Patient’s Condition

Describe about the “Treatment Plan of Nursing Care”. 

1. Singh has been suffering from certain health issues like- cerebrovascular accidents, right-sided hemiplegia, right sided dysphagia and right sided dysphasia.Cerebrovascular diseases are the sudden death of brain cells when they face deficit of oxygen and the blood flowing to the brain is impaired by blockage or rupturing of any artery to the brain. Cerebrovascular accidents are often referred to as the stroke (Bobath., 2009). The symptoms of this disease include weak face muscles, speech problems, weakness and paralysis of one side of the body which may lead to complete loss of movement.

The right hemiplegia is described as paralysis of a right side of the body. This disease is caused as after effect of the cerebrovascular disease. The principal diagnosis of this disease is the cerebrovascular disease with the infraction (Wagner-Sonntag & Prosiegel., 2014). Hemiplegia is always opposite of the brain cells as the nerve fibers cross over on the opposite side in the medulla oblongata. This helps in connecting the spinal cord to the brain.

Dysphagia is referred as difficulty in swallowing any liquid material or any solid material. Liquid matters, including saliva seem very hard to swallow. Dysphasia is difficulty with language or speech disorders. This is the condition when the patient loses the ability to express thoughts by speaking, writing (Vaclavik et al., 2015). There are two kinds of dysphasia which may be receptive or expressive. In simple words, it can be defined as difficulty in comprehension and difficulty in saying.

2. (a) The three modified food textures that are recommended for the patient are-

B = thin puree dysphagia diet

C = thick puree dysphagia diet

D = pre- mashed dysphagia diet

E =fork mashable dysphagia diet 

As the patient has been suffering from dysphagia, she is advised by the doctors to have texture modified foods. It is recommended as she has been facing difficulty in swallowing even liquid foods and thus she is advised to have soft foods (Gulanick & Myers., 2013). She may also face difficulty in aspiration of foods into the lungs. This kind of foods is generally prescribed by the speech and language therapist to help the patient in overcoming the problems of eating.

(b) The strategies that can be adopted for the patient to help her in assisting food are-

• Giving the patient foods in a slow manner so that she can eat every bite of food and chew it properly (Stemple & Hapner., 2014)
• Allowing her to chew and sip each bite for 5 10 seconds
• Checking the patient for pouching. As she has been suffering from hemiplagia, her head should be tilted slightly for avoiding pouching.
• The patient should be kept upright all the time during and before eating.
• Enteral tube feeding can be equally helpful for patients who are unable to meet their nutritional needs orally (Namdari et al., 2012).
• Appropriate bed positioning and spoon feeding laying her at 60- 90 degree upright and putting the pillow on her back makes her relax and will help in assisting her with food.

3.(a) The factors which the nurse needs to keep in mind before moving the patient are-

• The nurse should check her vital signs like respiratory reserves, medical conditions
• She should check that her blood pressure remains normal before and after mobilization (Shinde & Anjum., 2014)
• She should also focus upon the patient’s usual level of mobility and fitness(Kegelmeyer et al., 2014)
• Not causing too many vigorous movements and disturbances as this may be troublesome the patient
• The patient should be prior informed and relaxed before moving

Modified Food Textures

3(b) As the patient has been suffering from dysphagia so, the risks of falling while mobilizing and risks of developing more pain increases. The patient is an old woman, so she should be handled very carefully as risks of falling increases for her.  

4. Steps involved in changing colostomy bag are-

• Placing all the necessary equipment nearby hands
• Washing hands with water or antibacterial hand cleanser
• Removing the pouch easily by supporting the skin with one hand, adhesive remover can be used
• Emptying the used pouch by cutting at the bottom of the pouch bag. Rinsing the pouch under water and keeping the wastes into plastic disposal bags. Wrapping it in the newspaper bags and placing it in ordinary plastic bags (Kawai et al., 2016).
• The used pouch can be directly put into the disposal bag if not emptied. After all these processes are done, the disposal bags are to be dumped into the domestic refusal bag.  

5. Nurses who are available all the time and with members of the multidisciplinary team can be able to undertake initial isolation and develop interventions and outcomes. The nurse can identify the most adverse outcomes that can arise due to the dysphagia. She can also help in reducing all the errors developed due to dysphagia and dysphasia (Burns et al., 2016). Nurses can also help the patient by providing knowledge to her family members regarding the problems and causes of the diseases. Educating family members about the patient management and telling them about the treatment for dysphagia can help her. Nurses play very vital role in patient care and help her in facing the swallowing difficulties and assist in her movements. The nurses ensure that the patient gets all the necessary devices needed to care at home. Nurses work with multidisciplinary team members and ensure that the patient is directly linked with the doctors. They form direct link between in- patient and out- patient care.

6. Nurses value the diversity of people and nurses value a culture of safety in nursing and health care. These are the statements that best fits to the patient from the ‘Code of Professional Conduct for Nurses in Australia (Bos et al., 2016)’.

7. (a) Extrinsic and intrinsic factors are present that helps in the formation of pressure areas. The intrinsic areas are- the disposing factors like limited movement, lack of proper diet, aging of the skin (Bos et al., 2016). The extrinsic factors are- pressure, stress, friction, moisture, and shear. The position of the patient determines the pressure applied to the joints which may cause pressure in ulcers.

7.(b) Decubitus ulcers are also called as pressure ulcers. These are local injuries or harms to the skin, which occur in the tissue, which usually occurs over a bony prominence and evolves due to the pressure in combination with shear or friction (Bos et al., 2016). The common sites are- skin of sacrum, coccyx, heels, hips and elbows, knee skin.

