Restorative Case Study | EssayIvy.com

Restorative case study

RESTORATIVE CASE STUDY
2
UNRS 313P Case Study Worksheet
Identifying /Admitting Data
Student Name: _______________________________________________ Date: _August 15,
2018
Patient initials:
Age: 58
Gender: Male
Race: Caucasian
Marital Status: Married Occupation: Police dispatcher
Insurance: Medicad
Family Composition: The patient is married with 2 kids and a wife who is also working in a home care center
Home/ Living Situation: The patient lives with his family in a two story building which has 10-15 steps to the
entry in the suburbs of Wrightwood. His living condition can be considered to be relatively good.
Allergies (include allergen and reaction to allergen): The patient has no known allergies
Admit date: August 2, 2018
Hospital day # 7
Post-operative day
Dates of Care: August 8, 2018
Physician(s) (include physician specialty): K.G (practicing internal medicine)
3
Medical diagnosis (admitting): The patient has been diagnosed with an acute ischemic Infarct in the left
cerebellar peduncle
History of Present Illness (HPI):
The patient is a 58-year-old man who is right handed. The patient has a past medical history of
hypertension. He also suffers from type two diabetes mellitus. In July 2018 the patient also suffered from a left
lacunar infarct coupled by very high temperatures which saw him get hospitalized. Earlier in the year on 28 of
July the patient visited Desert Valley Hospital where he complained of vomiting, nausea which he alleged had
started on the previous day before the hospital visit. He also complained of experiencing weakness in both his
upper and lower limbs. The patient was diagnosed of leukytosis and a WBC of 18.7 plus anion acidosis. The
liver functions and lipase test were perfectly normal. ABG test showed a PH level of 7.4 chest x-ray and Ct
scan on the pelvis were negative for an acute process. The patient was later given a dose of Insulin. He patient
was later transferred to the Kaser Medical Center where he underwent further evaluation and medication. The
CTA scan performed at Kaser Medical center did not show any sign of extirpation of the disease. An MRI of
the brain showed that there was a focal region that restricted diffusion in the left cerebellar. The patient was
successfully medically stabilized a later transferred to the Casa Colina Rehabilitation center here he underwent
a series of rehabilitation programs
Past Medical (Comorbidities) and Surgical History:
The patient has not undergone any past medical surgery
Describe Chronological sequence of Hospital Course (including admission to acute hospital until transfer
of the patient to the rehab facility):
4
The patient first presented their case in Desert Valley Hospital where he presented complains of
vomiting, nausea. The symptoms had first started on the previous day before the hospital visit. The patient also
complained of experiencing weakness in both his upper and lower limbs. A diagnosis was performed which
indicated that the patient suffered from leukytosis and a WBC of 18.7 plus anion acidosis. At test was
conducted on the liver functions. A lipase test was also performed. The results of the two tests indicated normal
results. The hospital performed ABG test that showed a PH level of 7.4. Chest x-ray and Ct scan on the pelvis
were negative for an acute process. The patient was later given a dose of Insulin. The patient was later
transferred to the Kaser Medical Center where he underwent further evaluation and medication. The CTA scan
performed at Kaser Medical center did not show any sign of extirpation of the disease. An MRI of the brain
showed that there was a focal region that restricted diffusion in the left cerebellar. The patient was successfully
medically stabilized a later transferred to the rehabilitation center at Casa Colina Rehabilitation Center where he
underwent a series of rehabilitation programs .
Pathophysiology of admitting diagnosis (must include textbook references): look up and check when
done
On July 27 2018, the patient started experiencing symptom of nausea and vomiting which the patient
dismissed as being a minor health issue. The symptoms however persisted on 28th of July upon which the
patient got worried. The symptoms graduated to weakness in both his left upper and lower limb and thus his
wife rushed him to the hospital. A CT scan was able to detect a left infarct after an MRI was conducted
indicating a focal region was restricting diffusion in the left Cerebellar peduncle which is located in the
Medullary Junction. This was consistent with the left infarction. The size of the infarction indicates a lacunar on
the left hand side. In most cases a lacunar infarction is usually a small infarction that is smaller than once
centimeter in diameter. In line with Huether & McCone, 2017, (p.601) in some cases it may be coupled by small
perforation of the arteries. The major cause of lacunar strokes is the presence of lipid forming cells and fibrous
material that cause a thickening in the arteries w chi prevents proper blood flow. In line with Oliviera the major
5
cause of this element is associated to behavior such as smoking. However, in the case of the 58year old patient
he had no smoking history in his life and thus the lacunar stroke could in no way be associated with smoking.
