A Woman Who Had a Cerebrovascular Accident - Case Study Example

Clinical Nursing Practise Customer Inserts His/Her Name Customer Inserts Grade Course Customer Inserts Tutor’s Name 30, 09, 2010 Outline Introduction Care and treatment Conclusion Introduction This essay looks at the medical condition of the patient in question and focuses at the holistic care. Mrs. Alice Kramer is a 61 year old woman who had Cerebrovascular accident and was the main care taker of her fairly elderly husband. Her medical history shows that she had chronic venous ulcer in her left leg and also with partial deafness in her right-hand side ear. On assessment, it was discovered that the CVA had left her with right sided hemiparesis and dysphasia which meant that her verbal comprehension and speech were impaired due to damage caused to the brain, along with right sided weakness. Care and treatment Mrs. Kramer’s planned care in more detail and including neurological observations, signs and symptoms of the disease and her discharge needs will be discussed in this section (Alexander, 2006). The care and treatment will also in compliance with the laid down work ethics and professional regulation of the competency standards provided by the Australian Nursing and Midwifery Council. According to competency standards 6.2 (2006 p 9), ``nursing must identify the needs of the intended person and must meet the expected time and achievement.” The plan therefore should be implemented in consultation with the patient to ensure that her needs are properly taken cared and will address every single problem together with the proper diagnosis to be followed. Cerebrovascular Accident causes the disruption of the flow of blood supply into the brain causing neurological dysfunction to the patient. It happens when blood clots or blood vessels to the brain are ruptured hence killing all vital brain tissues (Rice, 2006). Generally, these accidents are brought about by vascular allotment, anatomic position in the brain, and age of the patient. Mrs. Kramer suffers from aphasia which has affected her ability to communicate and thus she requires the help of a speech therapist in order to restore her impaired speech. A Glasgow Coma scale therefore needs to be performed on her to assess her mental case. It comprises of three fronts, the eye, verbal and motor response. These tests are used to determine whether the patient is in deep coma or is fully conscious on a scale of 3-15 (Moss, 2002). A speech pathologist work is aimed to help in assessing and providing diagnosis for disorders related to speech. The pathologist will analyze Mrs. Kramer`s problem and develop personalized care according to her needs. This include teaching her how to make sounds in order to improve her voice and employ the use of verbal and written skills in order to communicate with her more effectively (Kullmer, 1999). The speech pathologist will also assist her to swallow food and liquid without chocking her and this will help her recover and gain reliable communication skills that will be important in enabling her perform her daily duties. He/she has the responsibility of keeping proper records of the progress made by Mrs. Kramer and point out where she is experiencing recovery process challenges. This is in compliance with the regulations and competency standards 5.2 (2006 p 8) for registered nurses. According to the competency standards nurses ``must use special techniques for collecting important data”. The plan will also involve working together with her family members to notice the change in her behavior and the speech pathologist will teach them techniques of communicating with her better at home (Geetika, 2009). The health plan for Mrs. Kramer will also involve her physical and psychological needs. The Cerebrovascular disease had caused serious damage to the blood vessels draining blood into the brain (Anderson, 2006). The objective is to repair the cerebral damage in order to restore the normal flow of oxygenated blood into the brain. This affects the patient by failing to recognize simple commands due to mental confusion. The physiotherapist examined the pupil size of Mrs. Kramer and her reaction to light in order to determine her level of consciousness. Her movement and strength needs also to be looked at in detail. There should be correct assessment of her situation according the competency standards 5.1 p 8), ``there should be relevant evaluation of the evidence based nursing about the social and mental state of the individual”. All these need to be looked at by the physiotherapist in to ensure the proper diagnosis is given. The treatment may also require the use of appropriate medicine which helps to significantly reduce the pressure in the veins (Swearingen ,2003). The common prescription for reducing high blood pressure includes beta blockers, diuretics among other drugs. This is in accordance with the Australian Nursing and Midwifery Council. The competency standards 7.3 (2006 p 10) state that nursing care ``must follow the proper care and diagnosis of the disease”. Therefore the treatment should include the use of the right medicine that will enable the blood pressure to reduce significantly (Elsavier, 2001). Mrs. Alice Kramer had a history of chronic leg ulcer. Chronic venous leg ulcer is a medical term that refers to changes in the leg tissues caused by sustained high pressure in the veins (Park, 2006). This high pressure occurs when flow blood in the veins is irregular, resulting to valvular ineffectiveness, causing reverse flow in the veins. In this case scenario, Mrs. Alice Kramer chronic ulcer affected her left lateral malleous and she needed the help of local nurses for daily probing (Foreman, 2009). The skin pigmentation around her gaiter area turned to brown and this is as a result of the bursting of the vessels causing the breaking of the red pigment to a compound known as haemosidrerin which is permanently deposited into the tissues. The treatment of this disease requires a careful assessment of what caused it (Clark, 2006). Cleaning of the wound is the first step in treating chronic ulcer regardless of what caused it. This involves cleansing of the wound and thorough skin care which is critical. Compression therapy is an important remedy for patients suffering from the disease (Myco, 2005). This is important because it is in accordance with the Nursing council of Australia’s regulations. The