NURS 2024: Nursing Management - Horizons Hospital Health Service - Assessment Answer

Nursing Management Case Study Assignment

Background:

In order to plan and provide optimal patient-centered nursing care, Registered Nurses need to be able to interpret clinical information and draw upon their knowledge of pathophysiology and evidence-based clinical practice. Therefore, the purpose of this assessment is to support the development of the skills needed to evaluate evidence and to develop reflection and clinical reasoning skills.

Note: Woolworths Holdings Limited (JSE: WHL) is not Woolworths Limited (ASX Code: WOW).

Assignment Task

Case Report:

Based upon the Horizons Hospital & Health Service (HHHS) NURS 2024 Health of Older Adults clientMary Young, construct a case report. The case report will draw upon your knowledge of pathophysiology and relevant academic literature to support an evidence-based plan of care.

Headings and a description of the content for each section of the report have been provided. These serve as a guide for how you will present your case report; however, it is important that all sections of the report are conceptually connected. For example, your knowledge of pathophysiology and your understanding of this particular client should underpin the nursing problems that you identify which should, in turn, drive the nursing management that is relevant for this clinical situation.

The case report should include the following:

Introduction

Introduce the client and provide a brief overview of their case. Provide an outline of the purpose and structure of the report.

You might like to think about the overview of the case study like a verbal clinical handover: what is the key information from theHHHS patient information,progress summaryandmedication chartthat would be relevant for the plan of care for this client?

Primary admission diagnosis

Identify the primary diagnosis for the client (i.e. the reason the client was admitted to the HHHS). Provide a brief description of the pathophysiology for the primary diagnosis.

As part of this discussion, it is important to relate the pathophysiology to client's risk factors and relevant previous medical history.

Nursing problems

Use your knowledge of pathophysiologyand the subjective and objective data provided in the HHHS progress summary notesto identify five (5) nursing problems that may arise as a result of the client’s primary diagnosis. These problems may be actual or potential nursing problems. Provide a brief description for why these problems may arise for this client.

From these, select two (2) nursing problems as the focus for the remainder of the case report. Provide a rationale for your selection.

Nursing Management

The nursing management should focus on the nursing assessment, nursing interventions and the role of the Registered Nurse (RN) related to medication management for this client and will address the two (2) selected nursing problems.

Nursing Problem 1: Nursing assessment, nursing intervention, medication management.

Discuss one (1) method of nursing assessment that would need to be performed related to theongoing

nursing management of this nursing problem. Provide a rationale for this type of assessment and briefly

describe how this assessment would be conducted in this case.

Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursingmanagement of this nursing problem. Provide a rationale for the intervention.

Discuss the role of the RN in the medication management related to the ongoing nursing managementof this nursing problem.

Nursing Problem 2: Nursing assessment, nursing intervention,medication management.

Discuss one (1) method of nursing assessment that would need to be performed related to this nursing problem. Provide a rationale for this type of assessment and briefly describe how this assessment would be conducted inthis case.

Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing management of this nursing problem. Provide a rationale for the intervention.

Discuss the role of the RN in the medication management related to the ongoing nursing management of this nursing problem.

Discharge planning

Identify five (5) issues/challenges that you may need to address for this client prior to discharge home. Discuss how you would facilitate discharge planning for this client, with consideration to two (2) of these concerns?

Conclusion (100 words)

Summarise the major findings of this case report.

Introduction

Mary Young is a 71 years old patient. She is considered as the active member of community. She had been suffering from blurred vision, dizziness and continuous headache. She had also been facing problem in getting around easily as she could do earlier. She had been found lying on her bathroom floor as she had suffered a stroke. With the symptoms and her health history received from her family, she was confirmed to be suffering with thrombotic ischemic stroke. This was confirmed on computed tomography. She had been a very reserve lady and did not have regular check-ups as she didn’t want to disturb the busy doctors. This report aims to draw upon your knowledge of pathophysiology and with relevant academic literature to support an evidence-based plan of care for Mary Young. The purpose of this report is to develop the evidence based understanding and reasoning skills towards preparing the care plan for the patient.

Primary admission diagnosis

Mary young was facing health problems since many days. She was brought to the hospital, when she was found collapsed on her bathroom floor. She was transported to the hospital through a car and initially she was considered to have suffered a minor to major stroke, as suggested by the NIHSS tool. Mary was immediately sent to the emergency department with left side hemi-paresis, hypertension and aphesis. According to the health history obtained from the family members and symptoms the patient was showing, it was suspected that she had suffered ischemic stroke (Hickey, and Hock, 2003). Through computed tomography it was confirmed that she has suffered thrombotic ischemic stroke. Such stroke is caused due to the sudden loss in the circulation of the blood in brain. This situation results in loss of neurologic functions in ischemic stroke can be caused due to different diseases, but the most common cause is narrowing of head and neck arteries. This happens due to gradual deposition of cholesterol. In the case of Mary Young she had suffered from hypercholesterolemia, which could be the one major reason behind the stroke. Under this condition the cholesterol level increases in the blood stream and this got deposited in the arteries that block the normal blood flow (Summers, et al, 2009).