However, in some case the presence of fibrous material is sometimes associated with hypertension. Earlier on
the patient was hospitalized with cases of hypertension. These provides a probable link between the lacunar
stroke and the hypertension. As such it is highly probable that the existence of the lunar stroke is connected with
the patient history of hypertension.
The patient was also diagnosed with some hemorrhages in the brain which can be attributed to the
hypertension. Heather and McCane argue that cerebella hemorrhage in most cases often involves hypertension
causing the arterioles to thicken and thus ink the process increasing the cellularity of the vessels. A cerebral
hemorrhage can only be trite through the process of reabsorption. in this case there is a focal region which
restitute diffuse and thus hinders the process of reabsorption of not fluids which happen through the process of
diffusion. Since in this case the patient lacks any other medical history the point to the lacunar stroke I can be
concluded that the hypertension that the patient suffers could be the major cause of the stroke w hitch mat= bye
induced by lack of pop diffusing in the brain causes by a focal region as identified through the MRI scan. In this
case it is wise for the patient to be put on aspirin medication which is likely to reduce the occurrence of a
hemorrhage and thus reducing the chances of the stroke reoccurring in the patient.
When the patient visited the hospital he complained of a weakness in his limbs. The condition is often
referred to as hemiparesis. Its f often a type of weakness that affect only one side of the body. Lacunar strokes
are known to cause hemorrhages which are as a result of hypertension which as a result ends up causing stroke
in patients. In line with Asimos (2017) it highly likely that the hypertension that the patient suffers from plus the
infarction on the left side could have caused the lacunar stroke. And as such resulting is patient experiencing
weakness in both his upper and lower limbs.
The patient has a 7-year medical history of hypertension. Hypertension is medically described as
consistent readings of the more than 140 mm/Hg systolic reading and a more than 90 mm/hg systolic reading.
6
When the patient was diagnosed with hypertension the physician was able to classify the hypertension as being
primary meaning that the hypertension had no root because that could be identified. Despite the fact that
primary hypertension has no main cause there are various factors that can contribute to its elevation. For
example, increased body weight and excessive use of tobacco are some of the factors that can contribute to
development of high blood pressure. The patient in this case has no history of smoking and the only factor that
can be linked to the development of hypertension is being overweight. The pathophysiology that can be
attributed to hypertension is the excessive increase in Systemic vascular resistance and also the increase in the
Cardiac output of a patient. The increase in SVR and CO in this case can only be attributed to his overweight
condition. A such it is very necessary that the patient adheres strictly to taking hypertension medication. Its I
also advisable that the patient be assessing his blood pressure even while at home so as to monitor any
fluctuation that could result in inducing another lacunar stroke.
The patient also has a past record of acute dysliphedimia, this is a condition which is characterized by
abnormal levels of a certain type of lipid in the blood. The condition can exist in either two forms, namely high
levels of low density lipoprotein or low levels of high density lipoprotein. The patient is currently overweight
which can explain the presence of an abnormal lipid. In this case the patient needs to consider taking reductase
inhibitors as they are likely to reduce the level of cholesterol in his body.
Correlation of admitting diagnosis to social history, comorbidities, or past surgical history (must include
textbook references):
During the clinic day the patient did not complain of any pain in any place. The lack of pain shows that
the patient is relatively which is further backed up by the fact that the patient does not report any pain during
any of his therapies. However due to the patient historical background of hypertension the patient needs to be
closely monitored. close monitoring of the patient blood pressure is likely to reduce any complication such as
increased hemorrhaging that may cause the reoccurrence of ischemic lunar stroke.
