Question :
The case scenario of Harold who has history of cerebral vascular accident (stroke) thus he was admitted to hospital after episode of angina and advised by doctor for surgical treatment.
- Give brief description of Harlod what disease he was suffering from?
- Identify need of patient and their complex care need
- Develop a care plan for patient and accessibility of health services.
- Describe the barriers to effective care planning.
Answer :
INTRODUCTION
Medical professionals are required to provide quality care services to the patients. They have to look at their medical history and accordingly have to prescribe them medicines and care. This helps them in improving condition of care users soon (Walther and et.al, 2017). Present study is based on Harold who is 83 year old man. He has past history of cerebral vascular accident and angina. Cerebrovascular accident (CVA) is the medical term which is used for cardiovascular problems such as stroke. It is the condition in which blood flow in the brain get stopped and due to blockage of blood person have to suffer from mental issues. Angina is chest pain, it is the heart disease in which caused due to reduced level of oxygen. In such situation blood fails to reach to heart on time and individual suffer from sever pain. Harold has admitted in the hospital after episode of angina. He is the non drinker but past medical histories show that he is suffering from hypercholesterolaemia and hypertension. Harold has gone through surgical treatment for Coronary artery bypass graft and two hip replacements.
Present study will discuss needs of patients. Furthermore, it will provide a plan for care for the user that encompasses their transition to home. Furthermore, study will explain potential barriers to effective planning for transition of care.
TASK
Needs of patients
Harold is the old age man who is suffering from Angina. He has various needs that are related with his medical condition. If these needs are being fulfilled the n individual will be able to live a healthy life. Needs of Harold are described as below:
Health care needs (Personal care)
Harold is the 83 old person, he has past history of cerebral vascular accident and angina. In the past he was suffering from Ischaemic heart disease, spinal injury, hypertension, two small ulcers etc. In such condition it was difficult for the person to perform their daily function easily. He needs personal care from the medical professionals (Ventura and et.al., 2014). Practitioners are required to give personal care to the patient so that their medical condition can be improved soon. Recently he is suffering from angina in which he has to bear sever chest pain. In such condition he needs close monitoring and care from the medical professionals. Doctors have to look at the medical history of the patients and accordingly have to prescribe them medicines. He needs secure environment because as he has gone through spinal surgery thus, he can not perform daily work without any support (Emerson and et.al, 2018). In such condition medical professional have to take care of their needs and have to provide them safe environment so that his medical condition can be improved soon. Due to his illness his confidence has been losses thus, he has need to get home environment in hospitals so that he can feel confident and can disclose all his medical history with the professionals in care home. Due to spinal surgery he needs all the time wheelchair. He has need of this wheelchair so doctors and nurses have to provide them this instrument so that he can move here and there easily (Minichino and et.al, 2018).
Social support needs
Another need of Mr. Harold is to get social support. Some times due to medical illness and old age people loss their confidence. In such condition they fail to coordinate well in the society. They become isolated from the society. His need is to enhance social interaction so he become involve in social activities. This boost the person and encourage them. By this way they activity take treatment for their illness (Larsson, Lööf and Nordin, 2017). If social needs of the patients are being fulfilled then it may help in recovery of the patients. Medical professionals are required to involve them in the discussion regarding treatment. This will help in increasing satisfaction level of patients and it will be beneficial for Harold in recovering soon from their medical condition. Social integration is the best tool that makes the person happy ad active. Inadequate communication between patient and staff members affect the person and individual feel alone. In such condition they fail to take proper treatment from the medical professional. Strong social network, effective communication always help the patients in changing their life. They become positive and always want to remain healthy (The Psychological and social needs of patients, 2011). As Harold is 83 year old man and he has less interaction with society members. If he gets social supports then he will be able to recover soon. He has need of good relationship with others for that health care professional have to interact with the care users and have to develop good relationship with them. This will support the Harold in improving their health condition soon (Minichino and et.al, 2018).
Psychological need
As Mr. Harold is the old age person, he can not take care of his health alone. In this age individual require love, support from family members. He also has need to get support from his family members. He wants to be with them and wants to share his feeling with them. This is the way that can help the person in feeling happy and individual can get recovered soon from their medical illness (Walther and et.al, 2017). He has past history of hypertension, if Harold gets positive environment from the family members then this illness can be minimized soon. Hypertension occur if the person is taking too much tension. Most of the time when individual fails to discuss their thinking with others then this tension get increased and individual fail to get relax. Communication with family, love and affection from close members assist in improving the health condition of the person (The Psychological and social needs of patients, 2011). If psychological needs of the person is being fulfilled then it assists in improving their situation well. One of the main cause of angina is hypertension. In the case of Harold he has hypertension due to which he has suffered from chest pain. If he got psychological support from family and friends then he may feel happy and by this way his condition may get improved soon.
