The purpose of this paper is to provide the nursing care plan for the 75 years old patient. The patient has suffered from stroke and also has right side paralysis. If, the stroke occurs in the left side of the brain then patient suffers from the problems occur on the right side of the body. This is the main reason of the right side paralysis. Stoke is considered as the major cause of mortality and morbidity in the older people. According to the definition stroke is “a sudden disabling attack, caused by an interruption in the flow of blood to the brain, especially through thrombosis” (Smith, 2014, p. 18). Stroke could cause the serious disabilities in the patient and can impact their social, physical and psychological functioning. Stroke also affects the cognitive functioning. Stroke can severely impact the quality of life and physical and psychological well-being of the patient. This paper will discuss the physical and psychological health assessment of the patient in order to indentify the three priority nursing problems in case of Kevin. Paper will also provide the evidence based knowledge relate to three priority nursing problems and will also discuss the nursing care plan for addressing three main nursing problems.
According to the given case study, Kevin Jones is a 75 years old man, who lives alone on his farm situated in the rural area. His wife died13 years back and since then he has been living all alone. He has three grown up children, two of them live outside Victoria, while one lives nearby. However, his children are busy with their families and work life. He had been living independently and verbalized his wish to return to home and live independently. The patient has limited finances and a very old farmhouse that is not in very good condition.
The past medical history of the patient displays that he had suffered from Prostate enlargement, hypertension, alcoholism, depression and anxiety. The problem of stroke can be associated with alcoholism and hypertension, because studies have shown that alcoholism can lead to brain damage and ultimately in stroke. Hypertension and alcoholism are the major risk factors that can lead to stroke. High blood pressure of hypertension is a disease, which is considered as a chronic illness. High blood pressure is also considered as the leading cause of stroke in older people. Hypertension can also impact the vital functions of the body. It can also lead to vision problems. Therefore, it can be said that people with hypertension are vulnerable to the risk of stroke. Hypertension is the condition, which the blood do not flow in the steady stream. Due to hypertension, Blood vessels can be damaged that can restrict the flow of blood to brain (Singh, Mensah, and Bakris, 2010). Since, the blood flow is restricted, some parts of the brain do not get oxygen in enough amount and brain cells are damaged leading to stroke.
Alcoholism is also a very important cause of stroke. Studies have shown that alcoholic people are more likely to suffer from stroke. From moderate to high consumption of alcohol can increase the risk of stroke (Cunningham et al, 2017). Kevin also has the history of alcoholism that may have contributed in stroke. The chronic and heavy intake of alcohol can result in causing many abnormalities in the blood. Alcohol misuse can result in many neurological disorders such as dementia, stroke and traumatic brain injury (Wadd et al, 2013). Alcoholism can also lead to cognitive impairment in older people, which can get worse over time. Cognitive impairments can be a significant problem for the older people that can affect their functionality, mobility. It can also lead to memory loss, lack of problem solving skills and disrupted behavior (Chen et al, 2010).
Some of the common dysfunctions associated with stroke are depression, anxiety, motor, sensory, cognitive and communication disorders. Kevin has also displayed the problem with speech, his speech is slurred and he faces difficulty in speaking. This situation of the patient makes them dependent and also reduces their quality of life. Studies have also associated psychological distress with occurrence of stroke (Henderson et al, 2013). Evidences have shown that psychological distress, depression and anxiety can also lead to stroke. Kevin also has the history of depression and anxiety that increases the risk of stroke, as well as the age is also considered as the non-modifiable risk factor of stroke. . Therefore, according to medical history of the patients, all of his physical and psychological problems can be associated with occurrence of stroke. Slurred speech and swallowing problem are also considered as the consequences of stroke (Chen et al, 2010). The various complications occur due to the changes caused by stroke. The patient may have reduced mobility due to weakened body parts. According to the study, “Common deficits after stroke include weakness, numbness, vision problems, slurred speech and swallowing problems, difficulties with language, balance and coordination problems, and problems with thinking” (Donkor et al, 2014, p. 197). The four main issues in the given case study are the mobility impairment, ineffective coping, risk of impaired swallowing and impaired verbal communication.
Stroke patients have reduced quality of life, so the nursing care priorities are required to be focused on improving mental and physical capabilities of the patient. The three main nursing problems associated with the case of Kevin are impaired physical mobility, impaired verbal communication and impaired swallowing.