7
Physical Exam
Ht: 5’11’’ Wt.: 215 lbs. Kg: BMI:
VITAL SIGNS:
Time
Temperature
(include route)
Pulse (apical/radial)
Resp
BP
3: 31 PM
98.2 (Temporal)
65 (Apical)
16
157/73
0700
97.7 (Temporal)
62 (Apical)
18
143/80
(sitting L
arm)
PAIN ASSESSMENT:
Time
Pain Tool
Used
Pain
Ratin
g
Pain Description
(OLDCART)
Functional
Pain Goal
Pain
Medication
Response To
Tx
0830
Numeric
0/10
N/A. Patient denies having
any pain throughout
clinical shift
N/A
N/A
N/A
O (Onset): N/A L (Location/ radiate?): N/A
D (Duration): N/A C (Characteristics, i.e. sharp, burning, ache): N/A
A (Aggravating factors:) N/A R (Relieving factors): N/A
8
T (Treatment): N/A
Skin:
Color: Even and consistent with genetic background Turgor: Good Temp: Warm to touch and
equal bilaterally Moisture: Dry Edema: No edema noted
Lesions/wounds: No lesion/wounds noted
Incisions N/A
Description of incision N/A
Drains N/A
Head, Face and Neck
Head: General size: Normocephalic, no lumps, no tenderness, no trauma noted.
Deformities: N/A
Face: Features are symmetric, no drooping, no weakness, no involuntary movements
Neck: Supple with full ROM, no pain. Symmetric, no cervical lymphadenopathy or masses. Trachea midline,
thyroid not palpable. No bruits
Other notes: The patient is relatively stable from the test carried above in different parts of his body
Respirations:
Rate: 18 breaths per minute Rhythm: Regular Depth: Unlabored
Labored (ICS retractions or use of accessory muscles) / Unlabored: Unlabored
Breath Sounds (posterior, anterior and lateral): Clear, diminished, absent: Vesicular breath sounds clear over
lung fields and equal bilaterally.
Adventitious sounds: No adventitious sounds noted
9
Oxygen Therapy: How Delivered (nasal cannula, face mask, non-rebreather, etc.): 99 Rate in Liters:
Trach: N/A Ventilator and settings: N/A
Chest tube (water seal or suction, cm of water): Pulmonary: N/A
Cardiovascular:
Neck Vessels: No jugular venous distention or pulsations noted
Heart Sounds: Rate: 62 bpm Rhythm: regular Extra Sounds or Murmurs: PMI (location
and size): noted at midclavicular line, in fifth intercostal space.
Pulses (R/L): Brachial 2+ bilaterally
Radial:2+ bilateral
Femoral: _1+ bilaterally during palpation
Posterior Tibialis:2+ bilaterally
Dorsalis Pedis: 2+ bilaterally during palpation
Capillary Refill (<1-3 sec): __ the capillary refill to less than 2 seconds
Skin color/temp: The patient’s skin color is warm and pink
Edema (location, +/0; pitting/non-pitting): The patient has a pitting edema on the lower left extremity
IV Site: The IV site is located at the left antecubital Infusion Solution/ R
Other notes- the IV is 22 in gauge and capped at present
Gastrointestina
Ability to eat/drink the patient is bale to drink and drink by himself without any difficulties.
Diet: The patient has a100 percent intake of food and liquids. The patient has no NG and G tube present.
Presence of ostomy device: The presence has no ostomy present.
Other drains: the patient has no other form of drains
Abdomen: (soft, distended, tender, ascites, masses or organomegaly): The abdomen is round non tender and soft
in feel without any signs of any masses or ascites
10
Bowel sounds: The patient has not experienced any abnormal bowel sounds and the sound are present in all the
four quadrants of the stomach.
Bowel program: The patient BM first occurred at 1000 hour on the 29
th
.
Stool Characteristics: The stool is large soft and has a normal color abnormalities were detected.
Emesis: No emesis present.
Genitourinary:
Urine: Output the patients output record was registered to be 450ml at 1000 on 27/08/2018.
Characteristics: The urine is yellow in color but not clouded.
Catheter (type and date placed): The patient has no catheter but is able to go to the urinary on his own.
Bladder Scan: The patients have not had a bladder scan yet.