Nursing problems

During the intervention, nurses may have to face few problems. The problem requires many factors to be remembered during the diagnosis. The diagnosis of the problem requires the nurses to handle the patient immediately. The stroke is caused to the blockage of the brain arteries. The sufficient amount of blood could reach to brain and the patient become unconscious. During the primary diagnosis, it is very important to provide sufficient oxygen to the patient. The blocked arteries provide less oxygen to the brain and patient can die it not reported to emergency unit immediately. The nurses can also face the problem of specifying the stroke. It could be solved through immediate neurological examination like NIHSS and CT scan (Jørgensen, et al, 1997). The fluctuation in the blood pressure can occur in the patient due to cerebral dysfunction, thus if nurses fail to monitor the blood pressure regularly than patient may have severed issues. It is also very important to note the heart rate, rhythm and noting patter, and provide respiratory support as otherwise the patient may suffer from increased ICP. The changes in the vision should also be documented as they reflect different areas of brain; failing to do this may result in losing vision by the patient.

Nursing Management

The brain attacks are considered as the acute and dynamic process. The stroke may occur suddenly, but the ischemic tissue, which results in the stroke, evolves over a long period of time. The recent researches have shown that there are chances of saving the brain tissues. Such researches had led to development of new interventions and treatments. The problems that may occur during stroke intervention and management are:

1. Intensive observation (ICU) :

Frequent neurological assessment: LOC, motor and extremity function should be checked in every fifteen minutes. The continuous monitoring is required for two hours initially. Then there should be monitoring of the functions in every thirty minutes. Later it could be done in every 24 hours. Continue monitoring for additional 2 hours then every 30 minutes for 6 hours and then hourly until The NIH scale should be completed, vital signs should be monitored and automatic BP cuffs should be avoided (Fink, et al, 2002).

2. Blood pressure management

• The blood pressure should be maintained as less than 185/110mm Hg. In the case of Mary Young, Labetol 10-20 mg IVP could be given in every1-2 minutes of initial intervention. This dose could be doubled or repeated in every ten minutes (Albers, eta al, 1999).
• After following the first bolus of the Labetalol, an IV infusion of 2–8 mg/min can be given until the desired BP is not reached. Sodium nitroprusside, IV infusion can be used in the case where the satisfactory response is not achieved
• Nicardipine, 5 mg/hr IV infusion as initial dose, titrating to desired effect by increasing 2.5 mg/hr every 5 minutes to maximum dose of 15 mg/hr (Albers, eta al, 1999).

3. Fluid and Nutrition Management

The management of fluid is very important in the acute stage of the stroke. The cerebral edema could be worsening in case of less fluid. The patient should not be given anything until swallowing through mouth is allowed by the physician. The patient, who are showing problem with swallowing should not had anything through mouth till more in-depth evaluation. To maintain the normal hydration state for the patient the fluids could be normal saline (NS) or half-normal saline (0.45 NS) (American Association of Neuroscience Nurses, 2004). It is the duty of the nurse to monitor the patient for the clinical signs of dysphagia. The patients, who are at higher risk of may display the signs of large hemispheric lesions, infarctions in the brain stem, multiple strokes, and also decreased LOC. The clinical signs of Dysphagia show chocking of food and coughing (American Association of Neuroscience Nurses, 2004). The more through swallow test should be perform on the patient to evaluate the signs related to pocketing of food and aspirations. In the case of Mary, such information is not available, thus nurse should monitor her condition to find if any such sings appear.

4. Depression Management:

Depression is the most common sign, which is seen in the victims of stoke. Depression is not the result of patient’s sadness towards his or her condition, or due to losing earlier lifestyle. But, depression is the result of physical and chemical changes inside the brain. “Studies have shown that patients with left frontal infarcts are 70% more likely to get depressed than those individuals experiencing similar devastating injuries” (Ross & Rush, 1981). In the case of Mary she had left sided hemiparesis, thus she could be affected by depression. Nurse is in the best position to notice the signs of depression in patients. For Mary, if such signs are seen than she could be given antidepressant with the concern of the physician. The depression could also occur due to hospitalization, in such case Mary’s family and patient herself could be educated about signs and symptoms of depression (Daley, et al, 1997).

Discharge Planning

Discharge planning should be properly documented in the discharge documents. The discharge documents could be the hard copy or the soft copy with the patient details (Ayana, et al,1998). The discharge document should legibly and accurately state the following information:

• Dignosis of Mary Young
• Investigations conducted and their results
• Duration of the treatment and prescribed medication by the physician (Shepperd, et al, 2013).
• Level of ability, recovery and achievements during the treatment.
• Proper team care plan
• The requirement of further investigation with dates, which are required at primary level.
• The dates of the further investigations, which are required to be done in hospital (Shepperd, et al, 2013).
• Details of the dates for hospital attendance, when Mary had to come and meet the doctor.
• Details about the transportation arrangements.
• Name of Hospital, telephone number of hospital, name of ward where the patient was admitted and number of ward.
• Name of the physician and nurse
• Proper date of admission in hospital and date of discharge.

Such information should be included in the discharge pan as it allows the officials, patient & his family, primary care team and care agencies to see that what kind of care plan is given and should be given to the patient. The confidentiality of the patient’s record is the most important aspect of care plan.

Conclusion

Mary Young have been very active women. But, her problem with cholesterol had resulted in the narrowing of the arteries. The care plan found many situations, where nurses can face problem in intervention and care management. Such patient requires effective stroke care. The stroke patient should be given the adaptive recovery planning. The stroke unit should have the nurses, who have special training and skills in dealing with stroke patients. The case of Mary Young suggests, that she requires proper monitoring of blood flow, respiratory system. Mary had normal and independent lifestyle, which can be affected due to stroke. Thus, she should be prepared and educated about the problem and should be given proper support from family and care givers.