NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan GC

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan GC

Introduction

According to George et al (2017), stroke first as the leading cause of long-term disability and the second leading cause of death across the world. In the US, about 800k cases of stroke occur annually; hence stroke is the fourth leading cause of death among women and the fifth leading cause of death overall (National Center for Health Statistics, 2018). There is a need for prompt recognition and treatment when a stroke develops. In patients with ischemic stroke, emergency treatments that help restore blood flow to the brain by removing or dissolving the clot blocking a brain artery have been found effective in improving outcomes. Fragmentation of stroke care is a major challenge in delivering the right care at the right time. Today, most acute stroke care is offered in different care environments such as hospitals, homes, emergency departments, and emergency medical services settings. The lack of communication from one caring setting and professional to the next can lead to inefficient or suboptimal care and confusion for the patient as well as their families when transitioning from one care to another (George et al., 2017). The challenge of fragmentation and its associated mortality and morbidity can be reduced and overcome where multiple, distinct components function as an effective and efficient integrated system.  

Cases of strokes could be prevented and improved by making healthy lifestyle changes and working with the healthcare team to control medical conditions that worsen or increase the risk for stroke. Choosing a healthy diet, maintaining a healthy weight, don’t starting or quitting smoking, and avoiding too much alcohol that can lead to hypertension can help improve the health situation of stroke patients 

Goals to Address Stroke

The nursing care planning goals for patients with stroke and the family include preventing complications, improving mobility, prevention of aspiration, avoidance of should pain, restoring family functioning, continence of bladder and bowel movement, achievement of self-care, relief of sensory and perceptual deprivation, maintaining skin integrity, and improve thought process

Care Plan 

It requires enormous effort to recover from a stroke. Caregivers must possess the skills and techniques to care for stroke patients, support them, and show them attention throughout the recovery period. They should create a positive emotional climate around the patient during rehabilitation therapy. When caring for a stroke patient, it is important to encourage independence and mobility all the time, discourage being depressed or lying down for too long, and praise every small achievement. Besides, measures meant to prevent recurrence must be taken. This allows consolidating and prolonging therapeutic effect as well as protecting the person from future health risks. The general care plan for homecare that the caregiver should provide includes:

Hygiene 

It is important to thoroughly clean the patient’s oral cavity if they cannot do it by themselves. Dentures should be removed for the night if necessary as they cannot be used by unconscious patients. Also, the patient’s bedding need to be changed at reasonable intervals; the bed should be made with special care, smoothing out all the bumps and folds because they can cause skin irritation and even bedsores for the ailing person. Those recovering from the disease must observe strict cleanliness. A relatively mobile patient should be helped with washing up and brushing teeth. Where he or she is unable to do this, the caregiver should wipe all folds of skin, face, neck, and the area behind the ears with cotton soaked in warm water or a gauze napkin. Following these instructions will help subside the post-stroke state and the patient will feel better. However, an important step at the start of the rehabilitation process is monitoring any changes on the surface of the patient’s skin like peeling, rash, and cracks. Recall that when the patient lies on their backs for an extended period, blood circulation in the skin and soft tissues is interfered with, particularly in places that are densely pressed to the bed such as heels, sacrum, elbows, and should blades. Pressure sores can also form due to poor hygienic care of the skin, crumpled linen, or an uncomfortable bed. Due to this, the patient should be turned every 2-3 hours and left in a new position for some time. Hygiene is an important element in the stroke rehabilitation process.

Nutrition

A good diet is an important section of the nursing care plan for patients with stroke that recharges a body that has endured an immense amount of stress. A healthy diet brings joy and helps regain power along the tough recovery journey. A patient with severe stroke should be fed with sour-milk products, non-hot liquid semolina, mashed liquid vegetable puree, and similar foods using a teaspoon. A blender is also recommended for grinding foods. The food should be served in small portions to allow the patient time to chew and avoid choking. Those in severe condition need to eat four to five times per day (300-400mg/serving) and the total volume of liquid should be approximately 1.5-2 liters daily. The ration should be rich in calories for a faster recovery but at the same time should not contain anything heavy for the stomach. Sugar, fried foods, spices, coffee, and tea should be avoided. 

Motor activation 

Restorative exercises are another important part of a stroke care plan. While lying on the back, the patient’s paralyzed arm should be put on his stomach in a bent form or taken away at an angle of 40-600 from the body. The regimen should be changed as the patient regains consciousness and speech. With the physician’s permission, the caregiver can raise the patient’s back using a pillow. After this, the patient should gain enough strength to get up on his own. Patients who can independently sit in bed should be supported to test it with a stable chair beside the bed. The patient should be allowed to stand near the bed, holding on to something for support if he or she easily tolerates a sitting position (no fear, dizziness, weakness). After learning to rise, the patient will slowly learn to walk again. First, he will need a special support cane with four legs before transitioning to the usual one. Be patient, because the leg muscles will gradually become strong and walking ability would soon be reestablished. Moving fingers and toes, gripping objects, crumbling paper, and sitting trunk rotations are effective therapies in the treatment of stroke survivors. The whole process of movement recovery takes approximately six months and during this time, exercise and massage therapy must be done daily. After doing this, you can be sure that the patient will recover. 

Care Coordination Resources List

Community support for stroke, including resources and support groups is important in helping stroke survivors to recover well, re-socialize, and transition into their communities. Some of the online resources for stroke patients are:

American Stroke Association (www.strokeassciation.org) 

This organization collaborates with the American Heart Association to provide valuable tips for life after a stroke, like selecting the best rehab facility based on patients’ needs. The site offers subscriber information for the award-winning Stroke Connection magazine that is published every three months and contains information for survivors of stroke and their families. 

The Internet Stroke Center (www.strokecenter.org)

This online resource provides caretakers with instructions and stokes recovery guides for patients. Visitors find home modification instructions such as changes to the kitchen, bathroom, and bedroom. Black Americans who have suffered a stroke are also provided with a special caregiving guide. 

The Atlas of Heart Disease and Stroke (www.who.int/cardiovascular_diseases/resources/atlas/en/) 

This website was created by the Centers for Disease Control and Prevention and WHO to address the global pandemics of stroke and heart disease. It has six sections with each written in a simple, concise language. It also includes images to assist readers to visualize the information. The website covers topics such as ways to reduce the risk of future stroke, treatment, and health education.

Rehab Without Walls (https://www.rehabwithoutwalls.com/services/stroke-rehabilitation/)

This organization offers personalized stroke rehab to meet emotional, physical, and cognitive recovery. It helps the patient and family come up with coping strategies to adjust to the new reality. The organization also works with the patient and family to set long-term personal goals such as returning to work, hosting a party, or coaching soccer again.  A team approach is used to help the patient during the recovery process. For instance, the physical therapist (focus on gait and balance) and the occupational therapist (focus on pathfinding and comprehension) may be ordered to go for a walk with the patient. 

References

George, M. G., Fischer, L., Koroshetz, W., Bushnell, C., Frankel, M., Foltz, J., & Thorpe, P. G. (2017). CDC grand rounds: public health strategies to prevent and treat strokes. MMWR. Morbidity and mortality weekly report66(18), 479.

National Center for Health Statistics. (2018). The underlying cause of death 1999–2014. Atlanta, GA: US Department of Health and Human Services, CDC. National Center for Health Statistics.

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