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Prepare your own assessment of the patient’s condition - explain why you have made each assessment. For example, suppose a patient has a diagnosis of prostatitis. One of the symptom presentations is difficulty in urination. You will need to document that urination issue and suggest potential causes of it. Then you will need to come up with options for treatment based upon the potential causes. And, in this case, how will you determine the cause of the issue?

Describe the nursing treatment, and explain why each treatment is /is not appropriate for the disease.
Discuss how the nursing treatment plan could improve the patient’s quality of life. What are the treatment goals? Are these short or longer-term goals? What are the criteria for evaluating success and how, specifically, will it be documented?
Once the nursing treatment has been implemented, it will be your job to critically analyse the research evidence behind it – how quickly should the patient’s condition take to improve, how, why? How will you know if it isn’t?  Suppose, for example, that you begin a regimen of twice daily dressings for your client. How will you determine success? How long will you implement the treatment to determine success or not? And if it is not successful, what is your next treatment option?
You must also analyze the evidence before you make decisions about the efficacy of the treatment plan. This might include consideration of a patients’ comorbidities, social and cultural contexts, documented personal desires and expectations.
Then you could come to conclusions about management of the patient. Toward the end of this section, you will be making recommendations – they may be simply to continue the current treatment plan and why; or you may have conducted some research that shows another or an additional treatment plan is warranted.
You may very well recommend this new treatment plan. Just remember, you must justify any recommendation you make, and this comes from nursing research literature.

Demographic of Stroke

According to Healthline (2018), stroke occurs when the blood vessels in the brain tend to rupture and bleed or when there is blockage in the blood supply available in the brain. The blockage and ruptures may prevent oxygen and blood from reaching tissues in the brain. According to the AHA ( American Heart Association) African Americans are more probable of experiencing first time stoke and much at a greater risk of getting killed by stroke compared to Caucasian people (Mclntosh, 2017). Therefore, it is essential that a patient gets diagnosed from stroke and seek the proper medical attention because it causes damage to the brain cells. The best way to prevent stroke can be by having a healthy lifestyle and having the underlying conditions treated as soon as possible. There are two types of strokes which may include the ischemic stroke and the hemorrhagic stroke. The ischemic stroke occurs in the blood vessels in the brain where there are clots that get formed in the blood vessels which inhibit oxygenated blood flowing in the brain cells. On the other hand, the hemorrhagic stroke occurs in blood vessels when they either rupture or break. Thus, the blood seeps into the brain tissues causing damage in the brain cells. It is mainly caused by high blood pressure or blood vessel thin walls which rupture due to blood flowing in high pressure (WebMD, 2017). It is also important to note that the two different strokes have different causes and treatment although they may have similar symptoms.

Cavalcante, Moreira, Araujo, and Lopes (2010) state that the stroke situation in Brazil led to an increase in chronic diseases especially of the cardiovascular system. In 2003, in North East Brazil, the mortality stroke rate was 54.6 over 100,000 inhabitants while in 2004, the morality stroke rate was 44.8 over 100,000 inhabitants. Furthermore, circulatory system diseases accounted for 25.4 percent of all hospitalizations where most were over 65 years old. Therefore, the aging population in Brazil got largely associated with stroke which increased other risk factors such as diabetes mellitus, arterial hypertension and dyslipidemia. Additionally, the high trend in stroke hospitalization increased the cost of admission in hospitals which also required complex and specialized treatment (Cavalcante et al., 2010). The other serious issue arising from stroke was that it affected the emotional, physical and normal functioning of the aging population in Brazil. Moreover, even after getting discharged from the hospital, the patient had to maintain constant communication with hospital to ensure continuity of care which was quite expensive. However, the partnership also reduced costs associated with readmission thus reducing cases of stroke.

In spite of that, close to a million people in USA suffer from ischemia stroke which costs the country over 70 billion dollar trying to improve the neurological outcomes caused by the disease. Therefore, it is a medical concern because even though it costs a lot in terms of treatment and care of ischemia stroke patients, the disease leaves mild to almost severe disability on the unfortunate patients.

