Case Study: Plan Of Care For Harold Graeme Blake

You are required to develop a comprehensive plan of care using the provided rubric for an adult using ‘Harold Blake’ from Case details who has a history of a left cerebral vascular accident and angina. He is admitted to hospital with an episode of angina and has another cerebral vascular accident. His plan of care will commence on day two on the ward. 

Consequences of CVA

The case study is about the 83 years old patient Harold Graeme Blake, who has a past medical history of left cerebral vascular attack or CVA and Angina and is admitted in the hospital with an episode of Angina and another cerebral vascular attack. He got the attack while he was waiting for taxi on his way to hospital for outpatient appointment and thus, he is admitted in the emergency department. The purpose of the paper is to provide a plan care for the patient based on second day observation. The following paper will discuss briefly about the consequence of CVA regarding deficient knowledge, impaired verbal communication, impaired skin integrity, self-care deficit, impaired mobility and risk of injury. The paper will discuss about the effective intervention, short-term and long-term goal in order to provide better care service to the patient.  The assignment will provide an idea about the ethical and legal consideration and inter professional collaboration regarding the care, which could help Harold to get rid of the illness in an effective manner.

Plan of care or care plan is defined as the outline of nursing process that includes all central requirements of the patient and effective strategies for meeting them. It is a process of documentation during the time of admission of the patient and remains in the state of continuous change by the caring staff of the patient according to the diagnosis, possible intervention and expected outcomes in order to ensure the consistency of the care service. It helps the nursing staffs to communicate and organize the process of care in order to provide fruitful outcomes (Alligood 2013). 

Impaired Verbal Communication

Impaired verbal communication is one of the major problems that causes due to CVA. CVA interferes in the process of cerebral circulation, which results in neuromuscular damage (De-Marchis et al. 2014). The consequence of the incident includes general fatigue, limited movement of the muscle and oral weakness, thus, the patient could suffer from improper verbalization (Mazaux et al. 2013). It is important to include the communication issues of Harold in the care plan in order to understand the level of difficulties. The effective intervention should contain comfortable communication process. The nurses need to understand the needs of the patient and observe the non-verbal cues of the patient. Nurses should maintain unhurried manner and calm process during communicating with the patient (Gregory and Bryan 2015). Destructive objects such as television, radio or phone need to be kept away during the time of conversation. It is important to provide ample time to the patient to respond so that he feels comfortable; otherwise, it could act as a trigger to Angina. The short-time goal regarding this is to help Harold to understand words and long-term goal is to improve his communication skill. Further, the patient could refer to a speech therapist that can communicate and understand the problem in an effective manner and provide proper therapies to counter the issue.

Effective Interventions

Self Care Deficit

Self-care deficit is the secondary consequence of CVA (Clark et al. 2014). It is mainly caused due to the destruction of motor neuron (De-Marchis et al. 2014). As a result, the patient face difficulties in activities of daily living or ADLs, for example, the patient faces problem related to eating, dressing, bathing and other regular activities. Thus, the plan of care should include proper care process in order to address the problem of self-care deficit (Clark et al. 2014). The interventions should include providing adequate resources to make the patient self-independence. Proper observation is needed in order to understand the weakness of the patient (Harkness et al. 2014). The nurses should allocate some task to Harold, like dressing, walking, writing and feed himself. It will help to build self-confidence. It is important to provide proper environment to carry out such tasks. The nurses should keep patience and provide enough time to the patient to complete the tasks. The short-term goal related to Harold is inspire him to do his own work and long-term goal is to make him self-dependent. For fast recovery, the patient could refer to a physiotherapist that could provide proper therapies in order to resolve the issue.

