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SIMULATION-CLINICAL ANALYSIS

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Table of contents:-

Introduction-

Comprehensive nursing assessment is a clinical practice performed by registered nurses to deliver care to patients. Apart from the nursing practices, the registered nurses include the social determinants in order to create a proper nursing plan prioritizing the care user’s preference. The nursing plan created as a part of the nursing assessment helps to implement the information gathered in order to meet the care user requirements.

Ischemic stroke and its interventions to Mr. Bright-

Ischemic stroke occurs due to blockage of any artery to brain and thus, brain receives less oxygenated blood and cannot perform its functions properly. As per the view of Schönenberger et al. (2016), the human brain depends on the arteries to bring fresh blood from heart and lungs. Therefore, in case of ischemic stroke, the blood vessels became narrower due to some blockage. Most common ischemic stroke is thrombotic stroke and the arteries carried out blood to brain become blocked. Therefore, the cells of brain died or became more damaged. As per the case scenario, it has been identified that Mr. Bright is feeling pain after having his angioplasty. Therefore, medical practitioners have assumed that he might have face ischemic stroke that can increase her life risk.

Symptoms of ischemic stroke of Mr. Bright-

It has been often been evidenced that Mr. Bright has often faced sudden weakness or numbnace of leg on left side. Moreover, he is not being able to speak properly and understand other’s instruction. As he is not feeling enough strength to his left leg, therefore, he might have been facing difficulties during his walk. He also lost his balance and unable to coordinate during his walk (Goyal et al. 2016). He has also faced dizziness and sudden headache, with no known causes. After identifying these symptoms, his medical supervisor assumes that Mr. Bright might have facing Ischemic stroke. Due to this, a blood cottage might have developed in the brain arteries and thus, brain cells receive less originated blood. Therefore, brain cannot perform its normal function.

Correct nursing treatment of Mr. Bright-

In order to provide proper treatment to people, who are having Ischemic stroke, need to be regularly monitored. As Mr. Bright has suspected to have Ischemic stroke, therefore, he need to be regularly monitored and care providers are required to list down every single detail about him. Therefore, it helps doctors to give appropriate therapy and medications by considering his physical symptoms. In addition to this, care providers are also required to give systematic approach to identify the area of discomfort. Intravenous injections of tissue plasminogen activator (tPA) can also be very effective in order to minimize the effect of ischemic stroke as well (Fransen et al. 2016). Furthermore, care providers need to practice verbal and non-verbal interaction as much as they can to understand physical discomforts of Mr. Bright.

Correct Nursing assessment performed of Mr. Bright-

In order to elect a stimulatory response to Mr. Bright, the correct nursing assessment was Physical assessment:

When Mr. Bright complained about the physical discomfort the registered nurse had undergone a physical assessment that included:-

  • Age consideration
  • Observatory information
  • Using a systematic approach to analyze the area of discomfort

Examine the painful regions such as hand and neck that co-related to the possible outcome-

Communicating with Mr. Bright and his family to record the exact cause:-

  • Admission assessment: The registered nurse completed the admission assessment with the assistance of a caregiver on arriving at the care homeward. The registered nurse completed the admission assessment within 24 hours of alarming symptoms (ncbi.nlm.nih.gov, 2018). Admission assessment was performed in the admissions tab of ADT navigator where some more information was included in the patient’s clinical notes. The registered nurse ensured the privacy of the patient and performed the data analysis by maintaining confidentiality.
  • Patient history: The registered nurse collected the patient history from other nursing staffs. The initial history was mainly collected on current injury or trauma that made the patient to get admit in ward. The initial assessment was followed by a past history that even included social history, allergies, medications used and the present immunization status.
  • Vital signs monitoring: The alarming observations in the case of Mr. Bright were noted and recorded during the admission assessment and noted in clinical notes of the patient. However, reviewing the patient condition was done with the help of VICTOR graph for every two hours of interval, depending on the patient condition in order to support the clinical decision-making process (ncbi.nlm.nih.gov 2017).

The vital signs were monitored noting the following parameters:-

  • Temperature
  • The temperature was recorded with the help of a digital thermometer which sets the most preliminary and important step for the assessment of vital signs since a very high temperature denotes pyrogenic infection.
  • Respiratory rate

Mr. Bright had undergone an angioplasty very recently and thus, it was necessary to record the minutes to monitor the proper functioning of the heart and heart rate pattern was also recorded simultaneously.

Along with this few more parameters such as blood pressure, oxygen saturation and pain were recorded as the fluctuations report which seemed to be a vital condition of the heart.

Assessment that was not performed on Mr. Bright-

  • Blood glucose management: The nursing staffs did not monitor blood glucose level which is very important in patient case undergone angioplasty. EMS obtains glucose level in order to rule hyperglycemia out because of it, symptoms of stroke might occur. However, hypoglycemia tends to cause any symptoms in patients having an altered psychological status but there is no occurrence of focal neurologic stroke symptoms which is likely to occur if the blood glucose level falls below 45 mg/dl (rch.org.au 2019).
  • Neurologic examination: An ischemic stroke might cause a focal neurologic deficit that depends on the localized tissue damage (nursingtimes.net 2016). The registered nurse did not perform the neurological examination which might detect the vascular territory and affected stroke origin (McKinney et al. 2015). The nursing personnel should have performed the neurological examination in the case of Mr. bright that would have revealed muscular strength and other sensory functions.
  • Supplemental oxygen:As per the current Nursing standards for Nursing Practice and National safety and quality Health Standards maintenance of oxygen saturation above 94% is desired for hypoxic patients.

