Mr. Sam Kwon Case Study - Nursing Assessment Answer

• Subject Code : HSNS273
• Subject Name : Nursing

Mr. Sam Kwon Case Study

A patient with facial dropping, aphasia, and right-sided hemi-paralysis has many associated health risk factors like risk of depression, right and left confusion, and others. If proper health treatments are not provided to the patient then the condition might deteriorate leading to ethical and legal implications. In this case, a 74 years old man named Mr. Sam Kwon was admitted to the hospital with issues like facial dropping, aphasia, and right-sided hemi-paralysis. These are associated with stroke on the left side of the brain which has the following symptoms: language and speech problems (aphasia), risk of depression, right and left confusion, and many others (Jones et al., 2020). According to Jones et al. (2020), the brain strokes are caused by cardiogenic emboli, atherosclerotic plaques in blood vessels in the brain, or artery thrombosis. There are many nursing interventions for such patients like visiting a speech therapist, preventing edema, maintaining personal hygiene of the patient, balance regaining, and many others. In the following sections, there will be a discussion about the analysis and interpretation of his assessments, health promotion strategies for him, his patient-centered care, and the ethical and legal implications in his case. 

The analysis and interpretation of assessment findings

Mr. Kwon has a body temperature of 36.8° C and the average normal body temperature is from 36.1 to 37.2° C, showing that he had a normal body temperature. His heart rate is 98bpm which lies in the normal range of 60 to 100 beats per minute. His respiratory rate is 24 per minute; this shows that is higher than normal indicating that he might be suffering from tachypnea (Htun et al., 2019). Tachypnea is abnormally rapid breathing that is also associated with other health problems like anxiety, depression, or stress (Htun et al., 2019). His blood pressure is 140/105 mmHg, this is a very high value. A systolic pressure of 140 indicates high blood pressure with stage 2 whereas the diastolic pressure with 105 mmHg also indicated a high blood pressure stage 2. His oxygen saturation level is 96% (room air) is acceptable as older patients have lower values than that of adults. He already had a medical history of diabetes, congestive cardiac failure, and hypertension.

His vital assessments showed that high blood pressure and tachypnea are associated with his health complications like cardiovascular problems, depression, and others making the condition worse (Ormazabal et al., 2018). According to Ormazabal et al. (2018), diabetes and cardiovascular problems are correlated issues because high blood sugar causes deposition in blood vessels causing cardiovascular issues. High blood pressure is also one of the associated factors that lead to hypertension, stress, or depression. Kwon’s CT scan suggested that he had left cerebrovascular accident that might lead to signs of edema, in this condition the fluid increases inside the brain that results in pressure on the skull. This will lead to reduced flow of blood in the brain and therefore less oxygen is available to the cells resulting in cell death in the brain that will cause serious health issues in the patient or could also be fatal (Khatri et al., 2018). Kwon’s assessments showed that he is suffering from homonymous hemianopia that leads to double vision, distorted sights, and many other health complications. 

The ethical and legal implications

    In this case, the patient’s CT was performed but no cerebral angiography was conducted. Such patients should be diagnosed with cerebral angiography to detect the specific cause of brain stroke. Transcranial Doppler ultrasonography should also be conducted by the physicians to measure the blood flow velocity in the blood vessels in the brain (Bonow et al., 2018). The medical management to be prepared for such patients: Neurologic assessment – to detect if the stroke is evolving or not, Hemodynamic monitoring – to keep the blood pressure under control and bleeding should be continuously monitored.  However, no such managements were made in this case for the patient leading to ethical implications as these lack of services can result in the poor quality of health care services for the patient.

According to Wittling et al. (2018), an effective care plan should be developed for the patient with inter-professional patient-centered care including nurses, physicians, physiotherapists, and others, and shared decision making with the involvement of the family members. However, in this case, the family members were not even available since morning. Even, there was no nurse or other health professionals for providing the medications for unbalanced vital signs of the patient, and no feedback was taken from the patient too. For dealing with homonymous hemianopia the patient was not provided with therapies by optometrists like vision restoration therapies and use of correct glasses for the patient. In this case, a blood clot in the brain was not resolved by the health care team that could be fatal for the patient leading to another ethical and legal implication. According to Abiodun (2018), clots in the brain may cause weakness in the body with associated risks like strokes and attacks.

A physician should provide neuro thrombectomy for treating blood clots in the brain (Wittling et al., 2018). However, no such service was made available for the patient. Moreover, the patient is provided with an IV catheter but it also not regularly changed to prevent the risk of infections in him. The patient in this case is unable to speak so the nurse should ensure therapeutic communications for the patient to provide information and support to the patient resulting in effective communications and comprehensive care (Abiodun, 2018). However, in this case, no such efforts were made leading to another ethical and legal implication.

The patient-centered care for Kwon

A patent with homonymous hemianopia suffers from dizziness and blurred vision and other visual problems. According to Abiodun (2018), if such patients are provided with flicker-stimulation training (FT) and explorative saccade training (EST) then the patient’s blind side will get improved. In these training the specialist asks the patient to do the rapid movement of eyes between the fixed points, these treatments are used to remediate the problems. As the patient is at high risk of developing depression and stress because of this present condition so, he should be provided with psychiatrists to deal with his emotions prevent the chances of developing depression and stress that will in turn help in maintaining his blood pressure. The nurse should use a blackboard/writing board and blood thinners for the patient so that he can write on it to express his needs.

