It will talk about how to maximise someone's health after they have had a stroke. This assignment will talk about a particular person called Mr J. The name has been changed for confidentiality reasons
This assignment is on maximising health. It will talk about how to maximise
someone's health after they have had a stroke. This assignment will talk about a
particular person called Mr J. The name has been changed for confidentiality reasons
in accordance with the Nursing and Midwifery Code of Professional Conduct (NMC
2003).
Strokes can affect anyone but they are more common in the older population
and those who suffer from high blood pressure or other circulatory disorders. The
effect of a stroke depends on how much, and which part, of the brain is affected.
Major strokes can be fatal. However, many people make complete recoveries from
minor strokes. Many, perhaps most, strokes can be prevented. The most effective
treatment for a stroke is to prevent it from occurring in the first place. Therapies to
prevent a first or recurrent stroke are based on treating an individual's underlying
risk factors for stroke or preventing the widespread formation of blood clots that
can cause strokes in anyone, whether or not risk factors are present. Some people
are at a higher risk of stroke than others. Factors such as age, gender,
race/ethnicity and family history of stroke cannot be changed. However you can
control other risk factors, such as high blood pressure, cigarette smoking and diet.
The earlier you get a condition diagnosed and treatment started, the better the
results. According to The Stroke association in 2002 (Stroke Association 2003) the
North West had one of the highest rates of stroke the vast majority were mild
strokes and the patients recovered within a few days some however were less
fortunate and were unable to recover.
Mr J is a 75-year-old male. He is married and has 2 children and 2
grandchildren. Mr J lives in South Manchester with his wife in a semi-detached
house. Mr J enjoys gardening and going for days out with his wife, Mr J also likes to
go to the pub in the evening where he would enjoy 4 pints of beer and a cigar. At
home Mr J would usually have 15 cigarettes a day and 3 cans of beer unless he was
going to the pub in the evening when he would have just 1 can of beer. Mr J usually
would go to the pub around 4 times a week. Mr J enjoys having fish and chips a lot, he
also eats a lot of ready meals because his wife is getting quite old and frail and
doesn't do a lot of cooking. Mr J enjoys eating fruit although he doesn't eat it a lot as
he finds it quite expensive and cant afford it on his pension.
Mr J has been diagnosed as having a stroke. This has left him with left sided
weakness. Mr J is finding communicating very frustrating. His wife says that he is a
very private and independent person. He now finds himself unable to eat drink or
attend his toileting needs without assistance. Whilst in hospital the nurses and other
professionals from a multi-disciplinary team will help Mr J get back to a healthy state
of living. The World Health Organisation (World Health Organisation 2003) suggests
that health is a state of complete physical, mental and social well being and not
merely the absence of disease or infirmity. Although Mr J may have thought that he
had a healthy life style before his stroke it is the job of the health care
professionals to encourage him towards a healthier lifestyle to maximise his health
and to prevent another stroke occurring once he has recovered from his first one.
The type of treatment Mr J will receive depends on the type of stroke he has
suffered and how long it has been since onset of the stroke. There are three phases
of treatment for stroke, these are prevention, therapy immediately after stroke and
post-stroke rehabilitation (Lauri S et al 1999). This essay will mainly be looking at
post stroke therapy and rehabilitation for Mr J and stroke prevention and how Mr J
can minimize some on the factors that cause strokes.
In hospital Mr J will have a multi-disciplinary team to help look after him. This
team will mainly consist of nurses, physiotherapists, speech and language therapists,
dieticians, occupational therapists and social services. All these care workers will be
involved at different stages of his rehabilitation. The nurse's role will ...
This is a preview of the whole essay
post-stroke rehabilitation (Lauri S et al 1999). This essay will mainly be looking at
post stroke therapy and rehabilitation for Mr J and stroke prevention and how Mr J
can minimize some on the factors that cause strokes.
