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Case Study 1

Describe about the Scandinavian Journal of Caring Sciences?

1. Anastasia faces difficulty in transfer from her hospital bed to the wheel chair and vice versa. Although she suffers from hemiparesis and the functioning of her body was reduced, she has regained some function, post accident. She even needs assistance in covering short distances. Since she does not know English, she faces problem in communicating and in expressing herself. She even faces difficulty in comprehending the language that is spoken by her family and this is the result of aphasia, which is a speech disorder and occurred as a result of injury to the left side of her brain (Head, H., 2014).

2. Since Anastasia is unable to express herself and comprehend the language of her family or nurses, it is important to use non verbal skills or use of communication aids like picture cards, using charades or employing bi lingual staff that can help in assisting the patient (Jirwe, M., Gerrish, K and Emami, A., 2010).

3. The actual nursing care needs of Anastasia are maintenance of correct body posture and preventing excessive stress or pressure on the body when indulging in daily activities like walking, sitting, etc. The other role of the nurses is to identify the signs and symptoms of stroke and provide supplementary oxygen to the patient. The nurses are also required to ensure efficient transfer of glucose containing fluids. Stroke should be taken and considered as an emergency situation and thus, high priority treatment action should be sought (Summers et al., 2009).

4. As a result of current medical condition of Anastasia, the potential complications that can occur can be related to disorders of sleep, atelectasis, pneumonia, depression, confusion, problem in swallowing and incontinence. Any kind of problem in the function of swallowing can eventually lead to undernutrition, dehydration or aspiration. Due to the hemiparesis condition, the immobility of her lims can further lead to thrombolic disease or UTI, contractures and pressure ulcers. The most dangerous and the most common problem is the inability to perform daily functions like ability to walk or see or think, speak, feel and remembers (The Merck manual, 2014). One other complication is the problem in the speech and the comprehending power of the patient. If the problem of aphasia still persist, it will be very difficult to speak, understand and even express what do you want to speak.

1. The methicillin resistant Staphylococcus aureus (MRSA) is mostly found in hospitals wards. This strain of bacteria is resistant to all the penicillins and the beta lactam antimicrobial drugs and thus, are confined to the hospitals and the health care units. This bacteria spreads with the number of people coming in contact with the health care facility (David, M & Daum, R., 2010). The standard precautions can help in prevention of MRSa infections in the health care facility. Hand washing, using gloves, protection of eyes, nose and mouth, wearing gowns, proper handling of laundry or disposable and lastly proper device handling of the care of the patient and the instruments or the devices, these methods can help in preventing the spread of MRSA. It is also important to ensure proper placement of the patients and not to keep the patients, already infected by MRSA in the common ward (David, M & Daum, R., 2010).

2. The possible risk factors for development of nosocomial infection are the death or discharge. Since the patient faced smelly discharge from the wound, this was the potential risk factor for developing the infection ( Wolkewitz et al., 2008). Secondly, the bacteria was already present in the hospital ward and the wound was not protected so as to avoid the initiation of infection.

3. The standard precautions to prevent the risk include hand hygiene, before and after every patient contact, use of personal protective equipment, use of sterile needles, aseptic non touch technique, waste management, proper disposal of waste, respiratory hygiene and cough etiquette, allotment of single rooms and cohorting of the patients (NHMRC, 2010). Apart from these measures, it is important for the nurses to cater to the surgical wounds in a proper and sterile manner. The would should not be left exposed to the environment and after contact, hands should be sterilized before touching another patient. This will prevent the spread of MRSA through contact. Being obese, the

4. mThe nursing strategies include developing an understanding with the patient such that it becomes easier to explain him about the effectiveness and use of the nutrients for curing of the illness. Another option is to build a more effective partnership or a therapeutic alliance with the patient.

Case Study 3

1. The pre existing conditions of the patient might be affected by the fall and hospitalization. Since he is not taking any medications for depression, the condition has worsened and he is having suicidal ideations. Secondly, due to asthma and obesity, he is facing more pain and is being given morphine for making the pain subside. The conscious level of the patient is good which signifies that the fracture in the skull was not that severe.