Bladder Program/Training: The patient does not need any bladder instruction
Sexually active: The patient claims to be sexually active
Neurologic:
Level of consciousness: The patient is conscious and alert
Glasgow Coma Scale (if coma) The glaucoma scale of the patient is at15
Orientation to Person: The patient has an orientation of x4 to both time situation and place. The long-term and
short term memory of the patient are all intact. The patient is able to learn new skill and as a better attention to
details of whatever he is doing or what is happening around him. The patient has no slur in speech and it can be
described as being clear. The patient’s facial muscles are intact and have not drooped. The patient was detected
to have EOMI present. The patient can hear well and has no assistive device, the patient is however
experiencing limb numbness in his hands and legs coupled by a general feeling of weakness in his limbs
The sensation to sharp or dull objects is not yet assessed in patients. Test for stereognosis show that it is
normal.
Musculoskeletal:
11
The patent is currently on washroom privileges and he can move easily without difficulties and does not need
any assistance as they have both an even and steady gait. The patient is not experiencing any signs of atrophy in
his upper and lower extremities. His muscles are however flaccid especially in his left lower limbs which has
been responding well to the therapy that the patient is undergoing. The ROM is within functional
Muscle strength (test strength and rate on scale 0-5/ 5; minimum of handgrips, footpushes)
(hands) Rt______5/5_______Lt_5/5_________ (Foot pushes)-
Rt__4/5______________Lt____4/5______________
Assistive Devices: patient has no assistive devices yet
Prosthesis: N/A
Psychosocial, Cultural, and Spiritual Assessment:
Psychosocial
In most cases when patient get out of hospital they are likely to experience anxiety. In most case they are
often afraid of what they are going to face and how they are going to take care of themselves once they are out
of hospital. The patient feels that he is not yet ready to go home and face the issue of dealing with the disease
despite the fact that he is medically stable to be released form the hospital. The patient has a family and a wife
who is working and as such feel that he might become a burden to his wife which may hinder her from working
to provide for the family. However, at the same time the patient feels that in a couple of days he might be able
to carry out ADLs on his own. His worries of being a burden are very normal however in some cases it is
important to encourage the patient to continue with the process of therapy in a bid to ensure that he is
progressing well. The patient however needs not to worry as his wife is very supportive and she will help him
with the process of recovery.
Mood/ affect: Sometimes the patient gets agitated and anxious
Coping: The patient is coping well with his condition and I believe he is strong enough to face his illness
Suicidal ideation: The patient has no suicidal ideas
12
Thought process/content (note any hallucinations, delusions): The patient is not experiencing any
hallucinations and delusions.
Notes: The nurses are able to relate well with the patient. They are able to sit down and establish any fears that
the patient may be having and as such are able to reassure them or offer support when necessary
Spiritual
The patient is a Christian however he does not attend church, however he believes in God and hopes that
God will help him with his process of recovery. The patient claims that he draws most of his strength to move
on from God and from his family who are ever there for him.
Cultural
The patient is Caucasian and thus can express himself comfortably in English both through spoken and written
word. The patient however has no strong affiliation to any cultural heritage or tradition that are likely to be in
contradiction with his medication plan.
Clinical Manifestations
Expected clinical manifestations/complications for medical diagnosis and any
manifestations/complications witnessed on day of care:
The expected clinical manifestation that are associated with the left infarction associated with the lunar
stroke include, numbness in his limbs, there could be slurred speech. Other manifestations that are likely to be
witnessed in the patient include confusion, dyspharia, loss of consciousness, headache and some difficulties in
walking. During the patient stay in the hospital the patient only experienced a number of symptom that include
numbness and weakness both in his hands and legs. Both the patient and the physicians have managed to
monitor the symptoms that the patient has shown so as to be able to tell when any further symptoms reappear.
The patient has been responding well to the therapies that he is undergoing and as such he can be said to be
progressing well as the weakness is gradually reducing with time
13
Laboratory Test
Test:
Results:
Normal
range:
High or
Low or
WNL
Relevant Rationale for ABNORMAL Test Results and
relate to any monitoring in relation to medications
CBC & DIFF:
***NOTE can make print smaller in grid- go to 10and single spaced
WBC
8.1
4.5-10.5 x
10^3/mm^3
The patient recently underwent surgery and prior to surgery had a
suspected pulmonary infection. Therefore, it is especially
important to watch the WBC level to ensure no infection is
developing. One of the patient’s medications, erythromycin
ethylsuccinate, mandates monitoring WBC count.
