Running head: Week 12 community health Care Plan 1 Week 12 community health Care Plan 2Danisse Gonzalez Florida National University Nursing Program NUR-4636 Community Nursing Prof. Eddie Cruz, RN, MSN November 18th , 2018 Community Health Planning, Implementation and Evaluation Care plans Attention Deficit Hyperactivity Disorder(ADHD): A syndrome characterized by degrees of inattention, impulsive behavior, and hyperactivity. Assessment · Identify the presence of other illnesses with symptoms that overlap with those of ADHD · Inspect for vision or hearing impairments · Social interaction with peers · Gather information about client’s behavior · Inspect for neurodevelopmental immaturity in relation to gross and fine motor functions and motor or vocal tics, and retardation. · Gather data of the person with suspected ADHD for example anxiety · Interview a relevant family member, partner, including teachers to ascertain observations of symptoms/behaviors in different settings · Gather developmental, medical and psychiatric history of the client · Collect information about related comorbidities present in the family. Diagnosis · Impaired social interaction · RT developmental disabilities (hyperactivity) · AEB feelings of inadequacy and need for acceptance from others. Planning · Implement appropriate memory retraining techniques, such as keeping calendar, writing list, memory cue games, mnemonic device using computers, and so forth. · Encourage ventilation of feelings of frustration helplessness, anxiety and so forth. · Refocus attention to areas of control and progress. · Provide emphasize importance of pacing learning activities and having appropriate rest. · Monitor client’s behavior by educating and assisting in using stress management techniques. Implementation · The nurse will consider patient’s condition and communicating with him as an equal. · The nurse will not use baby talk nor direct him as to his chronological age; encourage him to express his thoughts or emotions and respond to him therapeutically. · The nurse will use simple and direct instructions if needed, the nurse may utilize visual aids or pictures in order for him to relate well; in educating the child, the lessons should only be brief in duration due to his short attention span. · The nurse will implement scheduled routine every day making his routine predictable and something like ritualistic so that it will only be easy for him to grasp for his independent functioning. · The nurse will avoid stimulating or distracting settings. Also involve the child in his daily activities in a quiet and non-stimulating area to prevent him from becoming easily distracted and hyperactive. · The nurse will give positive reinforcements for example every good deed done should be rewarded even with a simple smile, nod or a star’ praise him for achieving his goals for the day or a task that was finished; it is also advisable to provide immediate reinforcement since t.

1. Running head: Week 12 community health Care Plan 1
Week 12 community health Care Plan 2Danisse Gonzalez
Florida National University
Nursing Program
NUR-4636 Community Nursing
Prof. Eddie Cruz, RN, MSN
November 18th , 2018
Community Health Planning, Implementation and Evaluation
Care plans
Attention Deficit Hyperactivity Disorder(ADHD): A syndrome
characterized by degrees of inattention, impulsive behavior, and
hyperactivity.
Assessment
· Identify the presence of other illnesses with symptoms that
overlap with those of ADHD
· Inspect for vision or hearing impairments
· Social interaction with peers
· Gather information about client’s behavior
· Inspect for neurodevelopmental immaturity in relation to gross
and fine motor functions and motor or vocal tics, and

2. retardation.
· Gather data of the person with suspected ADHD for example
anxiety
· Interview a relevant family member, partner, including
teachers to ascertain observations of symptoms/behaviors in
different settings
· Gather developmental, medical and psychiatric history of the
client
· Collect information about related comorbidities present in the
family.
Diagnosis
· Impaired social interaction
· RT developmental disabilities (hyperactivity)
· AEB feelings of inadequacy and need for acceptance from
others.
Planning
· Implement appropriate memory retraining techniques, such as
keeping calendar, writing list, memory cue games, mnemonic
device using computers, and so forth.
· Encourage ventilation of feelings of frustration helplessness,
anxiety and so forth.
· Refocus attention to areas of control and progress.
· Provide emphasize importance of pacing learning activities
and having appropriate rest.
· Monitor client’s behavior by educating and assisting in using
stress management techniques.
Implementation
· The nurse will consider patient’s condition and
communicating with him as an equal.

