Discuss about the Medical Condition Of The Virtual Patient.
The patient going by the name Barry West is a 64 year old male who had his first stroke in the year 2006. He is currently being treated for type 2diabetes and hypertension. It all started with West feeling unwell just a few months before he was admitted to the hospital. He complained of low energy levels, lethargy and hearing impairment. West was diagnosed and told that he had nerve problems. However, the lack of energy and the hearing impairment continued and that when he was taken to hospital. He collapsed at the hospital door. After assessment by a medical officer, West was found to have GCS of 10/15 and the blood pressure was 185/110mmHg and other tests also showed abnormal results. West has recently been described as not being able to move his arms nor speak. He has since been taken to a rehabilitation center to help take care of his condition.
Subjective data is the information from the patient’s point of view. The subjective data is used by a medical officer in trying to assess the illness or the medical problem that a patient may be having and hence help them to diagnose the disease (Bhalla& Birns, 2015, pg-87-92). Subjective data include the feelings, perceptions, and concerns of the patient. The subjective data obtained from West and his close family members include;
Barry West complained of lack of energy, lethargy, and hearing impairment. Mr. West indicates that he is not capable of moving to move his toes, arms, and legs. The patient is also not able to talk and he also indicates that his private parts were affected. The wife indicates that Mr. West was feeling very unwell before he suffered stroke. Mr. West physician concluded that Mr. West had bad nerves without taking any tests. He also says that Mr. West was very quiet and wanted to stay in the beach and talk funny little tunes. The statements made by the patient, Mr. West and his wife comprises the subjective data for this assessment.
The objective data is collected based on evidence through measurement and conducting of tests, or can be observed through physical examination and laboratory results. The objective data that was collected in the assessment of Mr. West include; Glasgow Coma scale (GCS) reading at 10/15 and a blood pressure of 185/110mmHg. The doctor also measured his respiratory rate and he found it was at 30breaths/min and O2 saturation of 100% on 2L per minute. The blood glucose levels were 16.5mmol/L at the time of the stroke.
Subjective and Objective Data
The virtual nurse prepared several assessments after the patient arrived at the hospital. The assessment were meant to enable the nurse understand the health condition of the patient in order to be able to administer the right medication and save the patient.
The first assessment that the virtual nurse prepared for based on the information from the assessment is measurement of the respiratory rate of the patient. This is used o determine breathing inadequacy as a result of respiratory muscles being unable to work properly. A respiratory rate is below 29 breaths per minute, it means that the patient is in gross danger (Cooper & Gosnell, 2015, pg-56-57). Mr. West respiratory rate was found to be 30 breaths per minute.
The other assessment prepared by the nurse is the test of glucose levels. The normal glucose level in the human body ranges between 3.9 and 5.5mmol/L. This level however fluctuates from time to time depending on whether a person is on fasting or has diabetes. Upon carrying out tests, it was found out that Mr. West glucose level was very high at 16.5mmol/L. The blood sugar needs to be lowered in order to save the patient on time. Insulin should be administered to the patient as the nurse may deem appropriate (Cooper & Gosnell, 2015, pg-30-31).
The nurse also prepared for the Glasgow Comma Scale. GCS provides a practical method of measuring the impairment of consciousness of a person in response to particular stimuli. The GCS is conducted on the eyes, nerves, and motor. The recordings of eyes response is recorded as spontaneous, to sound, to pressure and none. The verbal test is recorded either as oriented, confused, words, sounds or none. Test on the motor is recorded as obeying commands, localizing, normal flexion, abnormal flexion, or none. The three elements are combined to determine the level of responsiveness of a patient (Harris, 2016, pg- 70-74). Mr. West GSC was found to be 10/15. This means that the effect that the stroke has had on the brain is moderate. At this level, it means that the stroke is serious and emergency medical action need to be taken. A GCS scale between 8-9/15 is fatal and can easily cause death to the patient.
The blood pressure of the patient was also tested by the nurse. Blood pressure of Mr. West was found to be 185/110mmHg. This means that the blood pressure is very high above the normal 145/110mmHg. The patient with such high blood pressure is at the risk of blood vessels in the heart busting and hence resulting to death of the patient.
