Neurology Patient Scenario Nursing Essay Answers

Scenario 1 The Neurological Patient

June Osakwe is a 79-year-old woman. She has been admitted following a left hemispheric ischaemic stroke. June underwent thrombolysis with alteplase and has spent 24 hours in the acute stroke unit and has now been transferred to the stroke ward.

On assessment, June has moderate expressive and receptive aphasia. She has a right hemiplegia and moderate dysphagia. She has been incontinent of urine on five occasions since admission. Her vital signs are all stable. June lives with her husband Greg who is 86. They have two adult children but they live in the USA.

Suggested problems(for guidance only, you may choose to discuss other issues)

• Nutritional support
• Management of Dysphagia
• Communication
• Immobility
• Incontinence

PT SCENARIO GUIDELINE- Write an essay in the third person

Harvard reference style- 15 or more

INTRODUCTION

• OUTLINE THE SCENARIO YOU HAVE CHOSEN BRIEFLY, WHY THE PATIENT IS ADMITTED IN THE HOSPITAL, and what you will be discussing in the essay.
• PUT ABOUT NMC CONFIDENTIALITY i.e CONFIDENTIALITY HAS BEEN MAINTAINED
• Also, include that for the essay, you have chosen to discuss two of the patient problems i.e. management of dysphagia and nutritional support. State the reason for choosing to discuss the management of dysphagia and nutrition support

PARAGRAPH

Note- relate all discussions with acute care

What is ABCDE ASSESSMENT?

• DEMONSTRATE THE A TO E ASSESSMENT AROUND THE SCENARIO (AIR, B- BREATHING, C- CIRCULATION, D- DISABILITY, AND E- EXPOSURE

Briefly discuss what each stands e.g. A stands for airway……. and relate it to the essay and state what needs to be done as a nurse. I included an example below, do more research and add more…

YOU CAN USE THIS INFORMATION below AS PART OF YOUR DISCUSION BUT IT WILL NEED TO BE REWRITING PROPERLY AND ADD MORE INFORMATIONS.

 for example,

ABCDE are initial assessment used to prevent deterioration and rule out critical conditions (Mayo, 2017).

Airway- In the scenario, the patient's airway is opened and maintained. When engaging in conversation to observe any obstruction or noisy sounds (Smith and Bowden, 2017)

Breathing-

 The normal respiratory rate is 12 to 20 breaths per minute and the patient's respiratory rate is 14bpm which is normal. It is important to check the depth, pattern, and depth In assessing a patient it is important to look, listen, and feel. (Farrington, 2018) . To look out for the use of accessory muscles, any sign of respiratory distress and unable to finish a sentence. Movement of the chest should be symmetrical and normal breathing should be quiet, and effortless pneumothorax by looked out for any sign of chest pain, shortness of breath, and rapid heart rate (Peate and Dutton, 2013). Patient saturation is normal Spo2 >95% on room air and should be regularly monitored to prevent desaturation to rule out hypoxemia which is caused by lack of oxygen in the blood (Farrington, 2018).

 Circulation-

 Mrs X's heart rate is 86 within the range of 60 – 80 normal range. During assessment patient's pulse is palpitated to know if it is weak or strong, ready or regular (Peate and Dutton, 2013). Their blood pressure was higher than normal 190/88. At this stage, the nurse should check to make sure if Mrs. X has had any anti-hypertensive medication recently, and if not might need to give her medication to regulate blood pressure which might need to be given through IV if the patient cannot swallow (Peate and Dutton, 2013)

Disability

is assessing the patient's level of consciousness by using AVPU. They are used to check if the patient is Alert, response to verbal, response to pain and unresponsive and if there is reduced in the level of consciousness Glasgow Scale Coma is used to assess the patient further. In the scenario, patient GSC shows that E4- eye-opening is spontaneous, M5- best motor response is in localized pain and V3- best verbal response is inappropriate. The total score is 11 which means that the brain injury is moderate. This might lead to long-term cognitive impairment, physical skill and emotional functioning (Mayo, 2017). Patient's blood glucose is within the range, it needs to be assessed to know if it is hypoglycemia or hyperglycemia which might be a medical emergency (Peate and Dutton, 2013). Patient pupils are assessed for size, reaction to light and symmetry. During the observation, quick responses indicate “+” and slow responses indicate “-“. They are done to detect any medical condition such as developing intracranial lesions (Farrington, 2018)

Exposure/Environment

The news score was 1 due to saturation that was 95%, patient will need to be regularly monitored to prevent desaturation.