RBC
3.99
3.6-5.0
million/mm^3
low
The RBC level are low which could indicate that the patient is
becoming anemic
HGB
16
14.0-17.4 g/dL
Hemoglobin is important for the transportation of oxygen, helps
in the evaluation of anemia
HCT
44.9
42%-52%
It measure the percentage of RBC’s packed in the whole blood
and thus can be used to check for aneamia
Platelets
9/19
228 x
10^3/mm
^3
140-400 x
10^3/mm^3
WNL
Because the patient is receiving injections of heparin every 8
hours to prevent clots, it is essential to keep track of the platelet
levels. Platelets are necessary for blood clotting and with heparin
the patient is at increased risk for bleeding.
14
Basic Metabolic Panel or BMP:
Test:
Results:
Normal
range:
High or
Low or
WNL
Relevant Rationale for ABNORMAL Test Results and
relate to any monitoring in relation to medications
Na
139
135-145
mEq/L
Within
normal
ranges
Useful in regulation of the process of osmoregulation in the
body
K
3.9
3.5-5.0
mEq/L
WNL
Potassium plays“an important role in nerve conduction, muscle
function, acid-base balance, and osmotic pressure…it also controls
the rate and force of contraction of the heart and cardiac output”
Because potassium has these essential functions in the body, levels
need to be closely monitored for all patients
Cl
99
95-107
mEq/L
Within
normal
ranges
Necessary in the process of proper muscle functioning
CO2
32
23-30 mEq/L
Within
normal
ranges
Released during the process of breathing, useful in telling whether
there is proper balancing in the process of breathing
BUN
16
6-20 mg/dL
Within
normal
ranges
Blood urea is useful in measuring glomerular functioning
Creatinine
1.02
0.5-1.2 mg/dL
Within
normal
ranges
Useful in determining whether the process of excretion is taking
place normally
15
Glucose
47
60-100
mg/dL
Low
Used in providing the body extra energy in times of starvation
Complete Metabolic Panel /CMP (BMP plus the following):
Test:
19Resul
ts:
Normal
range:
High or
Low or
WNL
Relevant Rationale for ABNORMAL Test Results and
relate to any monitoring in relation to medications
Calcium
9.4mg/d
L
8.8-10.4 mg/dL
Normal
Useful in strong bone formation therefore preventing body
weakness
Albumin
3.2mg/d
L
3.5-5.2 g/dL
Useful in measuring proper functioning of the kidney
Total
Protein
6.2g/dL
6-8
normal
Total proteins for the patient is within the suitable ranges thus no
cause to worry
AST
12.5U/L
Men: 14-20
U/L
Four of the patient’s medications (Atorvastatin, Metoprolol,
Pantoprazole, and Erythromycin ethylsuccinate) indicate a need to
monitor AST and ALT levels while taking them. These two tests
indicate liver function as well as potential heart disease. The
patient’s AST and ALT levels should have been drawn, but none
were documented.
ALT
19U/L
Men:10-40
U/L
Normal
Normal ranges though there is need to keep on monitoring the
levels
Alk Phos
49U/L
25-100 U/L
Normal
ranges
Normal ranges though there is need to keep on monitoring the
levels
Bilirubin
6.4umol/
L
Total: 0.3-1.0
mg/dL.
Abnorm
al
Not within normal ranges thus indicating a problem in the
process of excretion
16
Conjugated:
0.0-0.2 mg/dL
Urinalysis
Test:
Results:
Normal
range:
High or
Low or
WNL
Relevant Rationale for ABNORMAL Test Results and
relate to any monitoring in relation to medications
Color
Yellow
“The normal
color of urine
is pale yellow
to amber”
(Fischbach,
2009, p.205).
All of the patient’s results from his urine analysis came back
normal. One of the patient’s medications, Erythromycin
ethylsuccinate, indicates the need to monitor UA to check for any
blood or protein in the urine. The patient only had the one UA
performed, without no repeats. This is most likely because all the
results came back normal.
Appear
Clear
“Fresh urine is
clear to slightly
hazy”
(Fischbach,
2009, p.204).
The color of urine helps in detecting whether there any urinary
infection. Clear urinary indicates that the patient has no urinary
tract infections
PH
7.4
4.6-8.0;
average is 6.0
(acidic).
