Orem+Care+Plan+Presentation%0d%0a%ef%81%ae%0d%0a%0d%0aBy+Gail+Bethea%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a1%0d%0a%0d%0a%0cClient+Profile%3a+Personal+Characteristics%0d%0aStephen+Jacobson+is+a+52-year-old+male+who+was+admitted+to+the+hospital+after+experiencing+chest+pain+while+working+out+in+his+yard+and+who+has+had+continuous+abdominal+pain+for+the+last+week.+%ef%81%ae+He+was+seen+in+the+emergency+department+and+then+transported+to+the+intensive+care+unit.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+2%0d%0a%0d%0a%0cClient+Profile%3a+Medical+History%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0aAfro-American+male+Hydrocephaly%2c+status+post+shunt+placement%2c+hypertension%2c+hyperlipidemia%2c+hypothyroidism%2c+and+hepatitis+C.+Smoke+cigarettes+(5+cigarettes+per+day)+for+the+last+twelve+years.+Denies+current+usage+of+alcohol+and+illegal+street+drugs%2c+but+he+has+used+them+in+the+past.+Works+as+a+pallet+porter+for+a+food+distribution+warehouse.%0d%0a3%0d%0a%0d%0a%0cClient+Profile%3a+Current+Medical+Diagnoses%0d%0aChest+Pain+rule+out+Myocardial+Infarction.+%ef%81%ae+Acute+Pancreatitis.+%ef%81%ae+Peripheral+Vascular+Disease.%0d%0a%ef%81%ae%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a4%0d%0a%0d%0a%0cClient+Profile%3a+Current+Health+Orientation%0d%0a%ef%81%ae%0d%0a%0d%0aHe+is+concerned+and+worried+about+his+present+pain+in+his+chest+and+abdomen.+He+is+aware+that+his+abdominal+pain+may+be+related+to+pancreatitis+because+his+family+doctor+told+him+to+eat+nothing+but+protein+and+to+take+an+over-thecounter+pancreatic+enzyme.%0d%0a3%2f26%2f2008+5%0d%0a%0d%0a%0cClient+Profile%3a+Family+Characteristics%0d%0aImmediate+family+includes+Stephen%e2%80%99s+wife+and+7-year-old+daughter+and+all+other+relatives+live+outside+of+their+current+home+state.+%ef%81%ae+They+know+no+one+in+this+state+who+can+take+care+of+their+7+year-old+daughter+while+his+wife+visits+him+in+the+hospital.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+6%0d%0a%0d%0a%0cClient+Profile%3a+Environmental+Characteristics%0d%0aPatient+states+that+he+lives+in+a+stable+neighborhood+and+community+where+he+and+his+family+feel+safe+and+secure.+%ef%81%ae+They+own+a+3+bedroom+home+with+1%2c425+feet+of+living+space.%0d%0a%ef%81%ae%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a7%0d%0a%0d%0a%0cUniversal+Self-Care+Requisites%3a+Air%e2%80%94Health+Habits%0d%0a%ef%81%ae%0d%0a%0d%0aSkin%3a+No+history+of+rashes%2c+scaling%2c+lesions%2c+tumors%2c+masses%2c+pigmentation+changes%2c+or+discoloration.+Stephen+does+complain+of+pruritis%2c+which+is+more+prominent+at+night%3b+he+has+good+skin+turgor%2c+but+has+noticed+quarter-size+lumps+on+abdomen.+Inner+aspects+of+both+arms+are+healed+track+marks+from+heroin+usage%2c+which+he+last+used+in+1973.%0d%0a3%2f26%2f2008+8%0d%0a%0d%0a%0cUniversal+Self-Care+Requisites%3a+Air%e2%80%94Health+Habits%0d%0aCardiac%3a+He+has+exercised+in+the+past%2c+when+he+was+younger%2c+but+he+exercises+irregularly+now.+He+states+his+job+is+physically+demanding.+No+history+of+cardiac+problems.+%ef%81%ae+Lungs%3a+He+wears+continuous+positive+airway+pressure+machine+at+night+for+diagnosis+of+sleep+apnea.+No+history+of+frequent+pneumonia+or+bronchitis.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+9%0d%0a%0d%0a%0cUniversal+Self-Care+Requisites%3a+Air%e2%80%94Review+of+Systems%0d%0a%ef%81%ae%0d%0a%0d%0aSkin%3a+No+rashes%2c+scaling%2c+lesions%2c+tumors%2c+ma+sses+pigmentation+changes%2c+or+discoloration.+Present+complaint+of+pruritis%2c+which+is+more+prominent+at+night.