Case study of Mr Harold Blake-Free-Samples-Myassignmnthelp.com

Question: Discuss about the Case study of Mr Harold Blake. Answer: The following assignment involves the case study analysis of an 83-year-old man, Mr Harold Blake who had a complex medical history of angina and left cerebral vascular accident. He was admitted to hospital after an episode of left cerebral vascular accident (CVA) followed by angina. The patient had an episode of CVA on his left side that impaired his mobility and sudden weakness and numbness resulting in paralysis on one side of the body. Moreover, after an angina episode, focused diagnosis is required looking into the medical history, physical examination and various signs and symptoms assessed in the emergency department (ED). Therefore, the assignment involves the plan of care for the patient along with rationale, short and long-term goals for recovery followed by legal and ethical considerations required for the case study analysis. The plan of care also requires inter-professional collaboration in giving well-articulated care that will also be discussed in the following essay. Anxiety is one of the main priorities after an angina episode, as Harold may fear of threat of sudden death. The patient that is accompanied by autonomic response experiences the condition of vague and uneasy feeling of discomfort or dread. This condition may be situational crisis or threat as he had encountered a second angina episode or due to underlying pathophysiological response (Anderson et al. 2013). In the case study, Harold was accompanied by negative thoughts, as he was worried about the effect of the diseased condition on his lifestyle and family. This was evidenced in him, as he was unable to comprehend as what was happening to him accompanied by restlessness, uncertainty and apprehension. The immediate and main nursing goals in the plan of care in reducing anxiety to a manageable level and verbalize awareness among the patient about feelings of anxiety with effective demonstration of coping skills. For reducing anxiety attributable to fear of unknown prognosis and diagno sis, it is important to perform stress testing in order to gather information about activities that preceded and precipitated the episode of angina detecting his response to the condition. It is important to promote the patients expression of fears and feelings because unexpressed feelings can create turmoil and presence of negative talk contributing to exacerbation of the condition (Jespersen et al. 2013). The nurse should administer tranquilizers, sedatives as indicated to relax him until he is able to cope up with the present condition. The nurse need to reassure Harold that medical regimen designed for him is aimed at reducing the future chances of angina attacks and increase stability. The rationale for this intervention is to encourage Harold to control his present symptoms, increase confidence and integrate his abilities in the plan of care (Amsterdam et al. 2014). As Harold is worried about his position in the family and lifestyle, his family need to be encouraged to treat h im as before so that he is reassured about his position in family and in turn reduces his anxiety levels. This is both a short and long-term goal as family need to maintain healthy relationships with Harold so that he feel secured and have fast recovery (Huffman et al. 2014). The second priority for the plan of care is impaired physical mobility as CVA affected his left side of the body and impaired mobility. The sudden onset of neurological deflects as a result of compromised blood flow affected his mobility, verbal and non-verbal response (Inglis et al. 2013). As a result, there is impaired physical mobility and affected physical movement in one or more extremities in the body. Decreased superficial reflexes, weak neuromuscular involvement, paralysis and perceptual or cognitive impairment can possibly evidence this condition. The nursing goals increase in function and strength of physical movement by the compensatory affected part and maintenance of optimal functioning in Harold and demonstration of behaviours that enable his activities resumption (Yi?iner et al. 2016). The plan of care involves assessing of extent of impairment on a scale from 0-4 because it helps to identify the deficiencies and strengths of Harold regarding recovery following the sec ond day. He should be made to change positions every 2 hours for reducing tissue injury, poor circulation and sensation. He should also be positioned in prone position depending upon his activity level because it helps to maintain his hip extension. There should also be beginning of passive (Range of Motion) ROM after admission and encouraging exercises such as squeezing, gluteal exercise, and extension of legs, fingers and rubber ball because there is minimization of muscle atrophy. This also promotes circulation and prevention of contractures along with reduction of risk of haemorrhage (de Oliveira Medeiros, de Arajo and de Arajo 2013). The nurse should assist Harold in developing sitting balance by head raising from bed and assisting him to sit on the bed. Moreover, the patient should also be supported at the lower back and knee positioning using parallel bars. The rationale for this intervention aids in enhancing proprioception, retraining of neuronal pathways and motor response . The long-term goal is to prevent pressure ulcers by positioning the patient and aligning of extremities correctly using high-top sneakers for footdrop prevention or pulsated mattresses (Evans et al. 2015). Fluid imbalance is the third priority as it is a common complication in CVD. Electrolyte and fluid imbalance can be life threatening for Harold due to rapid heart rate and tachycardia. The nursing goal involves maintaining normovolemic conditions, demonstration of lifestyle changes for avoiding dehydration progression and encouraging Harold to verbalize awareness of behaviours and