Physical examination is very important to check for any additional factors such as allergy reactions, inflamed areas, bleeding, rashes and skin integrity (Peate and Dutton, 2013). In the scenario, the patient has right hemiplegia which is a condition that affects one side of the body due to stroke. Nurses supported patients by making them comfortable and regularly turning of patient and supporting the affected arm on an adjustable base. She also has homonymous hemianopia which means half a vision on both eyes. Patients might be supported by placing objects where they can see. Pain assessment is also carried out by locating the pain and intensity of the pain if the patient is in pain. The patient might need to be catheterized to monitor the urine output and prevent pressure sores. The IV fluid is for rehydration (Farrington, 2018)

MAIN BODY

Problem 1- Nutritional support

THESE ARE SUGGESTIONS ON NUTRITION i.e. what you can work on, PLEASE DO MORE RESEARCH and develop the list below and reference it.

Define nutrition

Why is it important for stroke patients and consequence of inadequate nutrition for stroke patients?

Nutrition screening i.e. all patients admitted should have a nutrition screen by using the appropriate tool MUST if more than 2 referred patient to a dietician.

The dietician decides the type of texture and if the patient is at high risk of malnutrition and requires a high-energy and high-protein diet.

Oral nutrition supplements (ONS) e.g. fortis, ensure, fresubin and their benefit to patients with reduced oral intake.

Hydration i.e. IV fluid should be administered if the patient is having reduced oral intake.

Holistic care- to give regular oral care, maintain adequate oral intake by supporting patient to eat and drink, protect meal time etc

PROBLEM 2

Management of dysphagia

Note these are only Suggestions on how to answer the question, please do more research…explain the point below and reference them.

What is dysphagia and relate it to the stroke patient with moderate dysphagia in the scenario

Steps to take as a nurse i.e assess patient within 4 hours after admission and if failed assessment refer the patient to SALT i.e speech and language therapist and be kept nill by mouth (pls research and reference)

Patients with moderate dysphagia, do they need a soft diet or NG tube?

Nutrition statue assessment

Refer patient to a dietician

Treatment plan e.g thickened fluid, how to sit when eating, take small bites and sips, supplement need, etc

What other things can be done as a nurse i.e. holistic care…. how to support patient, carer and family member? Nurses are responsible for ongoing assessment, assisting during meal time if there is a need for it and Patient weight monitoring

 NEED TO DO MORE RESEARCH AND ADD MORE ON DYSPHAGIA

Managing the psychosocial aspect of stroke

• Working with MDT in collaboration to support patients.
• Working with patients to help them develop skills
• Early involvement of family and friends in planning the pathway
• Listening and providing a solution
  

CONCLUSION

• SUMMARY OF WHAT’S DONE TO THE PATIENT
• PULL TOGETHER ALL KEY POINTS U’VE DISCUSSED
• WHAT CONCLUSION YOU DRAW ON IT i.e LOOK INTO PRO AND CONS e.g NMC SAY THIS AND RCN SAID IT BETTER

NOTE

• BRING IN YOUR LITERATURE, USE GOOGLE SCHOLAR TO IDENTIFY EVIDENCE
• USE ROYAL COLLEGE OF NURSING
• ADVANCED JOURNAL OF NURSING
• MIX WITH THE INTERNET, BOOKS JOURNALS
• USE CURRENT EVIDENCE WITHIN 5 YEARS.
• USE HAVARD REFERENCES

FURTHER SUPPORT

INTRODUCTION

– what you are going to discuss mention two problems (200 words)

• Briefly discuss underlying pathology (respiratory, altered fluid balance, or neurological) optional
• A-E assessment, NEWS and SBAR in connection to your patient, consider investigations (600 words)

MAIN BODY (1500 words)

Problem 1

Problem 2

• Problems must be patient problems
• Nursing management, evidence base for this care and analysis WHY?
• Discuss themes that have been covered in the course not something else
• Pick the obvious don’t make this too hard for yourself

CONCLUSION (200words)

REFERENCE LIST

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