+Needle+track+marks+on+inner+aspects+of+both+arms+from+prior+heroin+usage.%0d%0a3%2f26%2f2008+10%0d%0a%0d%0a%0cUniversal+Self-Care+Requisites%3a+Air%e2%80%94Review+of+Systems%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aCardiac%3a+Telemetry+rhythm+is+sinus+tachycardia+with+no+murmurs+nor+irregularity%2c+but+has+frequent+ectopy.+He+has+a+right+pulmonary+artery+catheter+for+monitoring+hemodynamic+status.+Lungs%3a+Lungs+are+clear+bilaterally+both+anterior+and+posterior.+No+cough+present.+Does+smoke+5+cigarettes+per+day.+Presently+receiving+oxygen+per+nasal+cannula+at+2+Liters.%0d%0a3%2f26%2f2008+11%0d%0a%0d%0a%0cUniversal+Self-Care+Requisites%3a+Water%e2%80%94Health+Habits%0d%0aHe+states+no+previous+experiences+with+dehydration%2c+excessive+dryness%2c+sweating%3b+odors%2c+edema%2c+or+polydipsia.+%ef%81%ae+He+drinks+eight+glasses+of+water+a+day.+He+likes+water%2c+soda%2c+milk%2c+and+fruit+juice+served+very+cold+and+he+dislikes+vegetable+juices.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+12%0d%0a%0d%0a%0cUniversal+Self-Care+Requisites%3a+Water%e2%80%94Review+of+Systems%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aPoor+skin+turgor+with+dry+mucous+membranes.+Lab+values+show+hypocalcemia+(7.8)%2c+hypokalemia+(2.8)%2c+and+hypomagnesemia+(1.4).+IV+fluid+is+Normal+Saline+at+150+cc%e2%80%99s+per+hour+with+standing+orders+to+replace+calcium%2c+potassium%2c+and+magnesium.+He+has+a+history+of+alcohol+abuse+but+currently+does+not+drink+or+use+drugs.%0d%0a3%2f26%2f2008+13%0d%0a%0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not+see+himself+as+leading+a+successful+life.+However%2c+he%2c+currently%2c+sees+himself+as+successful+in+his+marriage+but+not+successful+professionally.%0d%0a3%2f26%2f2008+24%0d%0a%0d%0a%0cDevelopmental+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aPsychosexual+stage+(Freud)%e2%80%94He+has+an+oral+personality%2c+which+is+evident+by+nail+biting%2c+smoking%2c+and+substance+abuse.+In+addition%2c+he+is+overly+dependent+on+his+present+wife+and+has+a+history+of+aggression+towards+others.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a25%0d%0a%0d%0a%0cDevelopmental+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aPsychosocial+state+(Erikson)%e2%80%94He+is+a+productive+member+to+society+and+has+given+back+to+his+community+by+becoming+a+foster+parent+and+an+adoptive+parent.+He+has+developed+a+sense+of+being+a+part+of+the+bigger+picture+and+is+currently+in+the+psychosocial+state%2c+described+by+Erikson%2c+as+Generativity+vs.+Stagnation.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a26%0d%0a%0d%0a%0cDevelopmental+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aIntellectual+stage+(Piaget)%e2%80%94His+intellectual+stage+is+formal+operations%2c+which+is+evident+by+his+ability+to+apply+reversibility+and+conservation+to+both+real+and+imagined+situations+and+understands+the+concepts+of+cause+and+effect.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a27%0d%0a%0d%0a%0cDevelopmental+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aMoral+Stage+(Kohlberg)%e2%80%94He+has+a+higher+focus+morality%2c+which+is+evident+by+his+understanding+of+differing+opinions+of+others+that+are+not+a+part+of+his+culture+and+by+a+grounded+knowledge+of+the+concepts+of+right+and+wrong.+He+is+in+the+postconventional+level+of+Kohlberg%e2%80%99s+moral+stages+of+development.%0d%0a3%2f26%2f2008+28%0d%0a%0d%0a%0cDevelopmental+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aConditions+that+promote+or+prevent+normal+development+(life+events%2c+poor+health%2c+education)%e2%80%94Stephen+Jacobson+was+born+into+a+large+family%2c+which+he+has+9+siblings.