TOUS Powerpoint 2

1. Application to the Theory
of Unpleasant
Symptoms

2. Dyspnea
Non-productive cough
Fatigue
Peripheral edema
Anorexia
Symptoms experienced by the
patient

3. Characterization of symptoms
Intensity- patient indicates that the severity of her symptoms
have increased
Timing: non-productive cough for 1 week; dyspnea has
increased over the last few days
Level of perceived distress: “thought she would die”.
Quality: unable to wear shoes due to peripheral edema;
patient is unable to care for herself independently

4. Systemic Lupus Erythematosus (SLE)
Congestive Heart Failure (CHF)
EF of 15%
Malnourished
Physiological factors

5. Depression
 Anxiety
Lack of coping skills
Uncertainty of prognosis
Psychological factors

6. Homeless
Unemployed
Single
Lack of familial support
Situational Factors

7. It is evident that the patient’s overall functional
performance has declined. She is having difficulty walking
and is unable to perform ADLs.
Performance

8.  Physiological Factors → Symptoms Experienced → Patient Performance
The patient’s EF of 15% causes an increase in her fatigue and dyspnea
which negatively affects her overall performance and ability to carry out
ADL’s.
Propositions

9.  Psychological Factors → Symptoms Experienced → Patient Performance
The patient’s depression and anxiety cause an increase in her
dyspnea, fatigue, and anorexia which negatively affects her
performance and ability to carry out ADL’s
Propositions

10.  Situational Factors → Symptoms Experienced → Patient Performance
The patient’s lack of family support and living situation increase her
fatigue, anorexia, and anxiety which negatively affects the patient’s
performance and ability to carry out ADL’s
Propositions

11. Desired Outcome:
Patient will be able to perform basic ADL’s
The TOUS assists providers in understanding how the patient’s influencing
factors, symptoms, and performance interact with and effect one other. Recognition of
these relationships allows for a holistic treatment approach to achieve desired outcomes.
For this particular case study, providers can use this theory to guide their interventions to
affect the patient’s influencing factors and symptoms, and therefore her performance as
follows:
• Physiological Interventions- Treating the patient’s CHF and decreasing the
frequency and severity of exacerbations will decrease the amount of dyspnea and
fatigue the patient experiences to increase her ability to perform ADL’s
• Psychological Interventions- Providing counseling for both depression and chronic
disease management will decrease the patient’s fatigue, anorexia, and overall anxiety
to increase her ability to perform ADL’s
• Situational Interventions- Providing the patient with social support through a team
of doctors and support groups and assisting in finding her a place to live will decrease
her anxiety, fatigue, and anorexia to increase her ability to perform ADL’s