Impaired Physical Mobility: Stroke is the chronic condition that has potential for causing many disabilities in the patients. Impaired physical mobility is one such risk factor that can be a great barrier for the quality of life of patient. Stroke results in inherent psychological alterations. Stroke results in reduced muscle strength, decrease tendon reflexes, as well as change in gait and difficulty in maintaining body balance (Costa et al, 2010). Impaired mobility is associated with physical limitation. Kevin wants to live in house, where he lives alone and has no one to care for him. Physical limitations can make him self-care deficit and socially excluded. The signals from the brain are not effectively sent to the muscles after stroke, because of the damage occurred in the brain. Therefore the patient also suffers from paralysis and develops spasticity. Presence of impaired physical mobility implies the change in balance and gait, which further increases the risk of falls, higher dependency of the patient for activities of daily life and restraining the patient to resume back to normal life (Donkor et al, 2014).
Impaired Verbal Communication: due to the damages in the brain the sensory and motor functions are reduced in the stroke patients. Patient suffers from impaired verbal communication and finds difficulty in specking. Due to this problem, Kevin feels agitated and display emotional outbursts. This problem can reduce his psychological and mental health. Therefore, it is very important to address this nursing issue that may impact quality of life of the patient, because the sudden onset of communication problem can affect and disrupt almost all aspects of life (Bronken et al, 2012). The post stroke communication problems results in ineffective verbal expression. According to a study of “Left brain damage (LBD) may cause alterations in phonological, morphological, denotative semantic, and syntactic aspects” (Gindri, G. and Fonseca, R.P., 2012, p. 364). The damage in the left side of the brain is called as “Aphasia, which is a common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke” (Sinanovi? et al, 2011). The problem of Aphasia can also impact the psychological well-being of the patient.
Impaired Swallowing: Impaired swallowing is also a post stroke consequence that can create nutritional imbalance in the patient and can also hamper their recovery. The problem if impaired swallowing is called as ‘Dysphagia’ in the medical terms (Shaker and Geenen, 2011). This is the common clinical problem associated with stroke. The problem of swallowing also called as “Post stroke dysphagia (PSD)” is a complication that patient may face in the first few hours or for few days after stroke. Kevin has also displayed swallowing difficulties. This problem has significantly associated with increased rate of morbidity and mortality, because it can lead to malnutrition, pneumonia and aspiration (Cohen et al, 2016). According to the evidence provided in the study of Cohen eta al (2016), “Dysphagia leading to aspiration of ingested foods, liquids, or oral secretions, is thought to be the primary risk factor for pneumonia after stroke” (p. 399). This problem occurs due to the damage in the structures of cortex and subcortical. Therefore, it is important to address this problem in case of Kevin for preventing further complications.
Nursing care plan for the patients is the most important aspect of care. It is designed according to specific individual needs and for obtaining desired outcomes. Nursing care plan for Kevin will focus on addressing the problems of impaired mobility, imp0aired verbal communication and impaired swallowing.
Impaired Physical Mobility: Patient will be assessed regularly for evaluating the extent of impairment. This is important for developing the care plan accordingly. Indentifying the extent of impairment will also help in identifying the strength and deficiencies. Kevin will be encouraged to take part in light physical activities, like walking, gluteal exercise, squeezing rubber ball, extension of fingers and legs/feet. This will help in minimizing the muscle atrophy, will promote better blood circulation and will also help in preventing contractures (Costa et al, 2010).
Impaired Verbal Communication: Improving verbal communication in patient is important for reducing the chances of psychological disruptions. Patient will be encouraged to talk slowly. Nurse will also ask simple question to patient, which can be answered as yes or no. This will help in reducing patient’s confusion and anxiety caused due to inability to communicate properly. Taking slowly and asking simple questions will help to reduce complexity of communication. Patient will also be referred to speech rehabilitation program (Gindri and Fonseca, 2012). Speech therapies will help patient to communicate their feelings and will reduce psychological distress (Brady et al, 2012). The speech and language therapist will help patient in communicating in an effective manner and will also help in reducing problem of aphasia.
