ESSAY HNN227 Acute Illness And Supportive Care

HNN227 Acute Illness And Supportive Care

Answer:

Problem Identification

	1	2	3	4
Actual problem	Left hemiplegia	dysphagia	Respiratory failure	aphagia
Potential problem	Neglect	malnutrition	Love and belonging	hypertension

Planning

a) 2 actual problems and potential problems

	Actual/potential problem	Patient problem
1. 1^stPriority	Left hemiplegia	· Impaired physical mobility (Mr. Robertson cannot stand on his own and he is immobile) · Disuse syndrome, due to shifted weight to the affected side · Inability to self-care due to paralysis of the limbs and the left side of the body · Difficult in communication · Difficulty in swallowing · Pain · Ataxia · Mr. Robertson is inactive · Injury risks · Lack of self-care
2. 2^nd Priority	Respiratory failure	· Low oxygen saturation (Sp02 94% RA · Irregular breathing patterns · Irregular respiratory rates (RR is 24 bpm · Decreased levels of consciousness · Smoking can lead to lung problems (15/day)
3. 3^rd Priority	Neglect	· Social interaction limitations like communication, his sons do not attend to him he stays with his wife alone.
4. 4^th Priority	Malnutrition	· Mr. Robertson has aphagia · Mr. Robertson is immobile · Mr. Robertson has dysphagia (unable to swallow certain foodstuffs) · Lack of muscle coordination, he suffers from stroke as it is manifested by his left hemiplegia condition, so he cannot feed himself alone · Due to paralysis of the limbs and the left side of the body

b) Most appropriate care

		Patient problem	Planning
1	Left hemiplegia	Impaired physical mobility	Ø Assess the degree of the physical immobility and explore possible alternatives to aid in recovery Ø Monitor thromboplebitis symptoms Ø Observe the left side for changes in colour and oedema
Difficult in communication	Ø Determine the degree of aphasia and the levels at which the patient can express themselves Ø Determine the levels of brain involvement Ø Monitor receptive aphasia on pupil response Ø Monitor expressive aphasia Ø Monitor articulation of simple sounds Ø Monitor levels of mental well-being like depression and frustration
Pain	Ø monitor any possible instances of pain and stiffness in the shoulders and the left cheek Ø assess the possibilities of pain and sensory abnormalities Ø monitor the patient’s physical expression of feeling pain either by palpation, restlessness, or moaning Ø monitor the extent of laceration on the chin sustained after falling Ø use the wong backers scale to measure the extent of pain Ø investigate further signs and symptoms related to pain
Inability to self-care	Ø assess and determine the levels of the inability of the patient to meet personal needs Ø assess the patient’s ability to communicate when they need to attend to washrooms Ø determine the significance levels of bowel load
Difficulty in swallowing	Ø monitor the patient’s ability to swallow by monitoring tongue movements, teeth movements and sound, coughing patterns Ø maintain and monitor proper calories limits
2	Respiratory failure	Poor breathing	Ø to monitor breathing rates after every four hours to detect any alteration in the breathing system Ø monitor oxygen saturation levels and factors affecting it Ø monitor breathing patterns like breath cessations, deep breathing, intermittent breathing, shallow or quick breath, labored or unlabored breath, increased depth of breathing and rapid or shallow breath Ø monitor breathing sounds like wheezing, constant sounds or musical sounds Ø monitor any instances of shortness of breath Ø monitor any example of using accessory muscles to facilitate breathing Ø monitor diaphragm movements while breathing Ø monitor nostrils movements and contractions while breathing Ø monitor breathing positions of the patient, whether difficult or breathes at ease Ø monitor nasal secretions amount and colour Ø monitor anxiety and consciousness levels Ø monitor for instances of abdominal or chest pains while breathing
3	Neglect	Risk of neglect from his immediate family	Ø assess and determine the patient’s possible signs of neglect by his family or caregivers like clothing and hygiene Ø monitor sitting and sleeping positions Ø monitor feeding patterns Ø monitor head movements Ø monitor response to external environments from the neglected side Ø monitor grooming on the neglected side Ø monitor the ability to move body parts of the neglected side
4	Malnutrition	Poor access to nutrition	Ø determine the patient’s weight Ø monitor the patients feeding environments and the frequency of feeding Ø monitor physical and noticeable evidence of malnutrition Ø determine the living environments of the patient Ø determine the patients’s sensory abilities in taste Ø determine appropriate types of equipment for therapies, especially on physically challenged patients or immobile patients Ø determine the swallowing capacity of the patient on various foods Ø assess the patient’s other vital signs that manifest as malnutrition Ø assess food volumes consumed by the patient against wastes Ø determine on available options in cases of nausea and vomiting Ø assess proper renal functions