Preparing care plan for Harold
A cerebrovascular accident (CVA) is a sudden loss to the brain functions that can have greater impact on overall supply of blood to the brain of individual. However, there are various factor that can increase the probability of occurrence of disease in generally people belonging to the age of 55 years and above. These conditions are, hyperlipidaemia, obesity, diabetes, smoking, periodontal disease, hypertension and atrial fibrillation (Hung and et.al., 2012). The patient may feel numbness and weakness on face arm or leg, especially at one side of the body with increased in confusion or noticeable changes in overall mental status of the individual. Other symptoms can be related to understanding speech, visual impairment or disturbance, dizziness, loss of balance, difficulty in walking or sudden and severe headache.
Common issue related to CVA is flaccid paralysis and loss or decrease in the deep tendons reflexes. Also, abnormality in the muscle tone in the form of spasticity can also e noticed on the patient. Apart from medications given to the patient, it is also important to manage the complication that has raised out of it, in the patients. Pulmonary care is required due to decreased flow of blood in cerebrum, with the management of airway for the patient and administration of supplemental oxygen as required by the patient. It must also be ensured that UTIs are constantly monitored with management of complications of immobility as well.
The plan of care may change as and when days passes, and improvement can be noticed in the overall condition of the patient. During Acute phase of (1 to 3 days), it is important to weight he patient regularly and maintain neurological flow sheet considering various aspects. The change in consists and responsiveness level of the patient must be ascertained with his ability to speak and his orientation. Harold, being in the phase due to his past medical history, presence of voluntary and involuntary movements must be ascertained along with muscle tone, body posture and constant head position. Comparative size of the pupil with ocular positioning will help in ascertaining the consciousness (Im and et.al., 2013). Further, quality of rates of pulses and respiration is also an effective indicator to ascertain the patient’s condition on hourly basis. In addition to this, volume of fluids ingested in the body and urine excreted out of the body in 24 hours must be judged. It must also be ensured that the blood pressure falls within the normal limit.
Since, the major impact due to CVA and Angina can be found on motor skills and mobility. It is important for the patient to have major goals for improved mobility, avoidance of pain in shoulder, relief in sensory and perpetual deprivation, continuous function of bowel and bladder, maintaining integrity of skin, absence of complications, bring improvement in overall thought process and ensure achievement of self-care.
In order to improve mobility and preventing any type of deformity in the body, it is important for Harrold, family and personal care staff to focus on maintaining the good body alignment and prevent any type of compressive neuropathies (Su and et.al., 2015). Application of splint can help at night can help in preventing any type of flexion. Elevating affected arm so as to prevent any type of oedema and fibrosis. Further, Harrold can also be initiated with changing position every 2 hours and placing the patient in a prone situation of at least 15 to 30 minutes, several times in a day can also help in initiating adequate amount of mobilization in the body.
It is important for Harrold that an exercise program is initiated with four to five full range of motions, in order to maintain mobility of joints, regain motor control, preventing the situation of paralyzed extremity, prevent deterioration of neuromuscular system and enhance the overall blood circulation of the body. Exercise can also be helpful in preventing any type of venous stasis which can also lead the patient to thrombosis and pulmonary embolus as well. It is important for the personals cares at home for Harrold to ensure that, he is supervised and supported during exercises and encourage him to exercise from the unaffected side at regular intervals in a day (Xu and et.al., 2014).
Assisting in nutrition is another important aspect linked to it where, patient’s food dribbling out, coughing and pooling of food in one side of the mouth is observed. Retaining of food in mouth is also assessed with nasal regurgitation when swallowing down of liquids so that appropriate measure for4 the same can be taken appropriately. Consultation to speech therapist is also an effective controlling measure that can help Harrold in teaching alternative swallowing techniques. As suggested by the doctor, it is important to give thicker liquids or pureed diet to the patient for better and effective results. Prepare a GI feedings with the help of a tube. Also, elevate head of the bed while feeding, constantly check tube position and administer it slowly by ensuring that the cuff of tracheostomy tube is inflated. Also, it is important to constantly monitoring excessive retained or residual feedings (Alkemade and et.al., 2012).