Risk for Impaired Skin Integrity

According to the case study, Harold is unable to move his right and left arm. There is moderate weakness in his legs as well. Thus, he is resting in the bed. Such situation could increase the friction and pressure that can affect blood circulation and cause skin break down. The consequence leads to the risk of skin impairment that is mainly related to hemiparesis or hemiplegia (Paganin and Rabelo 2013). Thus, daily observation of the impaired tissue integrity should be an important part of the care plan. The intervention should include providing proper risk assessment tools in order to assess the risk factors related to immobility. Nurses should inform the patient about benefits of using pillow. It is important to turn and position the patient in every two hours in order to reduce the pressure. Rubbing or scratching the impaired portion could lead to serious issue, thus, glove or other covers should be provided to the patient if needed (Holmes et al. 2014). The short-term goal regarding this is to reduce the pressure and long-term goal is to reduce the risk factors of immobility. Such intervention could improve the blood circulation and reduce the risk of impaired skin integrity. 

Ethical and Legal Considerations

Risk for Injury

In case of CVA, there is high risk of injury as the illness affects the anterior or the middle cerebral artery. It increases the risk of injury due to fall as many body parts of the patient is not functioning well. Among the risk of injury, hip fracture is one of the most common issues that could lead to severe disability (Ambrose, Paul and Hausdorff 2013). Thus, the care plan should contain the process of managing such risk of injury. The intervention should include keeping the side rails of the patient’s bed raised in order to protect the patient from falling out of bed. In order to reduce the pain related to the injury, proper pain assessment need to be provided.  The short-term goal of the intervention is to reduce the risk of falls and long-term goal is to reduce the risk of getting serious injury that could lead to serious disability. If the intervention fails to give expected outcomes, the patient could send to other physicians for proper treatment related to serious injury.

Impaired Physical Mobility

As mentioned before, CVA affects the cerebral circulation and cause neuromuscular damage. The motor neuron is the most affected area due to CVA, thus, the receptors in the nerve fail to detect and transmit the signals (De-Marchis et al. 2014). Such incident could lead to permanent or temporary restriction to the muscle movement. As mentioned in the case study, the right arm and the right leg of Harold is affected due to CVA and he is facing difficulties in moving, thus resting in the bed and nurses assists him to do regular activities. In order to resolve the issue the care plan should include proper exercise. The exercise should include knee bend, abdominal tightening exercise, stand on toes and moving hand around, which will be easy to done by the patient. Mobility device such as,, trapeze and walker should be provided to the patient (Sricharoenchai et al. 2014). The short-term goal regarding this is to encourage the movement of restricted body parts and long-term goal is to improve the muscle strength and the mobility of the patient. Further, the patient could refer to physiotherapist that can help to increase the mobility through proper therapies. 

Deficient Knowledge

Due to lack of knowledge, most of the patient faces difficulties in understanding the process of treatment. This is mainly due to lack of proper information and less access to available resources. In order to counter the issue, the nurses should provide enough information to the patient and his family, so that they could understand the treatment process. The nurses should assess proper source of information that could help the patient to learn the impact of the disease and the importance of treatment (Yeh and Park 2015). The short-term goal of providing knowledge is to create awareness about the illness and the long-term goal is to make the patient understand the treatment process so that he could contribute in the treatment in order to recover fast.

Interprofessional Collaboration

There are some legal and ethical factors that need to be considered by the nurses while providing care to the patients. One of such important legal factor is informed consent. The informed consent is refer to the process of obtaining valid consent during admission, treatment or surgery of the patient. The nurses are bound to inform consent in order to respect the decision of the patient or their families (Williams and Howe 2013). In case of Harold, he is adult, thus able to provide valid consent. However, he is unconscious due to his illness. In this case, his wife Gloria has the right to provide valid consent. Another legal fact is the confidentiality of the information regarding the treatment of the patient. According to the code of law, all nurses are bound to keep confidential the information about the patient and his treatment (Williams and Howe 2013). Nurses should remember such important factors while providing care to Harold.

The Australian Primary Health Care Nurses Association has provided some code of ethics regarding nursing that need to be considered by the nurses while providing treatment. According to the code, the nurses are bound to provide quality nursing to all. The nurses must respect and value the diversity and decision making power of the patient. They should provide the best treatment process to the patient according to their illness. They need to build reliable relationship with the patient so that the patient could tryst them for their treatment (Kangasniemi, Pakkanen and Korhonen 2015). Thus, the nurses that are providing treatment to Harold need to consider such factors while handling the case. 

