Charlie Dee is a 56-year-old male client with a 30-year history of smoking two packs of cigarettes per day. He is seeing nurse practitioner Sandra Gee for the first time after being diagnosed with chronic obstructive pulmonary disease. Pattern appraisal begins with eliciting the client’s description of his experience with this disease, his perceptions of his health, and how the disease is expressed (symptoms). Mr. Dee states that he has a productive cough that is worse in the morning, gets short of breath whenever he is physically active, and always feels tired. Through specific questions, the nurse practitioner discovers that Mr. Dee has experienced a change in his sleep patterns and nutritional intake. He is sleeping for shorter periods and eating less. She also learns that Mr. Dee’s wife smokes, and that they have indoor cats for pets. He does not think that his wife will be amenable to changing her habits or getting rid of the cats. During this appraisal, the nurse seeks to discover what is important to Mr. Dee and how he defines healthy.
Mutual patterning involves sharing knowledge and offering choices. Upon completion of the appraisal, the nurse summarizes what she has been told and how she understands it. In this way, the nurse and the client can reach consensus about what activities would be acceptable to Mr. Dee. Ms. Gee provides information about the disease and suggestions that will increase his comfort. Noninvasive interventions include breathing retraining, recommendations for a high-protein high-calorie diet, eating smaller meals more frequently, sleeping with the head elevated, and using progressive relaxation exercises at bedtime. The nurse recommends that the Dees buy a high-efficiency particulate air (HEPA) filter and humidifier to assist in removing environmental pollutants and maintaining proper humidity in the home.
Because Mr. Gee has expressed a desire to quit smoking, the nurse suggests that he use forms of centering, such as guided imagery and meditation, to supplement the nicotine patches prescribed by his physician. She also provides him with written material about the disease that he can share with his wife. At the end of the visit, Mr. Dee states that he feels better knowing that he has the power to change some things about his life.
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