Assessing Patient with Cardiovascular Accident Using the Model of Roper, Logan and Tierney - Essay Example

? ASSESSING PATIENT WITH CARDIOVASCULAR ACCIDENT USING THE MODEL OF ROPER, LOGAN AND TIERNEY By University name City, State Date Introduction This is a case scenario analyzing the condition of patient X who has been admitted with cerebra vascular accident, and is also currently receiving treatment for high blood pressure and smokes. To assess the circumstance, it is necessary to evaluate problems such as mobility, communication, personal cleansing and eating and drinking and working condition since they are related to patient’s conditions. A cerebrovascular accident is the health term for a stroke which affects mobility of selected part of the body or entire body. A stroke is when blood flow to a part of brain blocks either by a rupture or a blockage of a blood vessel. Model of Roper, Logan, and Tierney" is recommended as the suitable model for use in intensive care settings (Robb, 1997; Sutcliffe, 1994). Molloy (Pg 176 1996) supports the use of this model in a neonatal situation. Tierney (1998) suggest that this model allows nursing to work directly with medicine, rather than separately which gives the nurse a chance to acquire knowledge of medicine in a manner which is simpler (Roper, Logan & Tierney 2001). The model measures the individual's potential and comparative independence for development. The rationale for choosing this model was based on its integration of nursing care with medication. The model provides a good chance to address my patient conditions where the cost of treatment as per this model is provided by the state. He is suffering from communication, breathing and personal cleansing which most stroke survivor’s experience. Diagnosis is an essential process during nursing activities since it assist to set goals of either remedying the situation or sustaining. The cases scenario brought challenge of communication issue, personal cleansing and breathing (Roper, Logan & Tierney 2001). Doctor patient confidentiality is a paramount duty of every health care provider and in this case the data provided regarding the patients would be essential for nursing him accordingly but not shared by anybody unless he authorize. The patient true identity must not be included in report though reference number must be given for proper identification and proper medication. Overview Objectives are imperative in that they provide direction in what health care needs to do, and present a principle by which to evaluate whether the objective has been attained (Mason-Whitehead 2008). It provides the anticipation that the patient may recover and illustrates something is being implemented to attain this with the client’s comprehension and participation in the procedure that considers patient’s values and desires during the process (Institute of Medicine 2003). The goal of this assessment is to incorporate Roper, Logan and Tierney Nursing Model, intervention process of the situation and confidentiality requirements of the patient. The goal of stroke treatment is to regain as much independence as possible; Recovery from stroke is a lifetime procedure. For my patient healing begins with formal treatment. It is vital for the nurse and patient family to recognize that no matter where they are in his recovery journey, there is always hope. Partnership and coordination is vital for the patient to learn as much as he can about stroke and healing, and utilize the funds those are available with collaboration and advice from the former employee which he was working early before the accident of stroke. Health insurance cover should subsidize his expenses on treatment (Lincoln 2012). This model of nursing ensures that patients are well taken care of even after discharge and gives the nurse in charge, to gain knowledge, learn practical experience and medicine point of view. According to the procedures of (NMC 2008), investigations were done after explanation on all the procedures he would subject to, the common causes of the accident such as hypertension, older age and smoking .he was given advice on the most appropriate management, such as stop smoking, using of drug therapy with the assistance of the nurse (Pasero & Mccaffery 2011). The question if he will recover? Was that the rehabilitation takes some time because the brain needs time to heal and he was comfortable with it. The hospitals had instituted procedures to manage the spread of methicillin resistant staphylococcus aureus (MRSA) by screening those patients they feel are at threat of being colonised with these anti bacteria. Upon admission of the patient X to the hospital investigation of MRSA was under screening and his family members was performed to identify the possible source of infection and to assist devise a plan to hold these infections. The hospital having modern technology it used the test through molecular methods that test for the mecA gene, which confers resistance to the antibiotics cefalexin, dicloxacillin and methicillin (Alonso, 2007). This method of screening has the potential to detect wound or nasal carriage within hours instead of days necessary by culture screening. The wound site culture or nasal screen was negative. The patient was the admitted on normal ward. Laboratory evaluation... Blood specimens (STAT) was conducted to screen if the patient had any other virus with complete blood cell tally with disparity, platelet calculation, partial thromboplastin point (PTT), blood glucose, and blood urea nitrogen (Level 3; Goldstein, 2007). The following ethics were applied while working with the patient at the ward. (NMC, 2008) Assisting the patient in accepting necessary amount of dependent Setting out short goals to assist the patient in learning and decrease frustration Encouraging independent and assisting where the patient cannot perform Use of consistence routine and allowing the patient to complete a task Provision of positive reinforcement for activities attempted, noting partial achievement Assessment of the problems identified during patient X diagnosis comprises methodologies of ascertains communication, breathing and personal cleansing. In communication evaluation, as a nurse I would assess water swallow, capability to pronounce words accurately though average time of 10 minutes face-to-face conversation with client and appropriate speech assessment. The process would assist in identifying patient’s problems that could be observed in difficulty controlling secretions / saliva, patient slurred voice, unable to move his lower and upper muscle when talking (aphasia) independently, slow response and other related communication difficulties (Cannon & O'Gara 2007). After assessing the problem, intervention process for communication that