Normal
Normal PH indicate proper functioning in the kidneys
Specific
Gravity
1.005-
1.025
1.005-1.030
Normal
The specific gravity is within normal levels hence no cause for
alarm
Protein
Negative
Negative
N/A
Within normal ranges
Glucose
Negative
Negative
N/A
Within normal ranges
17
Ketone
Negative
Negative
N/A
Within normal ranges
Bilirubin
Negative
Negative
N/A
Within normal ranges
WBC
Negative
0-4/hpf
No
N/A
Within normal ranges
Others:
Test:
Results:
Normal
range:
High or
Low or
WNL
Relevant Rationale for ABNORMAL Test Results and
relate to any monitoring in relation to medications
Coagulation
Panel:
PT/INR, PTT,
D-dimer
9/15
PT: 12.3
aPTT: 31
seconds
INR: 2.1
PT: 11.0-13.0
aPTT: 21.0-
35.0 seconds
INR: 2.0-3.0
Normal
When a patient is taking heparin, it is important to look at their
aPTT level to see if it is elevated at all. aPTT-Monitor for
platelet inhibitors or anticoagulants- Plavix or Heparin
PT/INR- Coumadin
Cultures:
Blood, urine,
wound
N/A
Normal blood
culture:
Negative for
pathogens
Normal Urine
culture:
Negative
N/A
N/A
Diabetic:
HgbA1C
Patient is
diabetic.
HGBA1C
>6.5
Diabetic
Diabetic
The patient has diabetes mellitus type 2
18
Inflammation
Panel:
ESR, CRP,
ANA, RF
No value
listed.
NO value
No value
No value
Iron Panel:
Serum iron,
ferritin, TIBC,
UIBC
No value
listed.
N/A
N/A
Not applicable
Lipid Panel:
Cholesterol
HDL, LDL,
Triglycerides
C: 161
mg/dL
H: 56
mg/dL
L: 79
mg/dL
T: 129
mg/dL
C:140-199
mg/dL
H: 35-65
mg/dL
L: <100
mg/dL
T: <150
mg/dL
Normal
ranges
Normal ranges though need for close monitoring to ensure
patient weight level is suitable.
All information retrieved from
Diagnostic tests
Test
Rationale for
Ordering Test
Results
Explanation
8/25/2014
Echocardiogram
The patient was
experiencing
unspecific chest pain
as well as SOB.
Evaluate for mitral
valve disease.
The results showed severe mitral valve
prolapse involving the posterior mitral
valve. There was a flail of the posterior
mitral leaflet, with direct evidence of
ruptured chordae. Severe mitral
regurgitation determined. Normal left
The patient has a history of mitral
valve prolapse, which was
diagnosed 10 years prior, as well
as hypertension. Mitral valve
prolapses is the bulging of one
or both of the valve leaflets into
19
ventricular size noted. There was
hyperdynamic left ventricular systolic
function. Ejection fraction determined to
be 73%.
the left atrium during ventricular
systole” (Black and Hawks,
2009, p.1385). Over time, this
can lead to the weakening of the
chordae tendinae, finally
resulting in rupture.
MRI
A CT scan which is
a type of x-ray was
ordered and taken
after the patient
was allowed to
take. This was due
to the fact that the
patient was
admitted on
grounds of major
complaint of left-
sided weakness as
part of the
initiated stroke
code. A CT was
also taken upon
admission to rehab
facility
The CT Scan identified a focal region
in the left cerebellar peduncle which
restricted diffusion in the brain.
A normal CT scan would find
no abnormal process
occurring in any tissue of the
brain. A such the information
is very useful to the nurse as it
helps the nurses to have
supporting evidence
concerning the diagnosis of
left ischemic lacunar stroke.
Chest X-ray and
EKG Imaging
A chest X-ray was
ordered to
determine any
There were no active disease found in
the chest
Important to the nurses so as
to be able to identify if the
patient had any chest related
20
abnormalities
issues.
A CT scan of the
pelvis was also
conducted as the
patient had
complained of
weak nesses in the
legs
No abnormal process were found in
the pelvis
The test was important for the
nurses to be able to identify
what could be the root cause
of the weakness in the legs
Medications
Drug Name
dose and
route
Indication
(specific to
your
patient)
Mechanism of
Action
Possible Side
Effects
Nursing
Implications (labs
to monitor, etc.)