Case Study Assessment

According to Stingley (n.d), Maxine is the client who has a severe left hemisphere stroke and she is 88 years old. Maxine was born at home which was a spontaneous birth while her mother was sitting at the mangle. Also, Maxine is the middle child and she lived the better part of her life in Oregon. She got employed as an executive secretary and got married twice though without a child. The following assessments got made during her first 24-hours in the hospital;

  1. Medical History

The health history of Maxine included hysterectomy where she experienced short bowel syndrome since part of her intestine was removed due to presence of clostridium difficile. Also, she had a severe serum hepatitis that got her bedridden for close to a year. At 86 years old she had three ruptured discs which got remediated by sacral occipital therapy. In spite of that, she had gentle chiropratic which caused chronic diarrhea leading to Maxine losing weight also due to the removal of most of her intestine (Stingley, n.d). During her stroke period, she took synthroid, hormone replacement and omega three fatty acids. Though Maxine experienced chronic diarrhea due to the short bowel syndrome she never got placed on a monitored diet. Thus, she was only able to eat small food portions of her diet. At the time of her stroke Maxine used to live independently at a retirement community neighborhood.  During her six month period in the retirement community she attended exercise classes and other weight training classes such as walking.

  1. Diagnosis

In January 1, 2008, Maxine experienced a severe left hemisphere stroke and she got hospitalized and when her niece arrived 24 hours later she could acknowledge her with a big smile and a huge hug. The diagnosis made on her show that she had a sever stroke which got caused by a blood clot resulting to atrial fibrillation and replacement of hormones due to increase in clotting. Hence, the clotting was a clear diagnosis of ischemia stroke. Furthermore, she was diagnosed with pneumonia which was before she experienced a stroke attack and the clotting made it difficult for medical practitioners to stabilize her quickly. Furthermore, she had no sensory response on her right shoulder down to her arm and also from her right side face (Stingley, n.d). However, there was minimal response on her right leg. Additionally, Maxine experienced right side vision neglect which led to visual loss, poor motility and speech loss. Maxine maintained good eye contact which was an indication of understanding on whatever her niece spoke to her about. She had a feeling of confusion, frustration and fear due to her stroke though she felt relief since her family was present (brother-in-law and niece’s sister). She also had low energy which made her get spoon fed to soft foods and slept a lot. The importance of making an effective assessment is that it helps in gathering information regarding the psychological, sociological and physiological information regarding a patient. In spite of that, the diagnosis made help in creating an effective care plan that would actually address the health problems that Maxine is experiencing (NurisngProcess.org, n.d).

  1. Nursing Care Plan and Implementation

The importance of the nursing care plan is to ensure that the patient has restored as much blood flow as soon as possible (NRSNG, 2017). Thus, the clot-busting medication can get prescribed to restore blood flow. The expected outcome of the nursing care plan is to ensure that she restores sensory on her face, right shoulder down to her arm and restore normal sensory in her right leg.  Furthermore, the other expected outcome is to ensure that Maxine does exercise which is essential in maintaining her muscles thus increasing her strength. Additionally, her meal times can get monitored and Maxine can get assisted with her meals until she is able to feed herself. Also, there would be visual improvement within some few weeks and speech therapy activities would help in effective communication (Nurisng Care Plan, n.d). Supporting her to verbally communicate would enable her get understood better when she speaks. Therefore, providing Maxine with passive ROM exercises could help her restore her various sensory that she lost due to the stroke. Additionally, it is important for her to have a stable and regular schedule for turning when she is in bed. Kabita and Ajish (2016) note:

“Thrombolytic therapy is appealing therapy for acute stroke. In principle, ischemic strokes can be treated with the thrombolytic therapy, tissue plasminogen activator (t-PA), which helps dissolve a blockage. The nurse is responsible for administration of thrombolytic therapy. The nurses should make sure that all intravenous lines are injected before administering thrombolytic therapy” (p.9).