Sterile catherization is an option that can be adopted by the individual so as to attain bowel and bladder control in the patient in such a manner that urine pattern can be examined. It can help in offering urine or bed pan based upon the voiding schedule of the patient. It is also important to initiate a regular time for the patient based upon their toileting patterns.
It is also important for the patient to improve the overall thought processes with the help of various training programs with the help of cognitive perceptual retraining, visual imaginary, orientation with respect to reality and cueing procedures. Supporting patient in order to observe the overall performance and progress of the patient. It can be initiated with the help of positive feedback, conveying attitude of confidence and hopefulness. Further, providing other interventions can also help in improving the overall cognitive functions after a head injury (Ortega-Paz, Garcia-Garcia and Brugaletta, 2016).
It is important for Harrold to indulge in individually tailored program. That can help in jointly establishing the goals so that one can take active participation. The atmosphere must be communication friendly with analysing the patient’s reactions and needs and responses must also be assessed and evaluated in an effective manner. It is important to remain sensitive to the patient’s reactions and respond to their overall requirements so that appropriate actions can be taken that are effective enough for the patients. Providing Harrold with emotional support and understanding his anxiety can help in giving a better life to him (Im and et.al., 2013). The carers can be consistent with respect to the routines, repetitions and schedules. Some written schedules with appropriate checklists and audiotapes can help in bringing back the memory and concentration power of the patient based on which he can establish the communication board.
When the patient is residing at home, it is important to ensure that skin signs of breakdown is frequently assessed by having strong emphasis on the overall bony areas and dependent body parts. There are other pressure relieving devices as well which can help in minimizing shear and friction when the patient is involved in positioning himself. Further, having support form the side of family and counselling him regularly can help in building back the lost confidence. Teaching stress management techniques and maintaining personal health for family can help in providing conducive environment to the patient at home as well. The family of patient must also be aware regarding expected outcomes of stroke and they must be aware of all signs and symptoms linked to it. Developing attainable goals to the patients can help in managing him in total health care team, patients and family. Adoptions of these aspects at home can help in reducing the chances of re hospitalization of Harrold (Alkemade and et.al., 2012).
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The community care team can help Harrold in informing, advising and giving treatment options that are associated to stroke and CVA. Further, referral to specialist hospital or community care services can also be given to the patients in such a manner that if the current treatment I not suiting to the patient and require some second opinion from any other doctor. The team is also involved in conducting tests that are required to be conducted so as to analyse the condition of the patient. Routine procedure inclusive if wound dressing and blood pressure monitoring in also initiated by the team.
Since, there is a constant rise in overall statistics of CVA patients in Australia, it becomes important for the government to initiate actions that can help in reducing the occurrence of disease in patients. hence, government has come up with stroke management techniques that help in reducing stroke related disability among people. Specialised doctors in the hospital with adequate amount of funds given to this section with respect to treating individuals have been appropriately initiated by the team (Ortega-Paz, Garcia-Garcia and Brugaletta, 2016).
Potential barriers to effective planning
There are various types of barriers with respect to transition of care for Harrold. The issues can be related to cultural, spiritual, psychological and social processes. It is quite important for the patient like Harrold, who has already been suffering from CVA, to have cultural support from the side of society. There are various cases, where patient suffering from any type of disease is not appropriately accepted by the society that can ultimately affect confidence level of the patient.
Spiritual issues are also present where the family think that religious convictions can help in sorting out the issue in such a manner that there is not requirement for continuing any kind of health care treatment to the patient. In this scenario, the patient may not be able to achieve his goals by coping up with the disease. Further, health treatment and illness are by individual’s choice. Hence, cooperation from the side of patient and his family is very much required for the health care professionals so that appropriate treatment can be provided to the patient (Hung and et.al., 2012).
Another important aspect that is linked to barrier is social process where social acceptance is quite lacking in the case where, the patient gets dependent to the other individual or family. In this case, ageism and racism are the other social differentiators that lead to create issues in the treatment aspects of the patient. It becomes difficult to even fulfil the medication requirements. In this scenario, it becomes important to ensure that better provisions are framed for the patient so that goals and objectives of healthcare can be achieved in a well-defined manner.
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