Patient Education
Docusate
calcium
250 mg twice
a day
Acts as a
stool
softener.
Softens stool
for ease in
egestion
cardiac
contractility
treats
occasional
constipation.
Assess the patient’s
constipation levels
and the way they
respond to the drug.
Educate patient on when to
stop the medication
Bisacodyl 10
mg daily
Serves to
relieve
constipation
To control the
constipation
suffered by the
patient
Treats stomach
constipation
Need to assess for
nay side effect. If
used for long-term
therapy it can lead
The patient should report
any cases of ototoxicity and
any allergies coming up as a
result of the drug. The
21
Other Treatment Modalities
Treatment
Schedule
Rationale for Treatment
Speech Therapy
The patient is being seen by a Speech
Therapist 3 times a week for a period of
two weeks.
Speech Therapy is common for stroke
victims. “About 83% of survivors
receiving a video fluoroscopic swallow
study receive referrals to other specialists,
swallowing therapy, prescribed
to diarrhea
patient must not exceed the
recommended dosage.
Glucose
11mg only
when
necessary
To increase
energy
levels in the
body
Treat diabetes
as a way to
control sugar
levels
No side effects
Patient should take only
when necessary
Lactulose
20g/30ml
Used to
induce
bowel
movements
Useful for
gastrointestinal
treatments
No side effect
Only taken when there are
no bowel movements
Novolog flex
pen
3 units for
BG151-200
5 units for BG
201-250
7 units for BG
251-300
9 units for
BG 30-350
11uints for
BG 351-400
13 units for
BG 401-450
Insulin
useful in
insulin
regulation
Treatment of
diabetes
No visible side
effects
Should be taken by the
patient as per the doctors
direction, there is need to
notify the patient incase
BG is more >=350
All information retrieved from
22
compensatory strategies to improve
swallowing, changes in nutritional intake,
and/or diet changes” (Mauk 2012 p.233).
Though the patient’s speech
comprehension and ability to speak is
intact, the patient still had speech therapy
appointments to work on strengthening the
swallowing muscles as well as to learn
techniques to compensate for the loss of
function. (Mauk 2012 p.233)
Physical Therapy
1000-1200, 1400-1500 on a daily
basis
The patient is supposed to
participate in physical therapy so as
to be able to attain full functioning
of the body and strength in the left
extremities. The patient has left
sided hemiparesis, meaning he
experiences some level of
weakness left upper and lower
limbs. The expected outcome of the
physical therapy is that the patient
should be able to regain strength in
the limb muscle as this will enable
him to stop feeling the weakness
Occupational Therapy
1000-1100 on a daily basis
The is need for the patient to
undertake occupational therapy so
as to enhance the strength of his left
23
side so that he is able to do his daily
activities. The expected outcome for
the therapy is that the patient
should be able perform ADLs even in
the absence of his caregiver.
Discharge Plan
An important priority for discharge is the need to consider a stroke prevention in the future. There is also
need to consider a symptom awareness. The patient however need to make a change in his lifestyle especially
his eating habits so as to manage his weight. The patient also needs to be educated so as to manage his
hypertension. The nurse also need to educate the patient on the need to manage the way he rises especially if he
is in a sitting position. The patient should also need to educated on each type of medication that he undertakes.
For example, the patient and his wife need to be taught on the need to use a blood pressure machine. The patient
also needs to be educated on the need to be aware of the black box warning that comes with the carvedilol since
the patient should not continue the medication consistently since a life threatening condition may occur.
The health practitioners need to assess the effectiveness of his teaching to the patient. For example, the
nurses can assess their teaching effectiveness by asking the patient question to ensure that they have understood
the medication and the way to take it. The patient can also be asked to mention some of the risk factor that can
lead to the cause of another stroke. Other ways of ensuring that the patient is ware of thecae he need s is to ask
the patient to name some of the symptoms of a stroke so that in the future if it happens he is able to tell if he has
a stroke or not. His family especially his wife also need to be made aware of the care that she needs to give to
his husband and how to go boat the medication. The patient is going to need some follow up from the physician
and thus will be needed to check with the physician every two week so as to be able ascertain his progress and
to be able to monitor any progress in the symptoms that he may be having.