competency standards 7.8 (2006 p 10) for registers nurses requires the ``the proper use of health care must be used properly ``Usage of proper healthcare to effectively enhance optimal health nursing’’. It is done by wrapping a bandage or a stocking from the knee area down to the foot. This creates external pressure on the blood vessels increasing its efficiency and pumps the blood forward instead off backwards thereby preventing the leg from swelling. Mrs. Kramer should continue receiving this treatment on her leg as she does every day to ensure to assist in the healing process (Bryant, 2007). Mrs. Kramer also needs the help of nutritional therapists who will advice her on the best diet to take to help in her recovery (Fox, 2005). Nutritional therapy helps to address the endothelial dysfunction and help to boost the production of nitric oxide which restores the blood flow. Nutrients like L-arginine play an important role in reducing blood pressure and help to keep the blood vessels dilated hence restoring the easy flow of blood in the system (Funnel, 2007). According to the competency standards 6.2 (2006 p 9) nurses ``must identify targets that are computable, attainable and fitting with principles and way of life of the persons or group and significant others”. Other nutrients like Vinpocetine have been proven to have the ability of restoring the flow of blood in the brains of stroke patients. It works by reducing the depletion adenosine the main cellular source of energy and also acts as an antioxidant (Hafner, 2002). The plan care for Mrs. Kramer requires the assistance from spiritual leader which may include a chaplain and the constant support of family members in her daily treatment. Medical research has shown that spiritual encouragement can prove to be very significant to the recovery of patients with chronic diseases and this is in accordance with the Australian Nursing and Midwifery council. The competency standards 6.1 (2006) p 6 states that ``nursing should consider individual and group preference when determining priorities for care actively in performance on review process”. Mrs. Kramer used to be the main care taker of her elderly husband. Due to her condition, her husband would require relief care which is the core of elderly care and support. She should consult any member of the family who is willing to assist and normally the primary caregiver is preferably a middle aged woman who has children and works full time. The person should be healthy strong and very supportive of her husband (Baranoski, 2007). They also should be physically and emotionally strong in order for the person to attend to the needs of the elderly person. The care taker is allowed to take a break but that does not mean abandoning the person in need of care (Long, 2008). The Australian Nursing and Midwifery Council rules and regulation is clear about this. The standard for competency (2006 p 7) requires nurses to accept individual person or groups for caring irrespective of their physical, religious, gender, age and mental condition. The care taker should acknowledge this rule and follow it to the latter and ensure the needs of Mrs. Kramer are well taken care of but should also allow him to do the things he can do by himself (Moffat, 2004). The care for Mrs. Kramer also requires regular exercise of the body. It is important for the nurse to remember to always ensure that her body alignment is in perfect condition and to prevent complications of the bed rest when she lies to sleep (Neil, 2004). The head should also be elevated to 30 degrees consequently reducing the intracranial pressure. The patient should be placed on a mattress and be assisted to turn every two hours to ensure her skin is in good condition. The final nursing care for the patient requires her discharge needs to be looked after. Mrs. Kramer needs assistance to enable her to move around her neighborhood. Community health centers are the best location for handling patients with leg ulcer just like Mrs. Kramer where they are assigned competent nurses to look after them on a regular basis (Morrison, 2004). The best strategy for the care of the patients is to place community leg ulcer clinics in appropriate locations with specialized nurses and vascular surgery capability within the clinic. The Australian Nursing and Midwifery council standard for competency 9.1 (2006 p 11) requires that nurses to create understanding with individuals that enhances their capacity to express themselves freely”. The two chronic diseases she is suffering from are well handled with a shared concern from special intervention at the community base clinics. Therefore Mrs. Kramer would be better off in the hands of a group of nurses who fully understand her situation and help her by bandaging the wounds and providing the best service (Jual, 2008). Conclusion The case study of Mrs. Alice Kramer who is 61 years old resided in her home and was the main caretaker of her fairly elderly husband. Here health history include being partially deaf in her right ear and had chronic venous ulcer located near her left malleous (Matzo, 2006). She was admitted to hospital where it was established that hemiparesis and dysphasia. The care plan developed for her was designed to address her cerebrovascular disorder and re-establish the flow of blood into the brain through evidence-based practice. Her speech was also impaired and with the help of a speech therapist ensured that she could be capable of communicating effectively (Morrison, 2007). The chronic venous ulcer also required special care and with the help of compression therapy it ensured that the extreme effects were minimized. Her ageing husband also required respite care and since this means he required someone to look after his special needs. The care plan offered a comprehensive approach to the needs of Mrs. Kramer and will go a long way to enable her recover quickly. References Alexander, F., Fawcett, J., & Runciman, P. (2006). Nursing practice: hospital and home. Sydney: Elsevier Health Sciences. Anderson, R. (2006). The Experience of Patients and Their Families. London: Cambridge University Press. Australian Nursery & Midwifery Council. (2006). National Competency Standards for the Registered Nurse. Retrieved October 16, 2010. http://www.anmc.org.au/professional_standards Baranoski, S.,& Ayello, E.A. (2007). 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