  1. Evaluation

RadiologyInfo.org. (2017) states that Computed Tomography (CT) scanning in combination with x-ray special equipment would help produce inside pictures of the patient. Hence, the physicians can use the CT scan to detect the stroke and determine the extent of clot in the ischemia stroke patient (Maxine) within the brain. Also, CT angiography (CTA) can get performed to detect and characterize the stroke. During CTA, a contrast material may get injected to obtain images on the cerebral blood vessels which will assess blood flow. These are essential to physicians because it would help them determine the best therapy for the ischemia stroke patient. In spite of that, MR angiography (MRA) may get used by physicians to take images of blood flow which would help the physicians to assess the brain damage that the ischemia stroke may have caused (RadilologyInfo.org., 2017).

According to Stingley (n.d), Maxine decided to move to a skilled nursing home which was around her retirement community. She had speech therapy, PT and OT done once per day every four or six days in a week. Also, the sessions used to last from about ten minutes to around an hour. The observation made is that she responded well to the therapy provided and she was often cooperative though she could complain especially when the she carried out the OT help skills.

Subsequent Assessment

The assessments made during this period got carried out through question and answer technique where Maxine was asked some question by the medical practitioners and she replied. In spite of that there were also observations made and feedbacks acquired from her. The following got obtained:

Ongoing Assessment on January 4th to 7th February 2008

Maxine had experienced pain in her neck though she had gotten treatment before the stroke. She had no sensory on the left inside side of her mouth which resulted to food collection between her cheek and teeth. In spite of that she had no sensory in her throat’s left side which made it difficult for her to swallow food and there were two chocking incidences. Maxine was not able to multi-task particularly when eating because she could stop eating when watching the television, thus, no television time got awarded to her. She also experienced speech difficulties though she could repeat common phrases such as ‘Hug and Tug’. However, she obtained spontaneous speech starting from the 23rd of January 2008 with some few words and phrases. She could speak sentences particularly when she had gotten enough rest. Starting from 23rd January Maxine had numerous improvements because she was able to express when she was happy, crying and pleased. Additionally, she began feeding herself with her left hand in the second week, however, it was sometimes difficult because she had to strategize on getting food to her right mouth side. On the third week, she started making some gross movements and she was able roll small objects and by the fifth week she was able to roll small objects using the space between her first finger and thumb. Her progress seemed to be going on well because she was able she could walk with the help of her therapist and during her fourth week she could walk with no assistance. Stingley (n.d) notes:

“She ate most meals in bed, occasionally sitting in a chair and only eating in the dining room a handful of times. She mostly chose to sit in bed rather than on a chair. She was extremely motivated to get better, often requesting HANDLE activities and speech activities; sometimes requesting to do arm and leg exercises and later to walk” (p.3).

 The face tapping got done on Maxine on several times per day which boosted her muscle tone, vestibular function, swallowing, facial expression, vision and chewing which were a great encouragement for her to get better. Furthermore, accentuation tap helped in stimulating her left hemisphere and interhemispheric intergration which got done using a pillow at first on her right arm. Most of the therapy that got done was mostly when Maxine was lying on the bed or seated. Moreover, skull tapping improved oxygen circulation in her brain which also improved her sensory cells. Angels in the Snow got used for Maxine’s bilateral intergration and proprioception which got done a few times because it was awkward having it done in bed.

The medical practitioner carried out sacral occipital and craniosacral therapies which reduced her neck pains and enabled her to walk without any aid. Due to the therapies Maxine was able to effectively move her right arm though she had already acquired spontaneous movement by the third week of her assessment (Day 23). She was able to squeeze some balls using both hands which gave the medical practitioner enough reasons to get her discharged and moved to a health center located in her retirement community. Prior to moving her, the niece was given an in-service training by the medical practitioners which would help her assist Maxine. Additionally, she acquired a certified private nurse who was with her for a few hours per week assisting her improve. Stingley states, “She was on a unit with 14 other patients and two to three attendants plus a nurse who served four similar units and the Skilled Nursing Unit. She received speech therapy, occupational therapy and physical therapy once or twice a week. Eventually physical therapy was dropped’ (p.4).