Impaired Swallowing: Impaired swallowing is neuromuscular impairment. The primary aim opf the dysphagia management is to reduce the problem of aspiration. The major aim is to manage the swallowing difficulties of the patient rather than rehabilitate the problem. Aspiration can be the significant problem. Another problem is that swallowing problem can result in malnutrition and can reduce patient’s weight leading to increased mortality and morbidity (Shaker and Geenen, 2011). The food provided to the patient will be modified. The amount of fluid will be increased that will help in reducing swallowing problem and will also address the problem on ineffective bowel movements. Patient will also be encouraged to change postures and changing swallowing techniques. Compensatory techniques can also be used for managing food and drink (Cohen et al, 2016).
Paper discussed the case study of Kevin Jones, who is a 75 years old man and had suffered stroke. Stroke is a serious neurological disorder that can restrict the functional ability, motor skills, physiological well-being and activities of daily life. It is very important o address the various functional issues for improving the quality of life. Kevin has been facing many psychological and physical problems occurred due to stroke. Therefore, paper discussed the detailed physical and psychological health assessment of the patient to determine the three priority nursing issues. The three nursing issues identified in the case of Kevin are impaired physical mobility, impaired verbal communication and impaired swallowing. The addressed issues are very important for Kevin because he wants to live independently and such impairments can restrict him from living an independent life. Paper also provides the three nursing interventions for addressing these problems.
Brady, M.C., Kelly, H., Godwin, J. and Enderby, P., 2012. Speech and language therapy for aphasia following stroke. The Cochrane Library.
Bronken, B.A., Kirkevold, M., Martinsen, R., Wyller, T.B. and Kvigne, K., 2012. Psychosocial well-being in persons with aphasia participating in a nursing intervention after stroke. Nursing research and practice, 2012.
Chen, R.L., Balami, J.S., Esiri, M.M., Chen, L.K. and Buchan, A.M., 2010. Ischemic stroke in the elderly: an overview of evidence. Nature Reviews Neurology, 6(5), pp.256-265.
Cohen, D.L., Roffe, C., Beavan, J., Blackett, B., Fairfield, C.A., Hamdy, S., Havard, D., McFarlane, M., McLauglin, C., Randall, M. and Robson, K., 2016. Post-stroke dysphagia: A review and design considerations for future trials. International Journal of Stroke, 11(4), pp.399-411.
Costa, A.G.D.S., Oliveira, A.R.D.S., Alves, F.E.C., Chaves, D.B.R., Moreira, R.P. and Araujo, T.L.D., 2010. Nursing diagnosis: impaired physical mobility in patients with stroke. Revista da Escola de Enfermagem da USP, 44(3), pp.753-758.
Cunningham, S.A., Mosher, A., Judd, S.E., Matz, L.M., Kabagambe, E.K., Moy, C.S. and Howard, V.J., 2017. Alcohol Consumption and Incident Stroke Among Older Adults. The Journals of Gerontology: Series B.
Donkor, E.S., Owolabi, M.O., Bampoh, P., Aspelund, T. and Gudnason, V., 2014. Community awareness of stroke in Accra, Ghana. BMC public health, 14(1), p.196.
Gindri, G. and Fonseca, R.P., 2012. Rehabilitation of post-stroke communication impairments. Revista da Sociedade Brasileira de Fonoaudiologia, 17(3), pp.363-369.
Henderson, K.M., Clark, C.J., Lewis, T.T., Aggarwal, N.T., Beck, T., Guo, H., Lunos, S., Brearley, A., de Leon, C.F.M., Evans, D.A. and Everson-Rose, S.A., 2013. Psychosocial distress and stroke risk in older adults. Stroke, 44(2), pp.367-372.
Shaker, R. and Geenen, J.E., 2011. Management of dysphagia in stroke patients. Gastroenterology & hepatology, 7(5), p.308.
Singh, M., Mensah, G.A. and Bakris, G., 2010. Pathogenesis and clinical physiology of hypertension. Cardiology clinics, 28(4), pp.545-559.
Sinanovi?, O., Mrkonji?, Z., Zuki?, S., Vidovi?, M. and Imamovi?, K., 2011. Post-stroke language disorders. Acta Clinica Croatica, 50(1), pp.79-93.
Smith, G., 2014. Acute stroke–diagnosis and management. Scottish Universities Medical Journal, 3(1), pp.18-27.
Wadd, S., Randall, J., Thake, A., Edwards, K., Galvani, S., McCabe, L. and Coleman, A., 2013. Alcohol misuse and cognitive impairment in older people. Tilda Goldberg Centre for Social Work and Social Care, pp.1-62.
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