3. · The nurse will not use baby talk nor direct him as to his
chronological age; encourage him to express his thoughts or
emotions and respond to him therapeutically.
· The nurse will use simple and direct instructions if needed, the
nurse may utilize visual aids or pictures in order for him to
relate well; in educating the child, the lessons should only be
brief in duration due to his short attention span.
· The nurse will implement scheduled routine every day making
his routine predictable and something like ritualistic so that it
will only be easy for him to grasp for his independent
functioning.
· The nurse will avoid stimulating or distracting settings. Also
involve the child in his daily activities in a quiet and non-
stimulating area to prevent him from becoming easily distracted
and hyperactive.
· The nurse will give positive reinforcements for example every
good deed done should be rewarded even with a simple smile,
nod or a star’ praise him for achieving his goals for the day or a
task that was finished; it is also advisable to provide immediate
reinforcement since they sometimes have decrease tolerance to
frustration.
· The nurse will encourage physical activity that he likes as this
may also help him make friends with other children; allow him
to exert his energy productively but do not let him get over
fatigued, too; physical activity helps in getting good sleep but
over fatigue fight as well make him uneasy and irritable.
Evaluation
· The patient know how to Implement appropriate
memory retraining techniques, such as keeping calendar, writing
list, memory cue games, and/or mnemonic device
using computers.
· The patient knows how to cope with his feelings of frustration
helplessness, and anxiety by refocusing attention to areas of
control and progress.

4. · The patient understand the importance of pacing learning
activities and having appropriate rest.
· The patient practices and uses stress management techniques.
Melanoma: A form of cancer that begins in melanocytes, which
are the cells that make the pigment melanin. It may begin in a
mole (skin melanoma), but can also begin in other pigmented
tissues, such as in the eye or in the intestines.
Assessment
· Asymmetry: two halves of the mole the different?
· Client presents asymmetrical shapes, which are generally
more concern.
· Border: are the edges of the mole are poorly defined? Is it
ragged, irregular, or blurred?
· Client’s mole is not well define and has irregular edges.
· Color: is the color uneven with shades of tan, brown or black?
· Client presents a mole colored blue, which it brings more
concern because those are usually the color of melanomas.
· Diameter: has there been a change, particularly an increase, in
lesion size?
· Client’s mole size is over 6mm diameter, and client states that
has being increasing in size.
· Elevation/evolution: How melanoma progresses
· Client’s mole is elevated, which according to client’s data
history of it, he states mole was flat in the beginning.
· Client states itching, bleeding and scabbing in the mole.
Diagnosis
· Anxiety
· RT Situational crisis (cancer)
· AEB Expressed concerns regarding changes in life events.

5. Planning
· Clarifies patient’s perceptions and misconceptions based on
diagnosis and experience with cancer of any.
· Patient may not feel accepted with present condition, is
important to assess feeling of judged to promote sense of
dignity and control.
· Coping skills are often stressed after diagnosis and during
different phases of treatment. Support and counseling are often
necessary to enable individual to recognize and deal with fear
and to realize that control and coping strategies are available.
· Treatment may include surgery( curative, preventive
palliative), as well as chemotherapy, radiation(internal or
external).
Implementation
· The nurse will encourage patient to share thoughts and
feelings, which provides opportunity to examine realistic fears
and misconceptions about diagnosis
· The nurse will assist patient in recognizing and clarifying
fears to begin developing coping strategies for dealing with
these fears
· The nurse will reinforce coping skills to minimize stress after
diagnosis and during different phases of treatment.
· Support and counseling are necessary to enable individual to
recognize and deal with fear and to realize that control and
coping strategies are available.
· Explain procedures, providing opportunity for questions and
honest answers.
· The nurse will ask if patient want her/him to stay during
anxiety-producing procedures and consultations.
· The nurse will provide accurate information that allow patient
to deal more effectively with reality of situation, thereby
reducing anxiety and fear of the unknown
· The nurse will promote calm, quiet environment to Facilitates
rest, conserves energy, and may enhance coping abilities.