24
Nursing Diagnosis and Plan of Care
Nursing Diagnosis #1: Risk for Aspiration related to impaired swallowing.
Nursing Goal/ Expected Outcome: The patient will tolerate tube feedings throughout the nurse’s shift, 0700-
1930, without any episodes of nausea, vomiting, or aspiration.
Intervention #1: During tube feedings, the nurse will assess the patient’s respiratory rate, depth, and
effort, making sure to make any signs of aspiration (coughing, dyspnea, cyanosis, wheezing, or
hoarseness).
Rationale: “Signs of aspiration should be detected as soon as possible to prevent further aspiration and to
initiate treatment that can be lifesaving. Because of laryngeal pooling and residue in clients with
dysphagia, silent aspiration (i.e., not manifested by choking or coughing) may occur” (Ackley &
Ladwig, 2011, p.152).
Evaluation: Patient did not experience any aspiration
Nursing Diagnosis #2 A decrease in the cardiac output which is related to the increase in peripheral vascular
resistance secondary as a result of hypertension
Goal/outcome. The patient will verbalize, demonstrate knowledge of, and participate in a minimum of two
activities for stress management and rest by 1600 after all of the patient’s scheduled therapies.
Interventions and rationale. The patient will attempt to rest in a calm environment with minimal environmental
noise and activity to help promote relaxation and reduce stimulants. The patient will schedule blocked periods
of uninterrupted rest to lessen physical and emotional stressors which may cause an increase in BP, affecting the
diagnosis of hypertension. The patient will participate in relaxation techniques such as guided imagery to reduce
stressful stimuli and calm the patient, therefore reducing the BP.
Evaluation. The patient was able to successfully demonstrate and verbalize knowledge of three methods
of stress management and reduction
Conclusion
25
One of the major learning outcome that was as a result of the restorative nursing practice was concerns
about the safety of the patient. For example, in an event that a nurse almost gives a wrong dose to the patient
there is need for the nurse to notify the nurse in charge so as to seek a clarification. In such a case the nurse
must be able to file an incident report so as to avoid such an incidence occurring in the hospital. The label
similarities are often the major cause of making confusion in medication.
It is also very important for nurses to be able to identify patients correctly. to avoid patient confusion
when seeking to administer a therapeutic or procedure assessment it is important for the nurse to use two
identifiers. For example, the nurse may consider using a combination of tow of either of the following
identifiers, a wristband, Chart or work station wheels. In case the patient is not able to speak the nurse may
compare the patient name with the medical records.
References
Ackley, B.J., Ladwig G.B., & Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to
planning care (10th ed.). St. Louis, MO: Mosby Elsevier: pp. 152
26
Asimos, MD, A. W. (2017, April 26). Evaluation of the adult with acute weakness in the emergency
department (R. S. S Hockberger, MD, FACEP & J. Grayzel, MD, FAAEM, Eds.). Retrieved February
12, 2018, from http://www.uptodate.com/contents/evaluation-of-the-adult-with-acute-weakness-in-the-
emergency-department
Oliveira Filho MD, MS, PhD, J. (2017, August 28). Lacunar Infarct (S. E. Kasner, MD & J. F. Dashe, MD,
PhD, Eds.). Retrieved February 15, 2018, from https://0-www-uptodate-
com.patris.apu.edu/contents/lacunar-infarcts?search=basal ganglia
infarct&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H19195119
1
Mauk, L. Kristin. (2012). Rehabilitation Nursing: a contemporary approach to practice. Valparaiso, Indiana:
Jones and Bartlett Learning: pp. 233
Copy of the articles where you can find here
https://textbookcentre.com/catalogue/nursing-diagnosis-handbook-an-evidence-based-guide-to-planning-care-
10th-edition_15930/
https://trove.nla.gov.au/work/38120038
https://www.uptodate.com/contents/evaluation-of-the-adult-with-acute-weakness-in-the-emergency-department
https://0-www-uptodate-com.patris.apu.edu/contents/lacunar-infarcts?search=basal ganglia
infarct&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H19195119
1

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