Case Study 2

2. The potential risk factors for Gordon after the surgery are his age and the size and deterioration of the hematomas. Even the anesthesia poses immense risk to his health.

3. Gordon can be lifted by making use of the mechanism by which the end of the bed can be raised or lowered, depending upon the requirement. In order to ensure that the back pain is not elevated, the upper end can be raise and the patient can be shifted.

4. Morphine is a schedule 2 drug. The seven rights of drug administration are right patient, right dose, right medication, right route of administration, right time, right documentation and right response (Lippincott Nursing center, 2014).

5. The discharge of Gordon will require his family and the doctors to identify the needs regarding his ability to perform the daily activities. The hospital will provide the walking aid to the patient and schedule the next check up time. The doctor will ensure that the environment of the patient’s home is such that his recovery will be stimulated and not inhibited. The patient will be required to take medications on time and report in case of any adverse drug reactions (Grimmer et al., 2006).

1. When Louise initially enter the ward her vital signs are not normal and thus, the priority of treatment is the management of these signs. The pulse rate is high, temperature is high and respiration rate is also high. It is required to provide her oxygen mask so as to provide proper respiration. Following this her wound need to be assessed for any kind of infection or discharge. She should be given pain relieving analgesia so as to reduce the signs and symptoms and restore the normal body vital signs. Since the wounds are oozing, they should be properly cleaned and anti microbial agents should be used to prevent infection.


2. The immediate assessment comprises of checking the airway, breathing and the circulation of the patient. In order to stabilize the patient, the oxygen mask should be supplemented. Cardiac monitoring should be done next and the blood pressure of the patient, pulse rate and the temperature should also be recorded. The patient should be checked for seizure too.

3. Lousie might be suffering from sepsis, which is infection by the bacteria. Since the wounds were open and ozzing, the contamination is quite possible. Also the symptoms of rise in temperature, elevated heart rate and increased respiratory rate, all point out to occurrence of this condition (Medicinenet.com, 2015).

4. To minimize further deterioration of the patient it is important to immediately implement clinical intervention and treatment procedure. The procedure of defibrillation should be performed and post resustication care should be initiated. The arrangements for transferring the patient to the secondary care unit should also be made simultaneously (NHS, 2015).

References

Head, H. (2014). Aphasia and kindred disorders of speech. Cambridge university Press.

Jirwe, M., Gerrish, K and Emami, A. (2010). Student nurses’ experiences of communication in cross-cultural care encounters. Scandinavian Journal of Caring Sciences, 24(3): 436-444.

Summers et al. (2009). Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient.  Stroke, 40: 2911-2944.

The Merck Manual. (2014). Overview of stroke. Retrieved on 18th March 2015 from https://www.merckmanuals.com/professional/neurologic_disorders/stroke_cva/overview_of_stroke.html.

NMRC (National Health and Medical Research Counsil). (2010). Clinical educators guide for the prevention and control of infection in healthcare, retrieved on 18th March 2015 from https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_icg_clinical_ed_guide_web.pdf.

Wolkewitz et al. (2008). Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models. Critical care, 12:R44.

David, M & Daum, R.(2010). Community-Associated Methicillin-Resistant Staphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic. Clinical microbiology reviews, 23(3): 616-687.

NHS (2015). Deteriorating patient policy: General policy no. 50. Wirral community.

Lippincott Nursing center.com. (2014). 8 rights of medication administration, retrieved on 18th March 2014 from https://www.nursingcenter.com/Blog/post/2011/05/27/8-rights-of-medication-administration.aspx.

Grimmer et al. (2006). Incorporating patient and carer concerns in discharge plans: the development of a practical patient centered checklist. The Internet Journal of Allied Health Sciences and practice, 4(1).

Medicinenet.com (2015). Sepsis. Retrieved on 18th March 2015 from https://www.medicinenet.com/sepsis/page2.htm.

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