6. · The nurse will encourage patient interaction with
support systems.
Evaluation
· The patient Displays appropriate range of feelings and
lessened fear.
· The patient is relaxed and reports anxiety reduced to a
manageable level.
· The patient demonstrate use of effective coping mechanisms
and active participation in treatment regimen.
· The patient understand his/her condition and ask about
possible treatments including its benefits.
Diabetes Mellitus (DM): a chronic disease characterized by
insufficient production of insulin in the pancreas when the body
cannot efficiently use the insulin it produces. This leads to an
increased concentration of glucose levels in the blood stream
(Hyperglycemia).
Assessment
· Monitor patient’s HbA1c-glycosylated hemoglobin.
· Assess for signs of hyperglycemia.
· Assess for tremors and/or slurring speech( hypoglycemia).
· Assess patient’s current knowledge and understanding about
illness.
· Assess patient’s current knowledge and understanding in
regard of diet and life change style.
· Assess feet for temperature, pulses, color, and sensation

7. · Assess the pattern of physical activity.
· Monitor urine albumin to serum creatinine for renal failure.
Diagnosis
· Deficient Knowledge
· RT Dietary modifications
· AEB statements of concerns and requesting information.
Planning
· Adherence to the therapeutic regimen promote tissue
perfusion. Keeping glucose in the normal range slows
progression of microvascular disease.
· Blood glucose should be monitored before meals and at
bedtime.
· The need to check glucose values to adjust insulin doses.
· Keep in mind that Hypertension is a common associated with
diabetes. Keep a blood pressure control can prevents stroke,
coronary artery disease and/or retinopathy and nephropathy.
· Patients with this disease have decrease sensation in the
extremities due to peripheral neuropathy. Is important for these
patients to uses thermometers to check the water before bathing,
wear shoes at all time, keep a good hygiene and nail control.
· Nonadherence to dietary guidelines can result in
hyperglycemia. Every patient should has an individualized diet
plan.
Implementation
· The nurse will educate the patient on the importance to follow
a diet that is low in simple sugars, low in fat, and high in fiber
and whole grains.
· The nurse will show the patient how to use insulin prescribed
for example long-acting (Lantus) only need to be injected once
daily.
· The nurse will teach patient on how to inject insulin and the
importance to rotate sites.

8. · The nurse will teach patient how to treat hypoglycemia for
example eating crackers, a snack, or glucagon injection.
Evaluation
· Patient demonstrated knowledge of insulin injection.
· Patient talked about symptoms and treatment of hypoglycemia.
· Patient gave examples of a diet that he/she is going to follow.
· Patient verbalized the importance of daily exercises.
· Patient demonstrated an adequate skill of taking and checking
blood glucose level.
· Patient understands the importance of control the glucose
levels for the prevention of other relate diseases.
References
Heinrich, E. (2013). Diabetes self-management: strategies to
support patients and health care professionals. Maastricht
University
Townsend, M. C. (2017). Nursing diagnoses in psychiatric
nursing: care plans and psychotropic medications. FA Davis
Kemp, C., & Kemp. (2015). Terminal illness: a guide to nursing
care. Philadelphia: Lippincott.
Rita Miller, R. N. (2018). Implementing a survivorship care
plan for patients with skin cancer. Clinical Journal of Oncology
Nursing, 12(3), 479.
Sook, C. (2013). Community Health Nursing: Promoting the
Health of Populations. Aorn Journal, 77(4), 857-858.

9. Chapter 7
Community Health Planning, Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
The Community as Client
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an imprint of Elsevier Inc.
2
Figure 7-1
Levels of
Community Health Nursing Practice
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
3ClientExampleCharacteristicsHealth AssessmentNursing
InvolvementIndividualLisa McDonaldIndividual with various
needsIndividual strengths, problems, and needsClient-nurse
interactionFamilyMoniz familyFamily system with individual
and group needsIndividual and family strengths, problems, and
needsInteractions with individuals and the family
groupGroupBoy Scout troop
Alzheimer’s support groupCommon interests, problems, and
needs
InterdependencyGroup dynamics
Fulfillment of goalsGroup member and leaderPopulation
groupAIDS patients in a given state
Pregnant adolescents in a school districtLarge, unorganized
group with common interests, problems, and needsAssessment

