Nursing Problems for Mr. Clarks Diagnosis of Acute Ischaemic Stroke - Case Study Example

Outline three (3) priority nursing problems (nursing diagnoses) for Mr Clark’s diagnosis of acute ischaemic stroke, providing a rationale for each priority problem. In order to understand the priority nursing problems the nurse should first collect the entire medical record of the patient, conduct physical examination of the patient, study the medical history and understand the symptoms displayed by the post-stroke patient. The nurse should be able to study the subjective and objective data in a careful manner to conduct the diagnosis properly. For instance, the nurse should be able to identify common symptoms such as breathing problems, inability to conduct everyday functions like bathing, eating etc, and weakness in the muscles, which may indicate towards conditions such as unilateral neglect and neurological disorders (Roth et al., 2001). Thus, it is essential to conduct a through clinical study of the patient to understand his or her nursing problems. In this case for instance, the nurse might face the following issues with the patient. Aphasia: It has been found that most post-stroke patients suffer from language impairments and are not able to write, speak or understand what others are speaking or writing. Stroke may injure the brain’s portion that controls the ability to understand language, which may result into damaging the verbal communication. Due to damage in the language centre, which is also known as the Broca’s area, may cause aphasia. Patients who have aphasia have problem in expressing their thoughts through written words and verbal communication. Such patients are not able to express themselves in a coherent manner by making correct sentences and have difficulty in understanding even others. Further, even if the patient is able to speak and construct sentences, most of them is often without any meaning. In case of severe aphasia, the patient suffers from extensive damage of the language function (Chapey, 2001). In this case study, the patient already has problems in hearing and wears hearing aid. Further, although the patient is able to answer all the questions properly, he does display mild slowness in his responses. The nurse should monitor this condition carefully to find out whether the situation is getting aggravated to aphasia. Aspiration: The entrance of foreign bodies in the lungs of a person through breathing is known as aspiration. Such a process may cause chest infection in post-stroke patients, which may often lead to malnutrition and even death. In case of post-stroke patient, the abdominal muscles are often weak and therefore, the person is not able to cough or have a clear airway (Marik & Kaplan, 2003). In this case as well, the patient is already facing weakness in his left arm and leg, which may indicate that the patient has weakness in the abdominal muscles. This may lead to aspiration risk and later to chest infection as well. As aspiration risk is often linked to high mortality rate as well, it is important for the nurse to monitor the situation and help in reducing complications related to respiratory organs. This in turn would help in reducing death risk and disability in post-stroke patients. Depression: Most post-stroke patients feel anxious, fearful and depressed about their condition. These patients go through a lot of psychological trauma as there is always a risk of repeated stroke and death. Such patient may also go through brain damage due to emotional disturbances. The most common problem that such patients may face is clinical depression, which creates an atmosphere of hopelessness in the patient. This also disrupts the daily functionality of the person. Some of the common sign of depression includes disturbed sleep, changes in eating habits, fatigue, anxious thoughts etc (Gilbody et al., 2003). In this case study, the patient has already shown signs of depression and fearfulness. Further he is also concerned about the fact that he may have another stroke which would impair his life further. Therefore, it becomes imperative for the nurse to monitor the condition of the patient closely and alert the physician at the first sign of depression in the patient. Discuss three (3) priority nursing interventions to prevent problems identified in Q1 (1 priority nursing intervention for each identified problem). Explain how you would specifically evaluate the success of your priority nursing interventions (at least 2 specific evaluation data for each) (Support with current evidence-based literature) Nurses are seen as a key personnal in the rehabilitation of patients who have suffered stroke. Nursing intervention provided by the nurse help in managing stroke in a better manner. Further, nurses are in a pivotal position to understand the need of the patient and find out whether the patient is being suffering from diseases and disorders such as aphasia, aspiration and depression. Aphasia: In case of aphasia, the nurse needs to understand that the patient is unable to communicate his problems effectively and therefore, the nurse need to study the clinical data of the patient carefully to analyse the problems being faced by the patient. The nursing intervention is especially required to understand the expressions of the patient by helping him communicate his needs. The nurse should be able to exercise different techniques such as silence, active listening and accepting the thought process of the patient to help him express his requirements (Chapey, 2001). The nurse should also be well-versed in understanding various neurological conditions that may also affect the power of speech. Some of these conditions include presence of tumor, hearing loss, multiple sclerosis etc. In order to establish the occurrence of such conditions, the nurse should conduct various tests including computed tomography (CT) scan and electroencephalogram (EEG) (LaPointe, 1997). Further, the nurse should be able to find out about the type of aphasia, whether it is motor, conduction, sensory or global. In case of motor aphasia, the patient would not be able to create images to articulate his speech, while conduction indicates decrease in the ability to comprehend things and using of inappropriate words even knowing about the error. Sensory aphasia on the other hand means the patient is not able to understand the words and does not even recongise the mistake, while global aphasia means complete inability to understand language and speak (Albert, 1998). The nurse in such cases should help the patient to use hearing aids and assist the patient in adjusting with life using aids. Further, the nurse needs to create great relationship with the client by listening and observing various verbal as well as non-verbal expressions of the patient. The nurse should also keep the means of communication very simple and may use various visual and auditory aids to communicate with the client. Never make assumptions about the meaning of the non-verbal communication used by the patient, the nurse should always seek guidance from experienced physicians in case of any doubt. The nurse may use several other means of communication such as picture, board, signals etc to help the patient communicate effectively with others (Albert, 1998). Aspiration: It has been found that the nurse is often the first person to identify the risk of aspiration in a patient. Although, the risk factors that are associated with identifying aspiration in a patient are not clearly demarcated, there are certain