7.(c) The strategies adopted for preventing the patient from this pressure problem are- timely risk assessment to identify the risk factors involved, not moving the patient too much as this may cause more pressure, not moving her elbows and knees as this may cause more pain. Pressure injury sites should be determined and taken into focus by the nurses and multidisciplinary team members(Bos et al., 2016) . As the patient is now suffering from decubitus ulcer, she should not be lifted suddenly and should be provided with the cushion at her back as this may help her in reducing pain while movements. She should be given wheelchair for more assistance and should not be placed from one place to another several times as this will increase pain. Healing can be done by applying dressings on moist wounds, cleaning her open sores with saline solutions and removing of damaged tissues by surgical debridement. Pain can be managed by giving proper antibiotics and healthy nutritional diet.(Singh et al., 2015).

Strategies for the Patient

7.(d) The risk assessment involved in the case scenario are- the Norton scale, the Braden scale and the Water low scale. The Norton scale was found to be the best as it gives complete analysis of patient’s physical, mental conditions along with mobility and activities(Bos et al., 2016).

8.(a) The patients’ poor sleep is due to certain factors like-

• Mobility problems due to pain in the broken bone and brain damage
• Poor nutrition due to difficulty in eating, difficulty in engulfing fluids in the body
• Declining health conditions due to problems in pressure areas in skin, knees and elbows.
• Mental health conditions are deteriorating due to the several problems faced by the patient. Difficulty in sleeping can also be because of paralysis of her right side.

8.(b) Nurses need to advise patients to avoid frequent movements as this can cause pain. The patient is suffering from pressure ulcers so, is advised to take complete rest and avoid mobility (Bos et al., 2016). The patient should be advised not to move out of the bed and should avoid standing and moving her hands and elbows. Giving the patient appropriate antibiotics and rest and assistance can help in promoting sleeping.

9. An advance health care directive is also referred to as living will or personal directive. It is in the form of legal documents that contains the necessary actions adopted for the betterment of a person’s health when they are not in a condition to improve their health conditions as they are ill.

10. The patient can be told to do the actions which they want to take. The patient is advised by the speech therapist to be in resting position and is advised not to move without the help of any family member. Advising her to follow the instructions as given by the speech therapist and doctors (Burns et al., 2016). By carefully understanding the patient’s needs and feelings we can provide respect to her feelings and decisions. 

References

Bobath, B. (2009). Adult hemiplegia: evaluation and treatment. Elsevier Health Sciences.

Bos, B. S., Wangen, T. M., Elbing Jr, C. E., Rowekamp, D. J., Kruggel, H. A., Conlon, P. M., … & Grubbs, P. L. (2016). Pressure Ulcer Prevention: Where Practice and Education Meet. Journal for Nurses in Professional Development, 32(2), 94-98

Burns, M. I., Baylor, C. R., & Yorkston, K. M. (2016). Words of Preparation for PatientsThrough a series of simple steps, we can help clients with communication disorders plan ahead to get what they need from medical visits—despite their challenges. The ASHA Leader, 21(3), 52-56.

Crisp, J., Taylor, C., Douglas, C., & Rebeiro, G. (Eds.)(2013). Potter & Perry’s fundamentals of nursing (4th ed.). Sydney, Australia: Elsevier .
Tollefson, J, Bishop, T, Jelly, E, Watson, G, Tambree, K, (2012) Essential Clinical Skills Enrolled/Division 2 Nurses. (2nd ed.) Melbourne, Australia: Cengage

Gulanick, M., & Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Kawai, K., Yoshizawa, K., Fujie, M., Kobayashi, H., Ogawa, Y., & Yajima, T. (2016). Use of Fentanyl Patch for Treatment of Moderateâ€Âtoâ€Âsevere Chronic Noncancer Pain: Postmarketing Surveillance of Medical Practice in Japan Using a Risk Minimization Action Plan. Pain Practice.

Kegelmeyer, D. A., Kloos, A. D., & Siles, A. B. (2014). Selecting measures for balance and mobility to improve assessment and treatment of individuals after stroke. Topics in stroke rehabilitation, 21(4), 303-315.

Namdari, S., Horneff, J. G., Baldwin, K., & Keenan, M. A. (2012). Muscle releases to improve passive motion and relieve pain in patients with spastic hemiplegia and elbow flexion contractures. Journal of Shoulder and Elbow Surgery, 21(10), 1357-1362.

Shinde, M., & Anjum, S. (2014). Effectiveness of Demonstration Regarding Feeding of Hemiplegia Patient among Caregivers. International Journal of Science and Research (IJSR), 3(3), 19-27.

Singh, S., Booth, A., Choto, F., Gotlieb, J., Robertson, R., Morris, G., … & Mauff, K. (2015). New graduates’ perceptions of preparedness to provide speech-language therapy services in general and dysphagia services in particular. South African Journal of Communication Disorders, 62(1), 8-pages.

Stemple, J. C., & Hapner, E. R. (2014). Voice Therapy: Clinical Case Studies. Plural Publishing.

Vaclavik, D., Solna, G., Lasotova, N., Lebedova, Z., Hofmanova, J., Baborova, E., … & Neubauer, K. (2015). Care of patients with dysphagia after stroke Standard treatment plan. CESKA A SLOVENSKA NEUROLOGIE A NEUROCHIRURGIE, 78(6), 721-727.

Wagner-Sonntag, E., & Prosiegel, M. (2014). Control of symptoms: dysphagia. Palliative Care in Amyotrophic Lateral Sclerosis: From Diagnosis to Bereavement, 91.