+His+father+was+a+selfproclaimed+Pentecostal+minister%2c+which%2c+because+of+the+early+childhood+abuse%2c+he+rebelled+against+everything+his+mother+and+father+stood+for.+This+led+him+to+steal%2c+use+illegal+drugs%2c+and+led+to+his+incarceration+by+the+age+of+12.%0d%0a3%2f26%2f2008+29%0d%0a%0d%0a%0cDevelopmental+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aConditions+that+promote+or+prevent+normal+development%e2%80%94He+has+a+G.E.D.+with+some+college+courses+completed.+He+has+had+a+felony+conviction+for+selling+controlled+substances+but+has+been+drug+free+for+10+years+and+did+not+return+to+the+prison+system+since+his+release+in+over+20+years.+His+current+poor+health+is+stated+by+him+to+be+most+likely+due%2c+in+part%2c+to+past+alcohol+and+substance+abuse+and+amateur+boxing.%0d%0a3%2f26%2f2008+30%0d%0a%0d%0a%0cHealth+Deviation+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aPresent+deviation%e2%80%94chest+pain+with+nausea%2c+no+emesis.+Abdominal+pain.+Short-term+memory+deficit.+Bilateral+feet+numbness+with+pain+felt+predominately+at+night.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a31%0d%0a%0d%0a%0cHealth+Deviation+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aPast+history+of+health+deviations%e2%80%94+hypothyroidism%2c+hypertension%2c+status+post+cholecystectomy%2c+hernia+repair%2c+shunt+placement%2c+parathyroidectomy%2c+seizure+disorder%2c+alcohol+and+substance+abuse%2c+and+elevated+liver+function+tests+with+hepatitis+C+complication%2c+anticoagulation+abnormality+with+elevated+PTT%2fINR.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a32%0d%0a%0d%0a%0cHealth+Deviation+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aFamily+health+history%e2%80%94diabetes%2c+hypertension%2c+colon+cancer%2c+stroke%2c+alcohol+and+substance+abuse%2c+mental+illness.+His+father+died+of+colon+cancer+at+the+age+of+72.+His+mother+died+of+a+stroke+at+the+age+of+75.+His+ten+siblings+have+all+had+problems+with+either+alcohol+or+drug+addiction.%0d%0a3%2f26%2f2008+33%0d%0a%0d%0a%0cHealth+Deviation+Self-Care+Requisites%0d%0a%ef%81%ae%0d%0a%0d%0aFamily+Health+History%e2%80%94His+eldest+sister+died+before+he+was+born+of+reasons+unknown+to+him+and+his+younger+brother%2c+who+was+diagnosed+with+schizophrenia%2c+died+of+a+massive+coronary+after+taking+an+overdose+of+cocaine.+Hypertension+exists+in+his+family+with+three+out+of+the+eight+living+siblings+having+been+diagnosed+with+this+illness.%0d%0a3%2f26%2f2008+34%0d%0a%0d%0a%0cNursing+Data+Base%3a+Client+Profile%e2%80%94Personal+Characteristics%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%ef%81%ae+%ef%81%ae+%ef%81%ae%0d%0a%0d%0aName%e2%80%94Stephen+Jacobson+Age%e2%80%9452+Sex%e2%80%94Male+Marital+status%e2%80%94Married+Ethnic+orientation%e2%80%94Afro-American+Religious+orientation%e2%80%94Muslim+Educational+level%e2%80%94GED%2c+with+some+college+classes+Language%e2%80%94English%0d%0a3%2f26%2f2008+35%0d%0a%0d%0a%0cNursing+Data+Base%3a+Client+Profile%e2%80%94Personal+Characteristics%0d%0aOccupational+history+(type+of+job%2c+duration)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e+speed+limit+or+five-miles-per-hour+above+the+stated+speed+limit.+Social+habits+(drugs%2c+alcohol%2c+tobacco%2c+coffee-tea-cola%3b+specify+level+of+use)%e2%80%94He+no+longer+uses+alcohol+or+illegal+substances.+He+smokes+5+cigarettes+per+day+and+he+drinks+2+cans+of+cola+per+day.