Demonstrating clinical decision

In the case of Mr. Bright intravenous thrombolysis accompanied by tissue, type plasminogen was recommended as per the stroke guidelines the beneficial effects of this intravenous treatment are more time dependent. In the case of intracerebral hemorrhage, the use of tPA is limited to a certain extent (safetyandquality.gov.au 2018). A detailed medical history from the patient family should be collected in order to avoid any complications (Triccas et al. 2018).

Structured verbal handover for chest pain in ISBAR

Introduction

Name: Lisa Gomes

Designation: Registered Nurse

Ward: adult patient cardiac care

 

 

Patient name: Mr. Bright

Age: 80

Sex: M

Admitting Doctor: Smith Carol

Situation

Mr. Bright had undergone angioplasty last week and after he was discharged he is experiencing pain on the left portion of his chest. The physical symptoms observed in the patient seem an alarming concern for the healthcare professionals.

Furthermore, it has also been identified that he was facing difficulties while walking on floor and unable to maintain body balance. Furthermore, he often felt dizziness and sudden headache without any known cause. He also felt weakness and numbness on his left leg and felt difficulties while speaking to other persons.  

Background

Mr. Bright is 82 years Male patient who had undergone a recent angioplasty and reporting to face adverse effect from the prescribed medicines. However, he was discharged within a day of angioplasty and no neurological examination was performed before performing angioplasty and post treatment.

In addition to this, it has also been found that, symptoms of his physical dis-comfortness were also not identified primarily.

Assessment

Mr. Bright is experiencing severe prolonged pain for the last few hours along with this sweating to a large extent. Patient is feeling difficulty in communicating with nurses probably due to difficulty in inhaling for ischemic stroke symptoms. In addition to this, it has also been discovered that he was not getting enough strength on his left leg and thus unable to move and make body balance while walking.

Recommendation

As per the documents provided patient has already mild stroke a few months before and the family history reflects heart disease to be a hereditary factor running for generations. His difficulty in uttering and sweating gives a vital symptom for stroke. Therefore he should be admitted to the emergency ward for clinician examination and effective treatment. He might require a pacemaker.

Furthermore, he also needs to give Intravenous injection of tissue plasminogen activator (tPA). Therefore, it can help to remove the clot, present in blood vessels. Thus, it also helps to send more oxiginated blood to his brain cells and improves his health condition. 

 

Conclusion-

Nursing practice is always preceded by the nursing assessment that depends on the guidelines laid by National Safety and Quality Health safety standards. The nursing assessment is to access all the social determinants of health, family, financial status food security and so on to understand present health status. When a care user undergoes a critical treatment or surgery it is very important to take utmost care for the patient failing of which might result in adverse effects.

Reference-
  • McKinney, E. F., Lee, J. C., Jayne, D. R., Lyons, P. A., & Smith, K. G. (2015). T-cell exhaustion, co-stimulation and clinical outcome in autoimmunity and infection. Nature, 523(7562), 612. Retrieved on: 12 March 2019  from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623162/
  •  Ncbi.nlm.nih.gov. (2015). A clinical decision support tool to screen health records for contraindications to stroke thrombolysis–a pilot study. Retrieved on: 5 March 2019 Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677442/
  • Ncbi.nlm.nih.gov (2017) The nurse's role in percutaneous transluminal coronary angioplasty Retrieved on: 6 March 2019 Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/6215383
  • Nursingtimes.net (2016) The impact of accurate patient assessment on quality of care Retrieved on: 5 March 2019 Retrieved from: https://www.nursingtimes.net/clinical-archive/haematology/the-impact-of-accurate-patient-assessment-on-quality-of-care/203387.article
  • Rch.org.au (2019) Care of the patient post cardiac catheterization Retrieved on: 5 March 2019 Retrieved from: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Care_of_the_patient_post_cardiac_catheterisation/
  • Safetyandquality.gov.au (2018) ISBAR revisited Retrieved on: 5 March 2019 Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/ISBAR-toolkit.pdf
  • Triccas, L. T., Burridge, J. H., Hughes, A. M., Pickering, R. M., Desikan, M., Rothwell, J. C., & Verheyden, G. (2016). Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: a review and meta-analysis. Clinical Neurophysiology, 127(1), 946-955. Retrieved on: 1 March 2019  from: https://www.ajog.org/article/S0015-0282(14)02223-7/pdf
  •  Schönenberger, S., Uhlmann, L., Hacke, W., Schieber, S., Mundiyanapurath, S., Purrucker, J. C., ... & Ringleb, P. A. (2016). Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. Jama316(19), 1986-1996. Retrieved on: 1 March 2019  from: https://jamanetwork.com/journals/jama/articlepdf/2577957/joi160125supp1_prod.pdf
  • Goyal, M., Jadhav, A. P., Bonafe, A., Diener, H., Mendes Pereira, V., Levy, E., ... & Saver, J. L. (2016). Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: results from the SWIFT PRIME randomized controlled trial. Radiology279(3), 888-897. Retrieved on: 4 March 2019  from: https://pubs.rsna.org/doi/full/10.1148/radiol.2016160204
  • Fransen, P. S., Berkhemer, O. A., Lingsma, H. F., Beumer, D., Van Den Berg, L. A., Yoo, A. J., ... & van Walderveen, M. A. (2016). Time to reperfusion and treatment effect for acute ischemic stroke: a randomized clinical trial. JAMA neurology73(2), 190-196. Retrieved on: 2 March 2019  from: https://jamanetwork.com/journals/jamaneurology/articlepdf/2478306/noi150085supp1_prod.pdf

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