Question

Life expectancy for older Australians is increasing due to advances in nutrition, healthcare and medications. Increasing longevity, however, can lead to a gradual decline in physical and mental capacity and growing risk of disease, with many health conditions, and associated impairments associated with ageing. Nursing care for the older person must include consideration of these impairments, particularly when patient safety is compromised.

This assignment requires you to write an essay discussing the implications of nursing care for a patient with Cerebrovascular accident.

In your assignment, consider the following: Discuss the issues associated with this condition which impact patient safety in the clinical environment, (for example, confusion, deteriorating mobility etc.)

Explain how the condition affects the older persons’ ability to safely perform their activities of daily living

Consider the implications for patient safety that should be considered in the development of nursing care plans for patients suffering from this condition (consider basic, patient centred nursing care and communication requirements)

Answer 1

#. Nursing Care :-

-ASSESSMENT OF ABCs ALWAYS FIRST PRIORITY

-Frequent neuro assessment (monitor for inc. ICP (more common with hemorrhagic))

-VS monitoring (possible permissive HTN; cardiac monitoring, esp. if a-fib)

-Antithrombotic therapy (ASA, plavix, coumadin): if tPA start 24hr AFTER, if no tPA start WITHIN 24hr

-Head CT/MRI trend over time

-Assess for pain, N/V

-Assess and treat fever (keep temp down to promote homeostasis)

- Assess the safety of the patient

-Bedsite swallow eval by MD to determine toleration of PO intake (determines need for SLP)

#. Nursing interventions :-

-Improve mobility (proper positioning, splint PRN, reposition Q2, ROM, OOB asap, PT/OT)

-Maintain skin integrity

-Prevent shoulder pain (paralysis can lead to neglect of arm; place on pillows, pain meds, use care with movement)

-Prevent aspiration (SLP eval, feed assist, elevate HOB and tuck chin)

-Enhance communication (SLP, communication board, speak slowly to allow time for processing

-Promote nutrition (may need enteral feeding)

-Promote blader function (may have incontinence or retention; may need intermittent cath)

-Promote bowel function

-Prevent complications (immobility, depression, etc.)

-Promote self-care

-Improve sensory/perceptual dysfunction

-Improve thought processes (re-orient PRN; maintain safety)

-Cope with altered sexual function

-Facilitate family functioning

-Rehabilitation

- safety precautions such as always raise the bed rails up , keeping floors dry , keeping patient article nearby to them etc

-Patient/fam edu on preparing for home (may need home health services)