Assessments Prepared by the Nurse
There are several assessment that the virtual nurse could have prepared for the patient apart from the ones indicated in the report. One of these is the assessment of signs of motor dysfunction. A bedside neuron assessment of motor functions helps to determine the extent to which the patient’s brain cells have been damaged by the stroke (Wong, 2017, pg-40-45). The assessment will involve examining the ability to move under command and the ability of the patient to understand what you’re telling them even thou they are not able to respond by speaking. The nurse can have the patient flex their hand against the arm of the patient, squeezing their fingers or lifting the leg while holding the thigh.
The nurse can also conduct an auditory symptoms test. This test is done to test the responsiveness of the patient to sound (Schweizer & Macdonald, 2014, pg-122). It can be done by making a loud unexpected clap away from the sight of the patient. The response is evoked by the auditory brainstem and it may be necessary to fully examine the responsiveness of the patients` brain.
The other objective assessment that could be conducted by the nurse is the speech and swallowing assessment. The nurse should have examined the ability of the patient to speak when something interesting is said to them. If the patient is completely mum, it means that the attack is severe.
Psychogenic myoclonus can be conducted on the patient. It has variable amplitude and frequency. This assessment can be done by eliciting of deep reflexes of the tendon (Doenges, Moorhouse & Murr, 2014, pg-56-59). Laborious research methods may demonstrate a reaction around 20ms before the movement.
Improving mobility and prevention of deformities
l Application of splint on the patient
l Elevating affected limbs
l Changing the position of the patient after every 2-3 hours with the patient being placed in a prone position for about 10 minutes a day.
l Positioning the patient to prevent contractures
l to prevent flexion to extremity.
l To prevent edema and fibrosis
l Changing position helps to prevent the patient from developing bed sores and becoming more immobile (Lee, 2017, pg)
-the goal is to be evaluated by assessing the progress of the patient every week. The ability of the patient to move their hands and to communicate better through speech will be an important means of evaluation.
The blood glucose level and the blood pressure need to be evaluated on a regular basis.
Establishment of exercise program after 6 months
l Ensuring movement of all body parts at least 6 times a day
l Observing signs of pulmonary embolus or excess cardiac workload
l Supervising the patient during exercises
l Prevent the neuromuscles from deteriorating further (Linton, 2016, pg-80-89).
l This helps to take corrective action through medication or further treatment
l Give encouragement to the patient and ensure that they recover gradually (Baird & Bethel,2011, pg- 122)
Measuring the frequency of respiratory rate lapses and increase in blood pressure.
Observation of improvement in movement of the patient over time.
This assessment evaluates the medical condition of the virtual patient who in this case is Mr. West. The report begins with an introduction of the patient. The medical history of the patient from the time immediately he suffered first stroke until now. This is followed separation of objective patient data from the subjective patient data. The objective data is the data collected from conducting laboratory test and observation of physical condition of the patient by the medical officer. The subjective data is based on the narratives of the patient on their feelings and beliefs concerning the disease which is affecting them. The report also examines the assessments prepared by the nurse. They include conducting blood sugar test, GCS test and blood pressure tests. The report also analyzes the nursing concerns and sets goals with a rationale and a method of evaluation.
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Bhalla, A., & Birns, J. (2015). Management of post-stroke complications.
Cohen, R. A., & Gunstad, J. (2010). Neuropsychology and cardiovascular disease. Oxford: Oxford University Press.
Cooper, K., & Gosnell, K. (2015). Foundations and adult health nursing.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: Guidelines for individualizing client care across the life span. Philadelphia: F.A. Davis Company.
Edmans, J. (2011). Occupational Therapy and Stroke. New York, NY: John Wiley & Sons.
Foster, J. G. W., & In Prevost, S. S. (2012). Advanced practice nursing of adults in acute care.
Harris, C. (2016). Neuromonitoring and assessment: An issue of critical care nursing clinics of north america. Elsevier.
Lee, S.-H. (2017). Stroke revisited: Diagnosis and treatment of ischemic stroke.
Linton, A. D. (2016). Introduction to medical-surgical nursing.
Schweizer, T. A., & Macdonald, R. L. (2014.). The Behavioral Consequences of Stroke [recurso electrónico].
Wong, O. I.-C. H. I. (2017). Evidence-Based Bedside Swallowing Assessment by Nurses For The Patients With Stroke. S.L.: Open Dissertation Press.
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