Mr. Harold Blake Case Study Sample

• Subject Name : Nursing

Development of A Person-Centred Care Plan

Introduction to Person-Centred Care Plan

As per the given case study, Mr. Harold Blake is an 83-year-old who has been admitted to the hospital after an angina attack. He has a complex medical history with experience of left cerebrovascular accident (CVA), Gastro-oesophageal reflux disorder (GORD), hypertension, and many other severe diseases. The nursing diagnosis suggests that Mr. Blake is suffering from acute pain and has ineffective airway clearance. The aim of this paper is to provide suitable nursing interventions that are related to these two nursing diagnoses. This paper also focuses on the development of a person-centred care plan for Mr. Harold Blake, which can improve his medical conditions.

Development of A Person-Centred Care Plan

As per Toney-Bulter and Thayer (2019), person-centred care plans are systematic approaches to use the fundamental principles of nursing care to improve patient outcomes in the future. There are five steps of a person-centred care plan. These are an assessment that involved data collection related to patient's medical conditions, a diagnosis, planning the goals and outcomes of the care plan, an implementation that aims at executing the plans of the care plan to improve patient’s health conditions and evaluation in which the impact of the nursing interventions and care plan are acces). The person-centred care plan developed for Mr. Harold Blake will also include all these five comprising of Harold-centric approach of treatment, diagnosis of the problem, planning the interventions and implementation of the effective and efficient intervention.

Assessment

As per National Heart, Lung and Blood Institute (2018), angina is defined as the pain in the chest that is caused due to oxygen deficiency experienced by the heart. It is one of the most common symptoms of Ischaemic heart disease (IHD). The patient in the given case study has a medical history of IHD, due to which the patient had an angina attack. Hemiplegia is defined as the acute pain in the shoulders, and it is one of the most common symptoms of stroke and most of the patients having stroke attack suffer from hemiplegia (Caglar et al. 2016). It has been observed that the chances of pain development increase with the age, and geriatric population are more prone toward the development of this kind of pain. This is because the body's physiological, functional and cognitive systems change due to ageing as all these body systems start deteriorating with ageing (Rajan & Behrends, 2019).

The assessment of all these body systems is required for developing an effective patient care plan. According to the given case, the stroke team detected that patient has an intracerebral haemorrhage in the left basal ganglia. As per the Human Memory (2019), basal ganglia are the parts of the brain that is responsible for controlling voluntary movements of the body and postural reflexes. The patient is facing difficulty in speaking and controlling the postural reflexes due to intercerebral haemorrhage. Moreover, it can also be assessed that intercerebral haemorrhage has affected the cough centre of the medulla oblongata due to which the patient has declined cough reflex. Impaired swallowing or dysphagia is also observed in stroke patients as the stroke damages the cortex and brain stem that is responsible for controlling the muscles of swallowing (SmithHard, 2016).

Diagnosis

The diagnosis for hemileia or angina attack can be done through the symptoms experience during the stroke like vomiting, degraded neurologic response, or other medical history (Asimos, 2018). It has been assessed that patient is having acute pain due to angina attack and hemiplegia. Moreover, the patient is unable to control the voluntary actions of the right hand and right leg. The disuse of limbs and hands are also results of the acute pain caused after stroke attack. The inability of the patient's right leg and right hand are due to stroke attack which causes acute pain. Hemiplegia is also a condition that causes abnormal pain in the shoulders (SmithHard, 2016). All these assessments indicate that the patient is suffering from acute pain and that proper nursing interventions should be provided to the patient for better pain management. It has also been assessed that the patient has an intercerebral haemorrhage in the left basal ganglia. The basal ganglia are responsible for controlling the voluntary movements of the body. The damaged left basal ganglia due to intracerebral haemorrhage affects the brain's ability to control the voluntary movements. Moreover, the intercerebral haemorrhage has also affected the patient's coughing centre in the brain due to which there is a decline in the cough , 2019). The damaged basal ganglia have also affected the swallowing capability of the patient due to which patient faces difficulty in swallowing the food.

Planning

The planning of patient-centred care plan involves useful nursing interventions that can help the nurses in providing best patient care. The nursing interventions are provided to stroke patients to prevent any type of secondary brain injuries and to maintain the airways to avoid paralysis (Thefanidis & Gibbon, 2016). These interventions also help in providing general body support to stroke patients (Thefanidis & Gibbon, 2016). The patient has been diagnosed with acute pain and ineffective airway clearance and thus, the nursing interventions should aim at treating these two abnormal health conditions. The acute pain caused by a stroke can be reduced or prevented through adequate nursing interventions. The nurses should promote stroke patients to take medications timely to prevent stroke attacks. It is important that the nurses should include a physiotherapist in the multidisciplinary team who can help in pain per the doctor guidance, the physiotherapist should made responsible for the regular exercise of the patient. The physiotherapist help in monitoring patient physical activity, help in maintaining blood flow and proper metabolite activities.