causative factors for detecting correct fluid balance (Aronson et al. 2013). For the plan of care, the vital signs like heart rate and blood pressure should be monitored and documented as alteration in heart rate and decrease in volume of circulating blood can result in tachycardia and hypotension. There should also be assessment of oral mucous membranes and skin turgidity for dehydration signs as elderly skin losses elasticity and hence skin turgor assessment is required (Floras and Ponikowski 2015). There should also be monitoring of fluid status that is related to dietary intake and this is important to verify that Harold is on fluid restraint or not. There should also be monitoring of serum electrolytes, urine osmolality to report abnormal values as elevated levels of blood urea nitrogen may indicate fluid deficit. The patient should be administered daily for fluid intake and need comparison with 24-hour output and input. This is important because these measurements indicate intravascular volume. There should also be monitoring of vital signs like orthostatic and hypotension and temperature elevation because these measurements are helpful in the determination of fluid deficit from the body (Lee et al. 2015). The nurse needs to ascertain the beverage preferences of Harold and encourage high fluid intake while consuming foods because it relieves discomfort and thirst. The plan of care should also involve taking safety precautions using bedside rails, bed placed in low position and if required soft restraints should be used. This would help to prevent patient fall and injury as decre ased cerebral perfusion often results in altered thought process and created confusion (Moorhead et al. 2014). Legal and ethical considerations are present in geriatric care and in case of Harold; ethical issues are involved as he is vulnerable as compared to an average adult. Ageing is a dynamic and complex process that is intricately inseparable and interrelated psychological, physiological and sociological aspects of human life. In this case, the ethical considerations involve conflicts of interest that may arise between Harold and professional caregivers or his family members. Harolds interests may interfere with healthcare professionals and these conflicts may interfere with the actual plan of care and treatment of Harold. Therefore, in context to elderly care in the case study, confidentiality should be maintained, as substantial amount of patient information like past medical history is required from Harolds family members. The healthcare professionals owe a duty of confidentiality to the patient that personal information should not be shared with others except for medical purpose (Car lson and Idvall 2015). In this case, informed consents should be taken from Harolds family maintaining confidentiality and disclosing only with prior consent from the patients family. The legal consideration involves decision-making capacity in case of elderly care, Harold. As the thought process is altered in the patient due to CVD accident, he may or may not be competent in participating in the medical decision-making process (Sahota et al. 2013). Therefore, in this case study, it is important for the healthcare providers should focus on including the family members in the decision-making process, as Harold is unable to think clearly about the medical decisions and consequences thereafter. For providing integrated care and assure that his needs are fulfilled, a specialist multi-disciplinary team (MDT) comprising of healthcare professionals like cardiologist, cardiac rehabilitation specialist, nurses, case managers and nutrition specialists are required. This combination is helpful in providing spectrum of approaches and manages Harold individually through tailoring in meeting patients needs. Depending upon the angina episode, cardiologists attended by junior medical nurse staffs perform assessments and develop plan to manage the emergency condition of angina episode. The case manager has the responsibility to undertake the assessment, planning, monitoring and advocate Harold case, linked it with support and rehabilitation services like cardiac rehabilitation specialist functioning for the illness management and prevention of further angina episodes. Nurses play the most important role in patient care as Harold is critically ill and it is their responsibility to relieve him from acute pain and cardiac workload reduction. The nurses in collaboration with nutrition specialists execute the plan of care for Harold monitoring his vital signs, fluid and nutrition balance, administration of medicines while working with families in indentifying their risk factors and necessary lifestyle modifications (Feltner et al. 2014). The allied healthcare professional in case of Harold is speech pathologist. Due to CVD, Harold exhibited sudden weakness, numbness and paralysis that results in decreased verbal and non-verbal response. Therefore, there is need for a speech pathologist or therapists for assessing, diagnosing, treating and assisting Harold in speech, voice, language, swallowing, cognitive-communication and fluency. Speech therapist is a part of team working in collaboration with cardiologists, rehabilitation nurses and specialists and physicians in improving communication and speech with Harold (American Speech-Language-Hearing Association 2016). From the above discussion, it can be concluded that angina episode requires integrated care for the better management of the patient by a MDT. In the case study, Harold was admitted to hospital after an episode of angina and CVA and at the hospital, the MDT provided a plan of care from emergency treatment to recovery. The plan of care involves three main priorities; anxiety, impaired physical mobility and fluid imbalance. The essay discussed the plan of care and rationale for the patient for managing and stabilizing his condition. 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