involves communication therapy would be initiated. This would be in line with patient’s capability to follow prescribed therapy program. Nursing objective of gaining 90% communication ability of the patients through (Weinstein & Plumer 2007): Request for language therapy session once a day Straight forward sentences Use of symbols such as drawing, pictures Allow plenty time for response There is need for assessment of patient's nasal fold for facial drooping during evaluation procedure for communication problem. The second problem to be assessed and intervention provided is the breathing difficulty of patient. As a nurse duty is to evaluate the possible causes of breathing problem. The following is done during the process coughs check up on routinely or from information gathered from the wife, capability to clear secretions, assess for clear breath sounds and evaluate patient’s physical activity/bedridden (Mason-Whitehead 2008). This should be able to assist in gathering relevant information regarding the patient’s condition. Failure to remove secretions by means of suctioning technique/ spontaneous cough independently, and inability to exert without shortness of breath independently could be possible causes of breathing difficulty (Taylor 2005). Intervention mechanism would follow to ensure condition is rectified or maintained. The following are recommendable interventions: Prevent increased intrathoracic pressure and allow for venous drainage. “Improve respiratory status as defined in functional limitations.” uplifting the head of the bed (HOB at 30 degrees or as stated in (NMC 2008) Pulmonary assessment Pulmonary function test (PFT) (if relevant) Oximetry Radiological findings Arterior Blood Gas (ABG) (if relevant). The third assessment involved Personal Cleansing. As a nurse duty, diagnosis process involve assessment of ability to carry ADLS (bath, groom, toilet), assist the patient to regain mobility, support for oral care, assessment of sitting needs, assessment of bathing and washing needs. The assessment of the patient revealed that he was unable to bath and groom himself independently and incapable to feed himself independently (Mason-Whitehead 2008). The objective of the process is to ensure the customer gain the mobility so as to carry out personal cleansing. Goal is to set regular exercise on right limbs to help him regain his normal activities. Intervention mechanism would comprise of: physiological homeostasis maintenance wheel chair for occupation therapy for movement special mattress to prevent pressure sores Consultation with Physiotherapist Assistance on oral cleaning Every day morning bath Electric razor for simple save Free standing shower and a chair in the shower and good mirror (Weinstein & Plumer 2007). Routine evaluation involving physical assessment (HR, RR, and BBS) recommended. Care plan after discharge Care plan Discharge Follow-up Development of the care arrangement with the beneficiary, family to determine sternness level and pharmacological Lifestyle change for example smoking habits by the patient Inhaler practice Respiratory therapist should identify indicators for Possible follow-up care, for example change of working environment. combined therapies(PT, OT, SLP) quarterly in a year Temporary goals: for example, develop respiratory status as defined in functional confines Beneficiary/ is able to follow agreed therapy program independently or with assistance A physician instructions discharge Need for oral steroids frequently once in a six month period. Lasting goals: for example, decrease or eliminate functional deficit Medicaid covers by for home health provision Quarterly physical evaluation [heart rate (HR), bilateral breath sounds (BBS)], skin color respiratory rate (RR), and tone, accessory Muscle use. Summary The higher nurse practitioner is in an exclusive role for the integration and assessment of a broad stroke care model. Highly developed practice nursing is based upon a complete approach to patient care through thorough history taking, physical assessment. Complex diseases check up. It is acknowledged when providers of healthcare, including nurse practitioners, take the point in time to educate patients about health, diet and exercise Reflection This method of treatment empowered me to learn the relationship between medicine and nursing role. In a real experience of practice, this model is simple and clear to every new practicing nurse; therapy should start in the hospital (Taylor 2005). As soon as possible after the stroke or after you experience signs and symptoms such as memory loss, sight difficulties and strain in communication, you should go for medical examination. If you are medically secure, treatment may commence within one day after the stroke, and should be sustained after discharge from the hospital if needed. Conclusion This culture should be embraced in all nursing professionalism for excellent results to patients; also it gives the nurse a chance to note any positive or negative outcomes on patients via record keeping. Also the there is a match in nursing code of conduct (NMC2008) in the practice. Where there respect, equality, and diversity to patient dignity and rights, also this model embraces partnership among different levels from the hospital to the society at large Reference List ALONSO, C. (2007). Viruses and apoptosis. Berlin, Springer. CANNON, C. P., & O'GARA, P. T. (2007). Critical pathways in cardiovascular medicine. Philadelphia, Pa, Lippincott Williams & Wilkins. INSTITUTE OF MEDICINE (U.S.). (2003). Crossing The Quality Chasm. Washington, D.C., National Academy Press. Http://Site.Ebrary.Com/Id/10056947. LINCOLN, N. B. (2012). Psychological management of stroke. Chichester, West Sussex, UK, Wiley-Blackwell. MASON-WHITEHEAD, E. (2008). Key Concepts in Nursing. Los Angeles, Sage. Http://Www.Credoreference.Com/Book/Sageuknurs. PASERO, C., & MCCAFFERY, M. (2011). Pain assessment and pharmacologic management. St. Louis, Mo, Elsevier/Mosby. http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=445453. RICHTER, J. (1997). The Development of Psychiatry and Its Complexity: Bilateral Symposium Rostock/Germany - Umea?/Sweden and "Vi. Restocked Psychiatrietage". Mu?Nster U.A, Waxmann. ROPER, N., LOGAN, W. W., & TIERNEY, A. J. (2001). The Roper-Logan-Tierney Model Of Nursing: Based On Activities Of Living. Edinburgh, Churchill Livingstone. TAYLOR, H. (2005). Assessing the nursing and care needs of older adults: a patient-centred approach. Oxford, Radcliffe Pub. WEINSTEIN, S., & PLUMER, A. L. (2007). Plumer's Principles & Practice of Intravenous Therapy. Philadelphia, Lippincott Williams & Wilkins. WHITE, J. W. (2011). Mirrors of memory: culture, politics, and time in Paris and Tokyo. Charlottesville, University of Virginia Press. Read More