A patient should be provided with complete, comprehensive, and patient-centered care that meets all his needs and results in effective care (Naylor et al., 2017). His family members should be involved in decision-making as the patient is unable to see and speak properly. The nurses and other health professionals should use therapeutic communication to get proper feedback from the patient and ensure quality care (Naylor et al., 2017). The patient and his family members should be explained about the conditions and treatments as well. He should be provided with visual aids, neurologists, physicians, physiatrists, pharmacists, vocational counselors, psychiatrists, physical therapists, and primary care physicians. He should be provided with medications to maintain his vitals and as the patient cannot feed directly from his mouth so, during catheter administrations it should be made sure that the site is intact, dry, and clean.

Moreover, he should be assessed by the physicians for his basal crackles and associated risks like bronchitis, pneumonia, and others. Therefore, he should be provided with respiratory aid devices to ensure proper breathing. Age-related crackles can also act as an interference barrier during the management of patients having brain strokes (Vieten et al., 2018).

The health promotion strategies

A health promotion program or surveys aimed at the objective to promote health can act as a strategy to achieve good health and quality care in patients. The health professionals should be made aware of the importance of patient-centered care that is a problem-solving approach to deliver comprehensive care to the patient. As in this case, the patient is suffering from many health issues like high blood pressure, unable to speak, right-brain stroke, and a few others. So, the patient-centered care approach will acts as a health promotion strategy in this case. As the patient is unable to speak so the family should be involved in major decision-making processes for the treatment and improved health of the patient. The involvement of family members or closed ones in healthcare can provide better health services to the patient (Aronis et al., 2017).

As in this case, the family members are not available with the patient, so they should be made aware of the importance of family involvement in the healthcare of the patient. Health professionals should be asked to inform the patient and their family members about the necessity of having a healthy lifestyle, especially in old age. A healthy diet and a healthy lifestyle can reduce the risk of developing health issues. According to Aronis et al. (2017), a health promotion strategy involves actions like addressing the factors that lead to good health in the community and informing the people about how to stay healthy. A health promotion strategy focuses on the people who are at risk of developing a specific disease and enables the community to improve their health with increased control over better health. A health promotion strategy should follow the Ottawa charter guidelines that provide a health promotion an identity and solid framework (Naylor et al., 2017). Moreover, the government policies should be successfully followed and non-government organizations should create awareness programs among the families and health professionals to spread the message of better health and ways to maintain it. 

The discharge plan

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Facial dropping, aphasia, and right-sided hemi-paralysis have many associated health risk factors like risk of depression, right and left confusion, and others. There are many nursing interventions for such patients like visiting a speech therapist, preventing edema, maintaining personal hygiene of the patient, balance regaining, and many others. High blood pressure is also one of the associated factors that lead to hypertension, stress, or depression. An effective care plan should be developed for the patient with inter-professional patient-centered care including nurses, physicians, physiotherapists, and others, and shared decision making with the involvement of the family members. The clots in the brain may cause weakness in the body with associated risks like strokes and attacks, which can be resolved by providing the patient with blood thinners. For dealing with homonymous hemianopia the patient was not provided with therapies by optometrists like vision restoration therapies and use of correct glasses for the patient. If such patients are provided with flicker-stimulation training (FT) and explorative saccade training (EST) then the patient’s blind side will get improved. The health professionals should be made aware of the importance of patient-centered care that is a problem-solving approach to deliver comprehensive care to the patient.

References

Abiodun, A. (2018). Stroke (Cerebrovascular Accident (CVA) or Brain Attack) and Its Management-Literature Review.
Aronis, K. N., Edgar, B., Lin, W., Martins, M. A. P., Paasche-Orlow, M. K., & Magnani, J. W. (2017). Health literacy and atrial fibrillation: Relevance and future directions for patient-centred care. European Cardiology Review, 12(1), 52.
Bonow, R. H., Young, C. C., Bass, D. I., Moore, A., & Levitt, M. R. (2019). Transcranial Doppler ultrasonography in neurological surgery and neurocritical care. Neurosurgical Focus, 47(6), E2.
Htun, T. P., Sun, Y., Chua, H. L., & Pang, J. (2019). Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review. Scientific Reports, 9(1), 1-10.
Jones, A., Smakowski, A., O'Connell, N., Chalder, T., & David, A. S. (2020). Functional stroke symptoms: A prospective observational case series. Journal of Psychosomatic Research, 132.
Khatri, N., Thakur, M., Pareek, V., Kumar, S., Sharma, S., & Datusalia, A. K. (2018). Oxidative stress: Major threat in traumatic brain injury. CNS & Neurological Disorders, 17(9), 689-695.
Naylor, M. D., Shaid, E. C., Carpenter, D., Gass, B., Levine, C., Li, J., & Brock, J. (2017). Components of comprehensive and effective transitional care. Journal of the American Geriatrics Society, 65(6), 1119-1125.
Ormazabal, V., Nair, S., Elfeky, O., Aguayo, C., Salomon, C., & Zuñiga, F. A. (2018). Association between insulin resistance and the development of cardiovascular disease. Cardiovascular diabetology, 17(1), 122.
Vieten, C., Wahbeh, H., Cahn, B. R., MacLean, K., Estrada, M., Mills, P., & Presti, D. E. (2018). Future directions in meditation research: Recommendations for expanding the field of contemplative science. PloS one, 13(11).
Wittling, K., Dufur, J. P., McClain, A., & Gettis, M. (2018). Behavioral Coping Plans: One Inter-Professional Team's Approach to Patient-Centered Care. Journal of pediatric nursing, 41, 135-139.