Question scenarioStrokeMr. González is a 70-year-ol

Question scenarioStrokeMr. González is a 70-year-oldretired bus driver who suffered an ischemic, thrombotic stroke on November 26, 2020. He has been in the rehabilitation hospital for 6 weeks and now is now being prepared for discharge to his home with his wife. Mr. González has physically responded well to rehabilitation. He has mild dysphasia but is able to communicate well, though takes a while to process words and respond appropriately. He has hemiparesis of his right side but can walk short distances with a walker, though is sometimes a little unsteady on his feet, and requires minimal assistance to complete his own bathing and dressing. Mr. González has been suffering from constipation since his stroke and his appetite has decreased, but he is otherwise well.PNC121_2197_2204Part #2 Nursing Diagnosis/Problem, Goal, Interventions, Evaluation (10%)The assignment includes completion of:1: One Nursing Diagnosis/ProblemSelect a priority problem from the problem area identified in part 1, and write one nursing diagnosis/problem statement.List the signs and symptoms that support your choice of priority problem.2. One short term SMART Goal/expected OutcomeWrite one SMART nursing goal/expected outcome for the nursing problem. This is a measurable statement of accomplishment that may be related to physical health or areas that need improvement for your client.3. Four Nursing Interventions with cited rationaleWrite a minimum of 4 appropriate interventions The interventions are nursing actions (treatments, behaviours, activities and therapies) that nurses perform independently on behalf of clients or in collaboration with other health care professionals. These are individual steps to help achieve the client outcome (goal).Provide ‘evidence based’ rationale to support and validate each intervention chosen. Use APA format for all evidence-based rationale supporting the chosen intervention. 4. EvaluationReflect on the effectiveness of interventions and the client’s progress to achieve the outcome. Do you believe the interventions would be effective in achieving the client outcome? Because you cannot truly evaluate the outcome it will be important to provide an explanation about what, When and how would you evaluate the nursing interventions? ExampleNursing Care Plan Part #2 Worksheet (10%)• Nursing diagnosis/problem • 1 Short term goal• 4 nursing interventions with cited rationale• EvaluationNursing Diagnosis/Problem: Review the priority cluster and select the priority nursing diagnosis/problem.1. In order to select a priority problem and write one nursing diagnosis statement follow these steps:Look in the Lewis Med/Surg textbook for your original medical diagnosis.For Morrie Flack it was COPD.There will be information in the text and/or a care plan with a list of nursing diagnoses/problems.Then you need to go back to part 2 and look at the priority problem area you chose from your assessment data. I chose Respiratory for Morrie Flack.Possible nursing diagnosis for COPD related to respiratory included:a. Ineffective breathing pattern r/t body position that inhibits lung expansion, fatigue, respiratory muscle fatigue as evidenced by the use of three-point position, pursed lip breathing, use of accessory muscles to breatheb. Ineffective airway clearance r/t excessive mucus, retained secretions as evidenced by ineffective cough, absence of cough, diminished breath sounds c. Impaired gas exchange r/t alveolar hypoventilation as evidenced by a headache on awakening, PaCO2 >45 mm Hg, PO2 <60 mm Hg, or SaO2 of < 90% at restetc. Firstly, I underlined the signs & symptoms in the diagnoses that match my assessment data. a. Ineffective breathing pattern r/t body position that inhibits lung expansion, fatigue, respiratory muscle fatigue as evidenced by the use of three-point position, pursed lip breathing, use of accessory muscles to breatheb. Ineffective airway clearance r/t excessive mucus, retained secretions as evidenced by ineffective cough, absence of cough, diminished breath sounds c. Impaired gas exchange r/t alveolar hypoventilation as evidenced by a headache on awakening, PaCO2 > 45 mm Hg, PO2 <60 mm Hg, or SaO2 of < 90% at restI can see that most of the signs & symptoms match the diagnosis of Impaired gas exchange.3PNC121_2197_22042. List the signs and symptoms from your data collection that support the chosen diagnosis/problem. 1. Headache on awakening2. PaCO2 > 45 mm Hg3. PO2 <60 mm Hg4. SaO2 of < 90% at rest5. Although there is not a 5th sign and symptom from the diagnosis we know from the outcomes section of the diagnosis that decreased dyspnea is also a problem, which Morrie has.Priority Nursing Diagnosis/Problem Statement:Impaired gas exchange r/t alveolar hypoventilation as evidenced by a headache on awakening, PaCO2 >45 mm Hg, PO2 <60 mm Hg, or SaO2 of < 90% at restShort Term SMART Goal/Expected Outcome:Once you choose your nursing diagnosis there will be information on goals/outcomes and interventions in the book.Outcomes/goals included:Has PaCO2 of 35-45 mm Hg or usual compensated baseline valueExperiences return of PaO2 to normal range for patientReports improved mental statusReports decreased dyspneaI chose the outcome/goalReports decreased dyspneaThis should be written as a SMART goalMorrie will report decreased dyspnea when attending to ADLs within 48 hours.Nursing Interventions: Identify four appropriate Nursing Interventions with cited rationale.Next is the choosing of nursing interventions. There are many to choose from in the textbook. Make sure you choose appropriate ones for your case study. And for your client’s goal.You must provide a rationale (reason) for each intervention you have chosen. You will have to4PNC121_2197_2204Nursing Intervention Research-Based Rationale1. Monitor respiratory and oxygenation status q4h2. Assist patient to assume position of comfort(e.g., tripod position) as required3. Administer and teach appropriate use of bronchodilators as ordered4. Teach signs, symptoms and consequences of hypercapnia (e.g., confusion, somnolence, headache, irritability, decrease in mental acuity, increase in respiration, facial flush, diaphoresis) 5. Teach avoidance of central nervous system depressants To assess the need for intervention. A study demonstrated that when the resp rate exceeds 30 breaths per min significant respiratory alteration occurs (Hagle, 2008).To maximize respiratory excursion. Leaning forward can help reduce dyspnea (Langer et al, 2009).To open the airways (Lewis et al, 2019).To recognize problems and initiate treatment.Changes in behaviour and mental status can be early signs of impaired gas exchange. In the later stages the client becomes lethargic and somnolent (Burns, 2011).Because they further depress respirations(Spruit et al, 2013)Evaluation: Because you cannot truly evaluatethe outcomes it will be important to provide5PNC121_2197_2204an explanation about what, when and how Would you evaluate the nursing interventions?1. Check respiratory and oxygenation status to ensure adequate oxygenation q4h.2. Assist to a position of comfort as required. Will assess comfort with each patient check.3. Administer and teach appropriate use of bronchodilators. Will administer bronchodilator as needed. Will monitor inhaler technique and teaching around identifying the need for inhalers.4. Teach signs, symptoms and consequences of hypercapnia (e.g., confusion, somnolence, headache, irritability, decrease in mental acuity, increase in respiration, facial flush, diaphoresis) and observe for symptoms on each patient checks.5. Teach avoidance of central nervous system depressants when administering medications and monitor respiratory status on each patient check.Use the care plan template below to put your final care plan together.Full Reference scenario: Nursing Care Plan Assignment Case Study – Ischemic, Thrombotic StrokeMr. González is a 70-year-old retired bus driver who suffered an ischemic, thrombotic stroke on November 26, 2020. He has been in the rehabilitation hospital for 6 weeks and now is now being prepared for discharge to his home with his wife. Mr. González has physically responded well to rehabilitation. He has mild dysphasia but is able to communicate well, though takes a while to process words and respond appropriately. He has hemiparesis of his right side but can walk short distances with a walker, though is sometimes a little unsteady on his feet, and requires minimal assistance to complete his own bathing and dressing. Mr. González has been suffering from constipation since his stroke and his appetite has decreased, but he is otherwise well.Mr. González, has a past medical history of type 2 diabetes but has been diagnosed with hypertension and hypercholesterolemia since admission. He has no past surgical history. Mr. González has no known allergies. On admission he was on Metformin 500mg PO BID but is now also going to be taking Plavix 75mg, PO daily; ASA 81 mg, PO daily; Bisoprolol 5mg, PO daily, Atorvastatin 10mg, PO daily and Senokot 2 tabs, PO daily. His latest labs are unremarkable except a fasting BS of 8.4. His vital signs are as follows; T-36.8; P-86; R-17; BP is 148/96; O2 sat-93% on room air; he denies any pain. His fall risk on the Hendrick II Fall Risk scale is currently 4. Mr. González’s abdomen is soft and non-distended with bowel sounds present in all four quadrants.Mr. and Mrs. González are both 70 years old and of Hispanic origin. The preferred language in the home is Spanish, although both Mr. and Mrs. González are comfortable speaking English. On discharge, Mrs. González will be his primary caregiver and though they have no children they have a very involved extended family. Since he has new medications, will need his blood pressure and blood glucose monitored frequently, requires assistance with his ADL’s, and has some safety concerns due to his hemiplegia, the nurse is conducting a number of teaching sessions with Mr. González and his wife prior to discharge. These have also included fall prevention and stroke prevention. According to Mrs. González, the extended family believes in treating those who are “ill” with special foods and spices. The rehabilitation nurse conducts a more detailed assessment of home remedies with Mrs. González and discusses the potential for harm from drug interactions. The nurse has noted that in the past week stressors have been interfering with the teaching sessions. Mr. González’s mood has become increasingly anxious, and he becomes easily frustrated. Mrs. González also seems anxious and concerned. She asks to speak to the nurse privately and confides that she is afraid of “making a mistake.” She states she “does not feel confident” about what she has learned and she is “worried” about being able to assist her husband with his care. She is also frightened that he might have another stroke. The nurse spends time carefully reviewing the discharge instructions and reassures her that a home care nurse will be visiting for the first few weeks to follow up on Mr. González’s care. She tells Mrs. González that she will call the home care nurse and provide an update of Mr. González’s status and inform the home care nurse of Mrs. González’s concerns. Health Science Science Nursing PH 133 Share QuestionEmailCopy link Comments (0)

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