenage boy, cycling home saw the incident and immediately alerted the emergency department.

Mrs T. was received at the hospital’s accidents and emergency department. On initial observation, her breathing was normal. She was, however, bleeding from concussions on the head and slightly from the nose. She had two concussion wounds one at the left temporal lobe and a smaller one at the occipital lobe. She was, however, unconscious. It was, therefore, necessary to arrest the bleeding and maintain the airway. Close observation and safety were ensured to prevent further injury. The patient was laid on a head-injury bed, a Glasgow-coma scale and physical assessment done. The baseline GCS was set at 5. Intravenous access was also established, and mannitol infusion started.

A brain scan revealed massive subdural hematoma at the temporal and occipital regions. The brainstem, frontal lobe, and the right temporal lobe were visibly normal. The level of consciousness was slowly improving, and the GCS improved to 9 within three hours. Further, the breathing rate and heart rate were within normal ranges. Motor and sensory functions were also normal. Evacuation surgery to remove the hematomas at the left temporal and occipital lobes was scheduled.

The patient was diagnosed with traumatic brain injury(Eades 2014). Cognitive interventions and rehabilitation were scheduled as the main focus for neuropsychological interventions. Learning abilities, memory, concentration and other cognitive abilities were periodically assessed to evaluate therapy. According to research, the depressive state after traumatic brain injury is manifested by loss of memory and cognitive disorders(Wing & James 2013).


The patient was put on Zopiclone for sleeplessness and paracetamol for pain. Zopiclone is a benzodiazepine receptor agonist that is a first consideration for the promotion of sleep in short-term and transient insomnia. According to research, the drug has selective hypnosedative effects and no CNS-depressing action commonly seen with benzodiazepines(Rösner et al. 2013). It is, therefore, favourable in head injury as it does not worsen or impair cognitive functions.

Paracetamol is an analgesic that works by inhibiting the production of prostaglandins thus relieving the sensation of pain. According to it is one of the safest analgesics options to use in head injury as it does not affect the brain functions(Jefferies et al. 2012). However, a different research indicates that paracetamol may cause hypotensive episodes. Its use must, therefore, be monitored(Picetti et al. 2014).

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