characteristics that may help the nurse in identifying aspiration in a patient. Some of these characteristics include changes in level of consciousness of the patient, gastrointestinal problems, difficulty in breathing etc (Holas, 1994). Many patients even display more than one risk factor such as changes in level of consciousness and gastric issues while being asked to take bed rest. Although, occurrence of diseases due to aspiration may not be very high due to the fact that the health factor of each patient needs to be taken into consideration to understand the risks factors associated with the onset of a disease due to aspiration. However, patients with pulmonary diseases become the major victims to be susceptible to various diseases due to aspiration. Diseases such as pneumonia and legionnaires' disease are often considered to be associated with transmitting foreign bodies through aspiration (Marik & Kaplan, 2003). Nurses should be able to minimise the risk of aspiration by checking the medical history of the patient to find out whether the patient had suffered any gastrointestinal problem or not. Disorders such as achalasia and dysphagia may complicate matters and possess higher risks of aspiration. Further, nurses should take extra care while dealing with patients who have difference in their level of consciousness, as these patients might be at a greater risk of aspiration (Holas, 1994). Nurses are the primary points in reducing the risk of aspiration. The nurses may reduce the risk factors by periodically checking the stomach of the patient for any residues and elevating the head of the bed to clear the airways of the patient. This helps in decreasing the risk of aspiration. Although, the nurse may help in decreasing the risk of aspiration, they might not be able to eliminate the risk factors altogether (Holas, 1994). Depression: It might be difficult to find treatment for depression, especially for patients who do not have the confidence in medical treatment at all. In such cases, the nurse needs to provide a very realistic medical framework and plan to help the patient come out of the psychological condition. The nursing intervention for caring for depressed patient would generally depend on the level of severity of the disorder. Further, the nurse should be well aware that the condition might require the nurse to provide continued care to the patient to even more than a year’s time (Bower & Gilbody, 2005). While helping out patients with psychological disorders, the nursing intervention should look at creating a strong nurse-patient relationship. The method of initiating a relationship with the patient would depend greatly on the behaviour of the patient and the current care is being given to the patient. However, the central issue while handling such patient is building trust rather than just being persistent or patient in the nursing approaches (Gilbody et al., 2003). The nursing intervention that is also important in such cases is to develop the skills to being an active listener and always provide a sense of being there to the patient. The nurse should also be aware of the fact that anxiety and depression often causes emotional issues in the person who is treating the patient. Therefore, the nurse should also constantly monitor his emotions to find out whether he is getting affected by the emotional upheavals of the client or not. The main motivation of the nurse should be to provide support to the patient so that he is able to recognise and deal with his feelings in an efficient manner (Gilbody et al., 2003). Discuss three (3) factors the nurse should assess that are related to outpatient rehabilitation for Mr Clark. Post-stroke patient rehabilitation focuses on facilitating the recovery of functional support through various therapies and enhancing the motor abilities of the patient’s neural system. Such therapeutic interventions if started at the earlier stages help in the recovery of the patient in a better and faster manner. Further, if the rehabilitation program is initiated in a comprehensive manner than the patient may regain his functional abilities sooner, while reducing the risk of mortality considerably. Further, such a rehabilitation program can also be extended while the patient is being discharged from the hospital (Dobkin, 2005). In this case, the patient would require outpatient rehabilitation in the following areas: language deficit, health care and emotional management. Language deficit: Research has found that around 19 per cent of stroke patients display language deficits while expressing or comprehending their opinions following a stroke attack. In order to help the patient to communicate in a basic manner, speech therapy should be initiated, which would help the patient in communicating with others through the means of verbal communication or head movement (Robey, 1998). Use of simple communication mediums such as boards and pictures would also help in understanding what the patient is trying to communicate about his needs. The patient should also be given aphasia training so that language deficits can be addressed. In case the patient shows sign acute aphasia, the intensity of the treatment should also increase. The patient should be encouraged to communicate and interact with friends and family, so that he is able to garner confidence in his social interactions (Kagan et al, 2001). Self-care and health care: The patient also needs to look after his personal care so that he does not get any infections. As the patient may be at risk of aspiration, he should be taught to care for himself, especially looking after his health. He should be told about the various risks factors associated with aspiration and learn about the symptoms of aspiration. The patient should be able to detect these symptoms on his own and inform the nurse about it. This would help in reducing the risk of infection and subsequent diseases such as pneumonia. Further, the patient should be made self-dependent and should be able to conduct his own daily activities such as eating, dressing etc on his own without any assistance (Duncan et al, 2005). Emotional management: As depression may impair the recovery of the patient considerably, it is important to control the psychological disorder of the patient through various counseling sessions as well as medications (Hackett et al 2005). The patient should be monitored constantly to find out if the patient is suffering from any emotional upheaval, especially after being discharged from the hospital, as the patient would remain alone at home, which might aggravate his condition. Therefore, it is necessary to screen the patient on a regular basis to find out if the patient is displaying any signs of depression or not, and provide adequate treatment at the onset itself (Gillen et al, 2001). Reference: Albert, M.L. (1998). Treatment of aphasia. Archives of Neurology, 55, 1417-1419. Bower, P., & Gilbody, S. (2005). Managing common mental health disorders in primary care: Conceptual models and evidence base. British Medical Journal, 330, 839–842. Chapey, R. (2001). Language intervention strategies in aphasia and related neurogenic communication disorders (4th ed.). Philadelphia: Lippincott, Williams & Wilkins. Dobkin, B. (2005). Rehabilitation after stroke. N Engl J Med., 352, 1677-1684. Duncan, P.W., Zorowitz, R., Bates, B., Choi, J.Y., et al. (2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36, 100-143. Gilbody, S., Whitty, P., Grimshaw, J., & Thomas, R. (2003). 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