%0d%0a3%2f26%2f2008+66%0d%0a%0d%0a%0cNursing+Data+Base%3a+Universal+Self-Care+Requisites-Normalcy%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aHealth+resources+used%e2%80%94He+sees+his+family+doctor+on+a+regular+basis+but+does+not+make+use+of+dental%2c+vision%2c+hearing%2c+or+counseling+resources+on+a+frequent+basis.+Personal+health+practices%e2%80%94Does+not+screen+himself+on+testicular+exams%2c+stress%2fanxiety+management+is+relaxing+with+wife+and+child+at+home+or+going+out+for+dinner+and%2for+seeing+a+movie.%0d%0a3%2f26%2f2008+67%0d%0a%0d%0a%0cNursing+Data+Base%3a+Universal+Self-Care+Requisites-Normalcy%0d%0a%ef%81%ae%0d%0a%0d%0aBody+image+(appearance%2c+boundaries%2c+limits%2c+inner+structure)%e2%80%94+He+feels+good+about+his+appearance+and+he+is+aware+of+his+physical+boundaries+and+limits.+He+is+worried+about+his+current+health+status+because+his+wife+depends+on+him+to+be+healthy.%0d%0a3%2f26%2f2008+68%0d%0a%0d%0a%0cNursing+Data+Base%3a+Universal+Self-Care+Requisites-Normalcy%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0aAttitude%e2%80%94is+very+positive+but+he+is+fearful+about+this+hospitalization+because+he+desires+longevity.+Affect%2fmood%e2%80%94He+has+an+appropriate+affect%2c+mood+is+calm+but+concerned.+Thought+processes+(logical%2c+coherent%2c+perceptual)%e2%80%94His+thought+processes+are+logical%2c+coherent%2c+and+perceptual.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a69%0d%0a%0d%0a%0cNursing+Data+Base%3a+Universal+Self-Care+Requisites-Normalcy%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae+%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aSensorium+and+reasoning+(levels+of+consciousness%2c+orientation%2c+memory%2c+calc+ulation%2c+abstract+thinking%2c+judgment%2finsight%2c+intelligence.+Locus+of+control%e2%80%94He+has+a+strong+internal+locus+of+control.+Potential+for+danger+(harm+to+self%2fother)%e2%80%94No+potential+for+harming+self+or+others.+Spirituality%e2%80%94He+believes+in+life+after+death+and+that+there+is+a+higher+being+than+him.%0d%0a3%2f26%2f2008+70%0d%0a%0d%0a%0cNursing+Data+Base%3a+Developmental+Self-Care+Needs%0d%0a%ef%81%ae%0d%0a%0d%0aLife-cycle+stage+and+related+concerns%3a+His+life-cycle+state+is+middle+to+late+adulthood.+Related+concerns+at+this+stage+include+stagnation+and+unproductiveness+with+resulting+depression+in+the+next+stage+of+senior+citizen+if+he+does+not+see+himself+as+leading+a+successful+life.+However%2c+he%2c+currently%2c+sees+himself+as+successful+in+his+marriage+but+not+successful+professionally.%0d%0a3%2f26%2f2008+71%0d%0a%0d%0a%0cNursing+Data+Base%3a+Developmental+Self-Care+Needs%0d%0a%ef%81%ae%0d%0a%0d%0aPsychosexual+stage+(Freud)%3a+He+has+an+oral+personality%2c+which+is+evident+by+nail+biting%2c+smoking%2c+and+substance+abuse.+In+addition%2c+he+is+overly+dependent+on+his+present+wife+and+has+a+history+of+aggression+towards+others.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a72%0d%0a%0d%0a%0cNursing+Data+Base%3a+Developmental+Self-Care+Needs%0d%0a%ef%81%ae%0d%0a%0d%0aIntellectual+stage+(Piaget)%3a+His+intellectual+stage+is+formal+operations%2c+which+is+evident+by+his+ability+to+apply+reversibility+and+conservation+to+both+real+and+imagined+situations+and+understands+the+concepts+of+cause+and+effect.%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a73%0d%0a%0d%0a%0cNursing+Data+Base%3a+Developmental+Self-Care+Needs%0d%0a%ef%81%ae%0d%0a%0d%0aMoral+stage+(Kohlberg)%3a+He+has+a+higher+focus+morality%2c+which+is+evident+by+his+understanding+of+differing+opinions+of+others+that+are+not+a+part+of+his+culture+and+by+a+grounded+knowledge+of+the+concepts+of+right+and+wrong.+He+is+in+the+postconventional+level+of+Kohlberg%e2%80%99s+moral+stages+of+development.