10. of common problems, needs, and vital statisticsApplication of
nursing process to identified needsOrganizationA workplace
A schoolOrganized group in a common location with shared
governance and goalsRelationship of goals, structure,
communication, patterns of organization to its strengths,
problems and needsConsultant and/or employee application of
nursing process to identified needsCommunityItalian
neighborhood
Anytown, USAAn aggregate of people in a common location
with organized social systemsAnalysis of systems, strengths,
characteristics, problems, and needsCommunity leader,
participant, and health care provider
Health Planning Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
4
Figure 7-2
Hogue (1985)
Steps in the Health Planning Model
Assessment
Meet with group leaders of aggregate to clarify mutual
expectations
Determine sociodemographic characteristics
Interview a key informant
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems

11. Identify health problems and needs
Prioritize the identified problems and needs to create an
effective plan
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an imprint of Elsevier Inc.
5
Four Types of Needs to Assess
Expressed needs
Demand for services and the market behavior of the targeted
population
Normative needs
Lack, deficit, or inadequacy of services determined by health
professionals
Perceived needs
Wants and desires expressed by audience
Relative needs
Gap showing health disparities between advantaged and
disadvantaged population
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an imprint of Elsevier Inc.
6
Factors for Determining Priorities
Aggregates preferences
Number of individuals affected by the health problem
Severity of the health need or problem
Availability of potential solutions
Practical considerations such as skills, time, and available

12. resources
May use Maslow’s hierarchy of needs or levels of prevention to
further refine priorities
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an imprint of Elsevier Inc.
7
Community Involvement Is Essential
“Start where the people are!”
Five spheres of empowerment
Interpersonal (personal empowerment)
Intragroup (small group development)
Intergroup (community)
Interorganizational (coalition building)
Political action
– Labonte (1994)
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an imprint of Elsevier Inc.
8
Steps in the Health Planning Model (Cont.)
Planning
Determine the intervention levels
Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned interventions according
to available resources
Personal, aggregate, and suprasystem

13. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
9
Development of Goals and Objectives
Goals—where we want to be
Objectives—steps needed to get there
Measurable
Specific measures
Instructions to guide population
Used to measure outcomes
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an imprint of Elsevier Inc.
10
Steps in the Health Planning Model (Cont.)
Intervention
Often the most enjoyable stage for the nurse and the clients
Implementation should follow the initial plan
Should include a variety of strategies
Prepare for unexpected problems
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an imprint of Elsevier Inc.
11

14. Interventions by
Type of Aggregate and System Level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
12ProjectType of AggregateSystem Level for
InterventionRehabilitation groupGroupSubsystem and aggregate
systemTextile industryOrganizationAggregate system and
suprasystemCrime watchGroup, organization, and population
groupAggregate system and suprasystemBilingual students
(case study)CommunityAggregate system and suprasystem
Steps in the Health Planning Model (Cont.)
Evaluation
Include the participant’s verbal or written feedback and the
nurse’s detailed analysis
Reflect on each previous stage to determine the plan’s strengths
and weaknesses
Evaluate both formative (process) and summative
(product/outcome) aspects
Communicate follow-up recommendations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
13
Importance of Each Step in the Nursing Process
Aggregate assessments must be thorough.
Should elicit answers to key questions about the aggregate’s

15. health and demographic profile
Should compare this information with similar aggregates
presented in the literature
The nurse must complete careful planning and set goals that the
nurse and the aggregate accept.
Mutual planning is very important.
Interventions must include aggregate participation and must
meet the mutual goals.
Evaluation must include process and product evaluation and
aggregate input.
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an imprint of Elsevier Inc.
14
PRECEDE-PROCEED Model
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an imprint of Elsevier Inc.
15
Federal Legislation Affecting Health Planning
Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources Development Act
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an imprint of Elsevier Inc.
16

16. Comprehensive Health Reform
Patient Protection and Affordable Care Act (2010)
Preventive services based on evidence-based recommendations
National strategy to improve the nation’s health
CMMS innovation center
National quality improvement strategy for services and
population health
Improved access to care
Reduction in the growth of Medicare spending
National workforce strategy
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an imprint of Elsevier Inc.
17
Nurses’ Role
Work collaboratively with health planners to improve aggregate
health
Fuse technology with knowledge of health care needs and skills
Become directly involved in the planning process
Engage in aggregate-level projects
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an imprint of Elsevier Inc.
18