Inter professional collaboration is a strategy of health care in order to improve the patient outcomes. It helps to build relationship within different health specialists. The effort of the team leads to desired outcome for the patient (Reeves et al. 2013). In case of Harold, role of medical officer is important, as he is the apex body that could introduce the effective intervention regarding the treatment. In addition, help of a speech therapist is recommended in order to address the issue of improper verbalization. To improve his mobility, he further refers to a physiotherapist. Care provided by such experts will help Harold to recover soon.       

Conclusion

From the above case study, it can be concluded that, the consequences of CVA could lead to other serious health issues, as the illness cause neuromuscular damage and affect the motor neuron. There is a risk of impaired verbal communication, physical mobility, skin integrity and injury. The patient is also susceptible to self-care deficit. Due to lack of proper information patient might face difficulties in understanding the treatment process. Thus, proper interventions are need to be introduced in order to provide effective service.  If the interventions are not satisfactory then the patient might refer to health specialists according to the need. It is expected that, with the help of such interventions and referrals, desired outcomes will be achieved. 

References:

Alligood, M.R., 2013. Nursing Theory-E-Book: Utilization & Application. Elsevier Health Sciences.

Ambrose, A.F., Paul, G. and Hausdorff, J.M., 2013. Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), pp.51-61.

Clark, A.M., Spaling, M., Harkness, K., Spiers, J., Strachan, P.H., Thompson, D.R. and Currie, K., 2014. Determinants of effective heart failure self-care: a systematic review of patients’ and caregivers’ perceptions. Heart, 100(9), pp.716-721.

De-Marchis, G.M., Weck, A., Audebert, H., Benik, S., Foerch, C., Buhl, D., Schuetz, P., Jung, S., Seiler, M., Morgenthaler, N.G. and Mattle, H.P., 2014. Copeptin for the prediction of recurrent cerebrovascular events after transient ischemic attack: results from the CoRisk study. Stroke, 45(10), pp.2918-2923.

Gregory, J. and Bryan, K., 2015. Speech and language therapy intervention with a group of persistent and prolific young offenders in a non-custodial setting with previously undiagnosed speech, language and communication difficulties. International Journal of Language & Communication Disorders, pp.1-14.

Harkness, K., Heckman, G.A., Akhtar-Danesh, N., Demers, C., Gunn, E. and McKelvie, R.S., 2014. Cognitive function and self-care management in older patients with heart failure. European Journal of Cardiovascular Nursing, 13(3), pp.277-284.

Holmes, R.F., Davidson, M.W., Thompson, B.J. and Kelechi, T.J., 2013. Skin tears: care and management of the older adult at home. Home Healthcare Now, 31(2), pp.90-101.

Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.

Mazaux, J.M., Lagadec, T., Panchoa De Sèze, M., Zongo, D., Asselineau, J., Douce, E., Trias, J., Delair, M.F. and Darrigrand, B., 2013. Communication activity in stroke patients with aphasia. Journal of rehabilitation medicine, 45(4), pp.341-346.

Paganin, A. and Rabelo, E.R., 2013. Clinical validation of the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac catheterization. Journal of advanced nursing, 69(6), pp.1338-1345.

Reeves, S., Perrier, L., Goldman, J., Freeth, D. and Zwarenstein, M., 2013. Interprofessional education: effects on professional practice and healthcare outcomes (update). The Cochrane Library.

Sricharoenchai, T., Parker, A.M., Zanni, J.M., Nelliot, A., Dinglas, V.D. and Needham, D.M., 2014. Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation of 1110 intensive care unit admissions. Journal of critical care, 29(3), pp.395-400.

Williams, S.P. and Howe, C.L., 2013. Advance directives in the perioperative setting: managing ethical and legal issues when patient rights and perceived obligations of the healthcare provider conflict. Journal of Healthcare Risk Management, 32(4), pp.35-42.

Yeh, D.D. and Park, Y.S., 2015. Improving learning efficiency of factual knowledge in medical education. Journal of surgical education, 72(5), pp.882-889.