In hospital Mr J will have a multi-disciplinary team to help look after him. This
team will mainly consist of nurses, physiotherapists, speech and language therapists,
dieticians, occupational therapists and social services. All these care workers will be
involved at different stages of his rehabilitation. The nurse's role will be to look
after the patient's physical and mental health. The nurse will help Mr J to regain
some degree of independence in the activities of living. Such activities are
demonstrated in Roper, Logen and Tierney model of nursing first developed in 1980.
This is probably the most commonly used in the UK particularly in adult nursing. This
model was adapted from Henderson's concept of nursing developed in 1966 (Aggleton
and Charlmers 2000). In Roper, Logen and Tierney model of nursing there are 12
activities of living the nurse would aim to meet all of these. The main ones would be,
communicating, mobilising, maintaining a safe environment and eating and drinking. the
nurse will also be responsible for writing in Mr J's care pathway.
Systematic approaches to care are demonstrated in care pathways. The care
pathway will allow Mr J's progress to be monitored throughout his time in hospital. It
will record his progress from being admitted through to being discharged. The Care
pathways contain an admission form. This is so the consultants and nurses can see if
Mr J has any special requirements. There is a ward admission; this contains a water
low assessment chart, manual handling and patient's own drugs. In the patients own
drugs part the nurse can see if Mr J is able to take his own drugs like he may do at
home. There is space for the nurse to write about Mr J's progress and what he has
done throughout the day and what other professions have been to see him during the
day, this will include the physiotherapist. When writing in this section the nurse must
be factual, consistent and accurate.(Thompson et al 2003). Health care records are a
tool of communication within the team. You must ensure that the health care record
for the patient or client is an accurate account of treatment, care planning and
delivery. It should be consecutive, written with the involvement of the patient or
client wherever practicable and completed as soon as possible after an event has
occurred. It should provide clear evidence of the care planned, the decisions made,
the care delivered and the information shared (Nursing and Midwifery Code of
Professional Conduct 2003). There is a discharge form were the nurse would go
through with the patient the things they need to do when they get home. This part
will contain useful numbers for Mr J and his family to use in case they need any extra
support. The nurse would be unable to do these activities demonstrated in Roper,
Logen and Tierney model of nursing without the help from physiotherapists, speech
and language therapists, dieticians, occupational therapists and social services.
The speech and language therapist will work along side Mr J very closely.
The speech and language therapist will see Mr J as he has difficulties in
communicating as a result of his stroke and he has problems swallowing.As Mr J is
finding communicating very frustrating, the speech and language therapist should
establish a communication system with the patient, for example a key words board
with which Mr J could indicate his needs. The key words board would have symbols on
it, these would include symbols for the toilet and eating and drinking.
Enhancing Mr J's ability to communicate is arguably the most important and
challenging aspect of caring for stroke victims. Time and gentleness should be given
to give the patient the confidence to make sounds. The temptation to speak for Mr J
or to make swift assumptions about what he wants must be resisted (Nicol. M et al
2000).
Mr J must never be treated like a child, or like someone who is incapable of
understanding. Speech and language problems arise when brain damage occurs in the
language centres of the brain. But this doesn't mean Mr J will never have a command
of language again. Due to the brain's ability to learn and change, other areas of the
brain can adapt to take over some of the lost functions. Speech therapy can help a
stroke Mr J relearn language and speaking skills, or learn other forms of
communication. Such therapy would also be appropriate if Mr J had problems
understanding speech or written words, or problems forming speech. With time and
patience Mr J should be able to regain some, and perhaps all, language and speaking
abilities. Mr J's family could become involved in his speech and language therapy. In
the early days the speech therapist may want to give intensive therapy, for at that
stage if is often the job of a specialist only after the initial stages may others help
with the treatment program (Edmonds J 2002). Mr J's family could bring in familiar
things from Mr J's life and encourage him to talk about them and what they mean to
him. By doing this hopefully Mr J will have to confidence to talk more and it will help
him regain his normal level of speech. Having his family around him may also make Mr
J feel loved and wanted and it may boost his confidence and give him something to
focus on. Mr J's grandchildren are very important to him and with them visiting and
helping him get better it may maximise his health physiologically, by knowing that he
is loved and wanted. Once Mr J has regained his speech his is able to tell people what
he thinks he needs to do and what he thinks he is able to do. Mr J needs to work on
his mobility if he wants to get back to the life he had before.
