Comprehensive Nursing Care Plan For Stroke Patients – Case Study Of Mr. Lim

Assessment of the Patient

Discuss about the Case Study of Lim Care plan.

Care plan provides directives for individualised care of the client. A care plan usually flows from the list of the patient’s diagnoses are usually organised as per the needs of the patient. It is the means of communicating among the nurses in a changing environment. An updated care plan transfer during the change in shift of the nurses are helps in reducing the medical errors. It is the care plan that helps in teaching documentation (Party, 2012).

The case study of Mr. Lim provides us with the fact that he had suffered from a sudden stroke, which called for an admission in to the emergency department. It has to be remembered after the stroke patient can have difficulty in the memory, understanding, attention, gait problem and decision making. It also affects the functional status of the patient. It is evident that Mr. Lim had suffered from a partial paralysis of the left side of his body. In order to restore the functional status of Mr. Lim it is necessary to chalk out a comprehensive nursing plan that would include proper neurological assessment, monitoring of the vital signs, pharmacological interventions, fall preventions strategies,   maintenance of gait, promotion of self-care, educating families.

The initial step to manage a patient who has just suffered from stroke is the proper assessment technique. The initially we assessed the facial dropping of the patient, followed by his slurry speech. It is evident that the patient was elderly, and the care for an elderly patient requires more attention in comparison to the young patients. While providing care to the patient, it was necessary to understand the pathophysiology of the clinical condition. It is known that oxidative stress is the major factor in the damage caused by the stroke. This oxidative damage is again more prone to the elderly people, establishing a link between stroke and ageing.

After the assessment of the patient it is necessary to identify the needs of the patient.  The goal of the nurse, caring for the client us to achieve a status of perceived optimum health and contentment (Grol et al., 2013). The nursing assessment requires to provide with nurses the necessary information for diagnosing the status of each of the areas. The goals of the assessment is to establish trust in the nurse client relationship.

The component of the senses framework that can be applicable in this case is the sense of continuity and the sense of security. Considering the sense of continuity we made sure that Mr. Lim experience a positive environment within the hospital stay and such that the expectations of care are conveyed consistently and carefully. It can be identified that Mr. Lim might face problems with mobility and impaired speech, hence the patient might expect a supportive environment in the clinical setting (Lindsay et al., 2013). Nurses are positioned to serve as the patient advocates and interdisciplinary leaders in the holistic recovery of stroke in patients. A holistic wellness involved the readiness of a person to change and be patient centred.  Being a nurse we looked after the social, emotional, spiritual, occupational, financial, intellectual, and physical and the environmental needs of the patient. The approaches taken by us involved practicing self-awareness, addressing the negativity, practicing gratitude and mindfulness (Lindsay et al., 2013). While addressing the physical needs we identified pain, loss of mobility and incontinence in the patient. Introduction of relaxation and breathing exercises, diet education, education regarding the medicines, gait exercises, speech therapy, prayer, mindfulness ad meditation therapy has been beneficial for this patient (Party, 2012).

Identifying Needs of the Patient

Patient Name	Mr Lim TK	DOB  2/5/1948
Baseline recordings	BP : 169/75mmHg	HR : 90bpm
	Temperature : 37.5’c	RR : 24bpm
Mr Lim is a 70 years old, Chinese Male Retiree, used to work as a chef. Staying with Spouse 65years old, have a son who stays aboard. Mr Lim has sudden onset of slurring of speech, facial droop over left side, weakness over both left upper and lower limb while having breakfast with wife. Called ambulance immediately. Past Medical History of 1. Hypertension, Diagnosed 5 years ago 2. Type 2 Diabetic Mellitus, Diagnosed 3 years ago, On PO Glipizide BD. The patient ranked 19 with the NH scale for the assessment of stroke. CT scan reports showed hypersensitivity in the M1 segment of the Right Middle cerebral artery with no other signs of ischemic stroke. The MRI scan reported a demonstrated an ischemic change confined to the right middle cerebral artery.