  1. Telemedicine

Telemedicine often begins when a community hospital seeks to have emergency consultation with a neurosurgeon or a vascular neurologist concerning an ischemia stroke patient. Most networking hospitals get equipped with robots which can get wheeled into a patient’s room. These robots provide physicians with visualizations and the ability to communicate to the patient (Goldsack, Bergey, Mascioli, and Cunningham, 2015). This would in turn help the physician to either recommend the patient for tPA or transfer if the need for endovascular intervention arises.

  1. Interventional Neuroradiology (INR) Nurse

The INR nurse may obtain reports regarding a hospital transferring on a patient to the surgical ischemia stroke team.  Thus, the INR nurse plays several roles in ensuring that the ischemia stroke patient gets catered for accordingly. It is important that the INR nurse receives proper training especially regarding medication which get used during drawing blood clotting tests (Goldsack et al., 2015).

Conclusion

This article gives a detailed assessment that got carried out on an 88-year-old woman who had ischemia stroke which caused adverse health effects on her. The ischemia stroke left her with no sensory from her right shoulder down to her right arm. In spite of that, her right side of the face had also no sensory which made it difficult for her to swallow food. Also, the stroke affected her speech which made it difficult for her to communicate with her niece, however, she could recognize her relatives. The medical practitioner prepared an appropriate nursing plan which would help in addressing the severe effect the stroke had on her right side. Some of the expected outcomes from the care plan were to ensure that proper medication got administered to address the blood clot problem that caused the severe left hemisphere stroke. Maxine was advised to engage in exercise which would help her restore her strength enabling her to feed herself. Also, she underwent speech therapy which could help her in restoring her communication capability.

References

Cavalcante, T. F., Moreira, R. P., Araujo, T. L. D., & Lopes, M. V. D. O. (2010). Demographic factors and risk indicators of stroke: comparison between inhabitants of Fortaleza municipal district and the national profile. Revista latino-americana de enfermagem, 18(4), 703-708.

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing2018, 45(2), 25-30. Retrieved from: https://www.nursingcenter.com/journalarticle?Article_ID=3647899&Journal_ID=606913&Issue_I

Healthline. (2018). Everything You Need to Know About Stroke. Healthline Media. Retrieved from: https://www.healthline.com/health/stroke 

Kabita, K. and Ajish, S. (2016). Evidence Based Nursing care for an Acute Stroke: Theoretical Study. The Degree Programme of Nursing. Retrieved from: https://www.theseus.fi/bitstream/handle/10024/118607/Thesis%20Final%20.pdf?sequence=1 

Mclntosh, M. (2017). Everything You Need to Know About Stroke. Medical News Today. Retrieved from: https://www.medicalnewstoday.com/articles/7624.php 

NRSNG. (2017).Nursing Care Plan for Stroke. Stroke.Org. Retrieved from: https://www.nrsng.com/care-plan/stroke/ 

Nursing Care Plan. (n.d). Nursing Care Plan: A Client with a Stroke. Wps Media Retrieved from: https://wps.prenhall.com/wps/media/objects/737/755395/stroke.pdf 

NursingProcess. Org. (n.d). The 5 Steps of the Nursing Process. The Nursing Education & Career Guide. Retrieved from: https://www.nursingprocess.org/Nursing-Process-Steps.html 

RadilologyInfo.org. (2017). What is Stroke? Radiological Society of North America. Retrieved from: https://www.radiologyinfo.org/en/info.cfm?pg=stroke 

Stingley, C. (n.d). Case Study Recovery from Major Left Hemisphere Stroke in 88-year-old Female. The Handle Institute. Received from: https://handle.org/Resources/Documents/CaseStudy_stroke_Stingley.pdf 

WebMD. (2017). Heart Disease ad Stroke. WebMD Media. Retrieved from: https://www.webmd.com/heart-disease/stroke 

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