The Physiotherapy is usually the cornerstone of the rehabilitation process. A
physiotherapist will use training, exercises and physical manipulation of Mr J's body in
hopes of restoring movement, balance and co-ordination. Through physiotherapy, Mr
J is working to relearn simple motor activities such as walking, sitting, standing, lying
down and the process of switching from one type of movement to another. The
physiotherapist will work with Mr J to encourage him to get back to the life he used
to have before he had his stroke. Mr J use to enjoy gardening and going out with his
wife and friends. The physiotherapist would have seen that he use to do these things
in his notes, and the physiotherapist may have also talked to Mr J's family too see
what he liked doing. Before the physiotherapist asks his family they must check with
Mr J to make sure that it is okay for his family to be involved in his care (Thompson
et al 2003). This is because Mr J has the right to privacy. Mr J has the right to keep
his condition private from his family. According to the Nursing and Midwifery Code of
Professional Conduct (NMC 2003) you should seek patients' and clients' wishes
regarding the sharing of information with their family and others. The
physiotherapist will encourage Mr J by telling him that by doing his exercises he
could get back to the things he used to enjoy like his gardening and days out. The
physiotherapist will start of by doing gentle exercises with Mr J. Research shows
(Johnstone M 2002) the earlier you begin physiotherapy the better. Even if people
cannot move at all just after the stroke the involvement of the physiotherapist to
advise on positioning of affected limbs and passive exercises to stop the muscles
stiffening is vital. Mr J has left sided weakness so the physiotherapist will work on
that side but they will also encourage Mr J to keep his right side strong whilst he is
in hospital if Mr J did not work his muscles in his right side as well they may
deteriorate and become useless, this will not be of any help to Mr J because he would
have twice the work to do when he is learning to walk again. The physiotherapist will
be preparing him to get back to the best state of health as possible in order for him
to return home.
In the hospital Mr J will be able to use all the facilities these include a
swimming and hydrotherapy pools and a gym. Hydrotherapy is treatment by physical
means in water with the reduced effects of gravity on the body. Treatment is usually
given in an above average temperature pool at 98 Degrees Fahrenheit using a series
of specific exercises. Hydrotherapy is very important in rehabilitating after many
conditions such as after a stroke. During the sessions of hydrotherapy Mr J will be
able to work his muscles on his left side without to much pain. The physiotherapist
will also work on his walking and balance.
Mr J's wife says that he is a very private and independent person; so working
on his needs in this way will encourage Mr J to do more because he may feel he is
getting his dignity back. Once he is able to do a lot more such as walking and getting
up on his own the physiotherapy will not be as intense. At this stage of his care when
Mr J is preparing to go home the occupational therapist will become involved.
Occupational therapy focuses on creating independence and will involve exercise and
training. The Occupational therapist will help Mr J relearn everyday activities such as
reading and writing, eating, drinking and swallowing, dressing, bathing, cooking and
using the toilet. An occupational therapist advises about how to carry out these
everyday tasks and discuses changes that might be needed in the home. The
occupational therapist will visit Mr J's home with his wife to ensure that the home is
safe and to advise on appropriate alterations and aids. This advice may include
bringing the bed downstairs or fitting a stair lift. Carpets should be checked to make
sure that they are tacked down and not likely to cause a fall, and aids may be
suggested to help with toileting and washing.
A week before Mr J goes home he will go on a home visit for the day.