Implementation

		Patient problem	Nursing intervention	Rationale
1	Left hemiplegia	Impaired physical immobility	Ø Change sleeping positions frequently. Ø Inspecting the affected side regularly and provide massage to any affected swollen or reddened parts and offer soft surfaces for sleeping	Ø To reduce instances of tissue damage and injuries. Ø To enhance blood circulation on the pressurized parts of the lower side.
Difficult in communication	Ø Provide alternative means of communication, for instance, the use of a sign or body language Ø Referring a patient to specialized professionals like a therapist	Ø To ease communication and information delivery. Ø To assess communication gaps and needs of the patient and recommend possible alternatives.
Pain	Ø Assist the patient when changing the position to ensure minimum pain is inflicted Ø Proper positioning of the shoulders when the patient is sleeping	Ø Use of appropriate method when shoulders and arms to reduce pain Ø Ensure proper inclinement of Ø the scapula and scapula joints
Inability to self-care	Ø Only chip in when necessary and promote patient independence in performing duties Ø Give feedback to the patient on progress and subsequent improvements	Ø To promote self-esteem and speedy recovery Ø Form of encouragement and it provides the patient with a sense of self-worth
Difficulty in swallowing	Ø Suggest alternative feeding methods Ø Provide food and water at desired temperatures	Ø To meet body fluids and nutritional needs Ø lukewarm temperatures impairs salivation
2	Respiratory complications	Poor breathing	Ø ensure the patient’s posture and position does not affect in any way the breathing pattern Ø determine the impact of introducing an inspiration muscle training model	Ø To allow enough space for the abdominal cavity movements to enhance breathing Ø To facilitate unwarranted movement of respiratory muscles and enhance their strength for efficient breathing
3	Neglect	Risk of neglect from his immediate family	Ø Promote the patient’s ability to accept, manage and cope with neglect. Show them alternative options for self-help Ø Initiate and promote fall associated risks management and interventions like outlining underlying factors that cause falls like mental health, gait and imbalances, cognitive and sensory challenges	Ø Promote self-acceptance, worthiness and fast healing Ø Reduce the dangers associated with fall risks as a result of involuntary or unwarranted fall downs
4	Malnutrition	Poor nutrition	Ø Include and collectively involve the patient’s family and caregivers in decision making, create awareness and explore possible alternatives for enhanced nutrition programs for the patient Ø Advise the patient and the family on the available option for laxatives and diuretics	Ø To promote a healthy feeding regime for the patient Ø Reduce the advanced feeling of self-unworthy and acceptance to minimise vomiting and enhance fluid balance in the body.

Evaluation

		Nursing intervention	Evaluation
1	Left hemiplegia	Ø Change of sleeping positions frequently Ø Inspecting the affected side regularly and provide massage to any affected swollen or reddened parts and offer soft surfaces for sleeping	Ø Improvement of blood circulation and reduced instances of damaged tissues or swollen and reddened parts
2	Respiratory complications	Ø Ensure the patient’s posture and position does not affect in any way the breathing pattern Ø Determine the impact of introducing an inspiration muscle training model	Ø Enhanced voluntary and unlabored breathing patterns. Ø The patient breathing is at ease; breathing rate, heart rate and oxygen concentrations are at the required levels
3	Neglect	Ø Promote the patient’s ability to accept, manage and cope with neglect. Show them alternative options for self-help Ø Initiate and promote fall associated risks management and interventions like outlining underlying factors that cause falls like mental health, gait and imbalances, cognitive and sensory challenges	Ø Decreased instances of fall risk effects like death and physical injuries and Ø improved sense of self-acceptance, reliance and appreciation of the patient’s condition and the ability to perform some tasks on their own or with less assistance from the carers
4	Malnutrition	Ø Include and collectively involve the patient’s family and caregivers in decision making, create awareness and explore possible alternatives for enhanced nutrition programs for the patient Ø Advise the patient and the family on the available option for laxatives and diuretics	Ø Collective response in ensuring nutritional requirements for the patient are met both in quality and quantity. Ø Improved feeding patterns, environment, patient weight and general body condition. Ø Improved electrolytes and fluid balance in the patient’s body

HNN227 Acute Illness And Supportive Care