These physical activities help in mediating the overall strength of patient. The patient should be given antipyretic medicine that will prevent hyperthermic condition (Nursing center, 2019). The nurses should timely monitor the changes in the movement of the patient's right hand and legs to evaluate the patient's recovery status. The nurses should provide lifestyle advice that can help the patient in managing acute pain. The acute pain caused due to hemiplegia can be reduced by using the methods of shoulder tapping (Stroke Association, 2017). The patient is also having difficulty in speaking and swallowing, thus, the nursing interventions should also aim at reducing these problems. Mr. Harold Blake suffers from various health issues, but he must be put on the good and nutritious diet. Stroke effect the whole body internally or externally as well. Thus, the good diet need to be encountered for better health. His diet must comprise of full good size three time meal, with healthy drinks. Fruits and vegetables should be introduced in the diet which help in boosting energy (Healthy eating and stroke). Along with this, his diet also contain protein, vitamins, mineral, fiber rich food. These help in increasing its antioxidants level, which increase the repairing mechanism of body and also, provide energy to him.

Evaluation of Person-Centred Care Plan

The implemented nursing interventions must be evaluated properly to understand their effect on patient's recovery status. All the nursing interventions that have been used to manage patient's acute pain, speaking difficulties and swallowing difficulty must be evaluated to judge whether the interventions were effective or not. The nursing intervention of conducting physiotherapy sessions can be evaluated by monitoring the movement of patient's right arm and right leg. In case, if these sessions have been effective, then the patients would not face any difficulty in moving the right legs and right arm. The nurse should take regular follow up regarding acute pain from the patient and should monitor the physiotherapy . Other than this, numeric rating scale, visual analog scale, and categorical scale can be used in identifying the level of pain the patient is suffering from. The effectiveness of medications that are used to control pain can be analyzed by observing their effect on patient's mobility. The nurse should evaluate the improvement in patient's speaking by observing whether the patient is still unable to speak clear words. The nurse should evaluate the social interaction skills of the patient to understand the nursing intervention of including a speech therapist in the multidisciplinary team. The interventions taken to improve swallowing difficulties can be evaluated by monitoring the improvement in the patient's ability to swallow the This an be addressed through meal time assessment tool, that help in improving and monitoring the eating habits of patients.

Health Professionals from The Multidisciplinary Team

The patient has been diagnosed with swallowing difficulty or dysphasia, which is associated with the abnormal functioning of the throat. The patients that have swallowing difficulty generally face a problem of odynophagia, which means pain while swallowing (National Institute on Deafness and Other Communication Disorders, 2017). The healthcare experts who specialize in treating the swallowing difficulties and odynophagia are termed as otolaryngologists. The nurse should include an otolaryngologist in the multidisciplinary team as it is the responsibility of otolaryngologists to treat the damaged throat, larynx and oesophagus (Columbia University Irving Medical Center, 2019). It will help the patient in improving the swallowing difficulties caused due to dysphasia. The nurse should include a speech-language therapist, as the patient is unable to speak properly and faces difficulty while speaking.

The speech-language therapist is the healthcare professionals who have the role of assessing and treating speech-related disorders (Clemson, 2019). They help the patients in improving their speaking abilities, they also treat language-related disorders and social communication disorders. The speech-language therapists improve the problems related to voice or vocal cords. The nurse can include a physiotherapist and a pain medicine specialist in the multidisciplinary team because they have the key responsibility of managing patient's acute pain. These health professionals use different pain-relieving treatments and medications to control the acute pains caused due to stroke and hemiplegia. All these health professionals can help the nurse in providing optimal care to the patient, and they will also improve the patient's overall health outcomes.

Ethical and Legal Standards to Patient's Care Requirements

All the nurses have to follow certain principles of ethics such as autonomy and beneficence during patient care (Haddad & Geiger, 2020). The American Nurses Association (ANA) has developed a set of guidelines for all nurses to maintain ethical standards. One of the important ethical principles that all healthcare professionals and registered nurses must follow is autonomy which is the ability to use professional knowledge in making safe clinical decisions for the patients (Rao, Kuma &

Conclusion on Development of A Person-Centred Care Plan

Thus, this paper concludes the different assessments, diagnosis and interventions that are related to a patient having acute pain, speaking difficulty and dysphasia. The assessment of the patient's medical conditions revealed that patient is suffering from intracerebral haemorrhage that has affected the patient's ability to speak and swallow. The patient suffers from hemiplegia and angina that have caused acute pain. However, the nursing interventions such as including a physiotherapist, dysphasia team and speech-language therapist can improve patient's medical conditions. All these interventions must be implemented adequately by the registered nurses and must be evaluated properly. This will help the nurses in ensuring that the patient care plan is effective in treating patient's abnormal health conditions. Moreover, all the ethical and legal standards must be followed while proving care to the patient.

References for Development of A Person-Centred Care Plan

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