When he goes the Physiotherapist and occupational therapist may go with him to see
how they think he will cope. At this stage Mr J can suggest things that he thinks will
help him in his daily activities as well as the things that the occupational therapist will
suggest. Mr J may feel that he would like hand riles put outside his house to help him
in and out. Mr J only has a bath in his house the occupational therapist will give Mr J
the information on how to contact Social services to see if he is entitled to benefits
to help him raise the money so he could have a walk in bath or a sit down shower
installed.
Due to Mr J's lifestyle it is possible that he could have another stroke or
that his wife may have a stroke, which will affect him physically and mentally.
Because of this Mr J is a prime candidate of health education and change. Once Mr J
is home he is getting use to the changes in his health and his house, however he is not
changing his lifestyle. Mr J is still smoking 15 cigarettes a day. Mr J finds this very
expensive and would like to stop, but he does not think he has the will power to do it
on his own. Whilst in hospital Mr J was told about the Smoking Cessation clinics that
go on there. Mr J could go to free clinics provided and he could get the help and
support that he may need. The smoking cessation nurse will talk to Mr J about the
reasons behind him wanting to stop smoking. The nurse will give Mr J an information
pack that contains all the information about stopping smoking. This pack will list all
the possible nicotine replacement therapy's that are available on the NHS. The nurse
will discuss with Mr J which one he thinks will suite him best. The nurse will inform
Mr J that as he is over the age of 60 he will be provided these for free from the
NHS. The nurse will talk with Mr J about the benefits of stopping smoking. She will
go through with Mr J what will happens to his body after he stops smoking. This
includes the amount of carbon dioxide that is in his body. Within 24 hours of stopping
smoking the amount of carbon dioxide that is in Mr J's body would be that of a
person that has never smoked before. The nurse will also discuss with Mr J the
amount of money he will save if he stops smoking. At the moment Mr J is smoking 15
cigarettes a day if Mr J stopped smoking he would save £22 a week (Smoking
cessation 2003). After 48 hours of stopping smoking taste and smell starts to
improve, so Mr J can start to enjoy his food again. The nurse will give ideas to Mr J
about what he could spend the extra money on if he stopped smoking. The nurse
should empower Mr J and encourage Mr J to save some of the money and put in
towards a holiday, that way he has something to focus on and look forward to. The
nurse should also encourage Mr J to buy extra fruit and vegetables that he says he
like but cannot afford on his pension. When at home Mr J eats a lot of ready meals,
as his wife is unable to cook a lot anymore. Whilst in hospital the dietician would have
come to see Mr J and explained the options to him. Mr J and his wife are eligible for
the Meals on Wheels service in there area. This service will provide Mr J with a hot
meal every day. This service will benefit Mr J, as he will now be getting regular
balanced meals, which will help keep him healthy and perhaps prevent another stroke
occurring.
References
Aggleton P, Chalmers H (2000) Nursing Models and Nursing Practice. Palgrave. Second Edition
Manchester, Salford and Trafford NHS Trust (2003) Smoking Cessation An Information Pack to Help You Stop Smoking.
Edmonds J (2002) Occupational Therapy and Stroke.
Johnstone M (2002) Home Care for the Stroke Patient (Living in a Pattern) Churchill Livingstone
Lauri S, Lepisto M, Kappel S, (1997) Patients' needs' in hospital: Nurses' and Patients views. Journal of Advanced Nursing
Nicol M, Bavin C, Bedford-Turner S, Gonin P, Rawlins-Anderson K (2000). Essential Nursing Skills. Mosby London
Nursing and Midwifery Code of Professional Conduct 2003
Stroke Assosiation (2003) The Stroke Association [website]. Available from: <www.strokeassociation.co.uk> [Accessed 12 November 2003]
Thompson I, Melia K, Boyd K (2001) Nursing Ethics, Churchill Livingstone.
World Health Organisation (2003). World Health Organisation [website]. Available from:< www.worldhealthorganisation.co.uk> [Accessed 24 November2003]