%0d%0a3%2f26%2f2008+74%0d%0a%0d%0a%0cNursing+Data+Base%3a+Developmental+Self-Care+Needs%0d%0a%ef%81%ae%0d%0a%0d%0aConditions+that+promote+or+prevent+normal+development+(life+events%2c+poor+health%2c+education)%3a+Stephen+Jacobson+was+born+into+a+large+family%2c+which+he+has+9+siblings.+His+father+was+a+selfproclaimed+Pentecostal+minister%2c+which%2c+because+of+the+early+childhood+abuse%2c+he+rebelled+against+everything+his+mother+and+father+stood+for.+This+led+him+to+steal%2c+use+illegal+drugs%2c+and+led+to+his+incarceration+by+the+age+of+12.+3%2f26%2f2008+75%0d%0a%0d%0a%0cNursing+Data+Base%3a+Developmental+Self-Care+Needs%0d%0a%ef%81%ae%0d%0a%0d%0aHe+has+a+G.E.D.+with+some+college+courses+completed.+He+has+had+a+felony+conviction+for+selling+controlled+substances+but+has+been+drug+free+for+10+years+and+did+not+return+to+the+prison+system+since+his+release+in+over+20+years.+His+current+poor+health+is+stated+by+him+to+be+most+likely+due%2c+in+part%2c+to+past+alcohol+and+substance+abuse+and+amateur+boxing.%0d%0a3%2f26%2f2008+76%0d%0a%0d%0a%0cNursing+Data+Base%3a+Health+Devia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ythm.+(a)+%ef%81%ae+Infuse+IV+magnesium+piggyback+as+per+physician+parameters.+(a)+%ef%81%ae+NIC%3a+Electrolyte+Management%3a+Hypomagnesemia.%0d%0a%ef%81%ae%0d%0a%0d%0a3%2f26%2f2008%0d%0a%0d%0a88%0d%0a%0d%0a%0cNursing+Rationale+and+Evaluation+%231%0d%0aRationale%3a+To+prevent+ECG+changes+such+as+prolonged+PR+and+QT+intervals%2c+presence+of+U+waves%2c+T+wave+flattening%2c+and+a+widened+QRS+complex.+To+prevent+vasospasm+of+the+heart+and+coronary+artery+spasm.+%ef%81%ae+Evaluation%3a+Patient+continues+to+need+replacement+therapy.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+89%0d%0a%0d%0a%0cAdvantages+of+Orem%e2%80%99s+Theory%0d%0aApplicable+across+lifespan.+%ef%81%ae+Applicable+in+a+variety+of+clinical+settings+(acute+care%2c+ambulatory%2c+home%2c+or+community+-+based+care).+%ef%81%ae+Views+nursing+practice+as+autonomous.+%ef%81%ae+Through%2c+comprehensive%2c+logical+tool.+%ef%81%ae+Encourages+or+supports+health+promotion.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+90%0d%0a%0d%0a%0cDisadvantages+of+Orem%e2%80%99s+Theory%0d%0aThe+major+disadvantage+of+using+Orem+in+clinical+practice+is+its+focus+on+self-care.+%ef%81%ae+For+example%2c+the+quadriplegic+patient%2c+the+Alzheimer%e2%80%99s+patient%2c+and+the+comatose+patient+will+be+unable+to+learn+behaviors+that+will+allow+them+to+perform+self-care.%0d%0a%ef%81%ae%0d%0a3%2f26%2f2008+91%0d%0a%0d%0a%0cDisadvantages+of+Orem%e2%80%99s+Theory%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aHowever%2c+the+theory+deals+with+a+dependent-care+agent%2c+who+is+a+person+other+than+the+client+that+provides+the+care.+Therefore%2c+a+family+member+or+a+caregiver+that+the+family+hires+to+care+for+their+comatose%2c+quadriplegic%2c+or+Alzheimer%e2%80%99s+patient+(family+member)+provides+dependent+care+for+the+client+when+this+client+cannot.%0d%0a3%2f26%2f2008+92%0d%0a%0d%0a%0cReferences%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0a%ef%81%ae%0d%0a%0d%0aBlais%2c+K.%2c+Hayes%2c+J.%2c+Kozier%2c+B.%2c+%26+Erb%2c+G.+(2002).+Professional+Nursing+Practice%2c+Concepts%2c+and+Perspectives+(4th+ed.).+New+Jersey%3a+Prentice+Hall.+Carpenito%2c+L.+(2002).+Nursing+diagnosis%3a+Application+to+clinical+practice+(9th+ed.).+Philadelphia%3a+J.+B.+Lippincott+Co.+Shannon%2c+P.%2c+(2002).+%e2%80%9cOrem%e2%80%99s+Self-Care+Deficit+Theory+of+Nursing.%e2%80%9d+University+of+Phoenix+Materials.%0d%0a3%2f26%2f2008+93%0d%0a%0d%0a%0c