Need	Goal	Nursing Intervention
1.  Engage family member to participate in patient’s care	Short Term Long Term	a) Physiotherapy and Occupational therapy management b) Care Giver training on patient’s latest mobility and functional status. c) Engage a long term caregiver d) Look into mobility aids that suits patient’s need for long term (Jauch et al., 2013)
2. Management of pain	Short term Long term	a)      Correct dosages of pain medication should be given in order to alleviate the pain. b)      Long term pain management involves complementary therapies, physiotherapies, exercises, cognitive behavioral therapy to deal with stress and depression (Grol et al., 2013).
3. Improve the  impaired physical mobility	Short term Long term	a)      Maintenance of optimal position for functional hip extension, less tissue injury, use slings (Saunders et al., 2013). b)      To be under the surveillance of a long term physiotherapist even after the discharge.
4. Restoration of the impaired verbal communication	Short term Long term	a)      Assessing the extent of the dysfunction.  b)      To ask the patient to produce simple words. c)      Provision of bells or alarms that would be activated by minimal pressure. d)      Use alternative methods of communication such as pictures, writings. e)       To consult a speech therapist, who would assess the verbal capacities of the individuals and would help the patient in restoring the speech.
5.  Emotional Support to both patient and family	Short Term Long Term	a) Educate patient and family about the treatment options and consequences of the illness b) Provide education regarding the home environment modifications suitable for a stroke patient. c) Provide education regarding the adherence to medication. b)Provide education on stroke patient care (Fearon & Langhorne, 2012) c)Education on prevention of recurrent stroke
6. Discharge Planning	Short Term Long Term	a) To community nursing home for physiotherapy and occupational therapy course B) Care Coordination to home service

It is evident from the case study that Mr. Lim had suffered from a stroke, for which he was suffering from restricted mobility, gait disturbances and impaired speech. Stroke rehabilitation does not necessarily mean, addressing the physical needs of the patient but also the psychological and the spiritual wellbeing of the patient. The nursing management of the stroke patients involve improvement of the cerebral tissue perfusion, improving the physical mobility, improving the sensory perception of the patient, improving the coping strategies in the patient, fostering the concept of self-care in patient and the family, lessening the risk for impaired swallowing, addressing the deficient knowledge in the patient and the family (Grol et al., 2013). In order to establish a successful care plan it is understand the health behaviours of a patient. The health belief model can be used to design the both long term and short term interventions for the patients.  The

Conclusion

In conclusion it can be said that, Mr Lim requires a comprehensive care that included physical, mental and spiritual care. Analysis of the senses framework has helped in understanding the needs of the patient. The needs that has been identified by the nurses were management of pain, maintaining the gait, restoration of speech, proper nutritional assessment, and ability to return to the normal pace of life. In order to follow a holistic care approach it is necessary to maintain the dignity and the integrity of the patient. The care should be such that the patient feels free from physical threat and feels valued. Furthermore the making of a proper discharge plan would help the patient to cope up with the aftermath of the disease.

References

Fearon, P., & Langhorne, P. (2012). Services for reducing duration of hospital care for acute stroke patients. Cochrane database of systematic reviews, 2012(9), 1-97. doi:10.1002/14651858.CD000443.pub3)

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons. https://books.google.co.in/books?hl=en&lr=&id=oEEzUjFbDM8C&oi=fnd&pg=PT9&dq=care+plan+for+patient+with+stroke&ots=6YcmOgjDTM&sig=cq287h-ojC5SjgILdukHS89bhtY#v=onepage&q=care%20plan%20for%20patient%20with%20stroke&f=false

Jauch, E. C., Saver, J. L., Adams Jr, H. P., Demaerschalk, B. M., McMullan Jr, P. W., Qureshi, A. I., … & Wang, D. Z. (2013). Guidelines for the early management of patients with acute ischemic stroke. Stroke. doi/10.1161/STR.0b013e318284056a

Lindsay, P., Furie, K. L., Davis, S. M., Donnan, G. A., & Norrving, B. (2014). World Stroke Organization global stroke services guidelines and action plan. International Journal of Stroke, 9, 4-13. https://doi.org/10.1111/ijs.12371

Party, I. S. W. (2012). National clinical guideline for stroke. https://bsnr.org.uk/wp-content/uploads/2014/05/national-clinical-guidelines-for-stroke-fourth-edition.pdf

Saunders, D. H., Sanderson, M., Brazzelli, M., Greig, C. A., & Mead, G. E. (2013). Physical fitness training for stroke patients. Cochrane Database Syst Rev, 10(9), 2235.

Trialists’Collaboration, S. U. (2013). Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev, 9(9).