Question

Scenario:

Joanne is a 40 Y.O. woman admitted under your care after a stroke. Joanne has a R) sided facial droop and dysphagia. She has a supra-pubic catheter insitu. Joanne has a history of DMT2 and was on oral hypoglycaemic agents; however, her medications have been withheld since coming to hospital. The following are ordered:

DVT prophylaxis

IV Antibiotics

Rest in Bed

Passive exercises

4/24 neurological observations

IDC and 2/24 urine measurement

Nasogastric tube and commencement of feeds via tube

Allied health referral

Q:1) Prepare a Nursing Care Plan for Joanne

Q:2) Prepare a plan for discharge and relevant community care for Joanne

Answer 1

1 Risk for impaired swallowing associated with deficits in oral,pharyngeal or esophageal structure or function.

Desired outcomes

• Demonstrate feeding methods appropriate to individual situation with aspiration prevented.
• Maintain desired body weiight.

Nursing interventions

• Review individual pathology and ability to swallow,noting extent of the paralysis.
• Have suction apparatus available at bedside ,especially during early feeding efforts.
• Promote effective swallowing,by sscheduling activities and medications to provide a minimum of 30 min rest before eating.
• Provide pleasant and unhurried environment free of distractions.
• Assist patient with head control and position based on specific dysfunction.
• Place patiennt in upright position during and after feeding as appropriate.

Evaluation

• Demonstrates improved swallowing ability.

2

• Patient and family education is a fundamental component of rehabilitation.
• The nurse provides teaching about stroke ,its causes and prevention nd the rehabilitation process.
• The patient and family are informed about the medical treatments that are implemented and the importance of interventions taken to prevent and detect compications.
• Teaching addresses the use of assistive devices or modification of the home environment.
• Advice the patient to take medications exactly as directed.
• Advice to begin sn excercise program.
• Keeping up with medical appointments and close follow-up is important to stroke rehabilitation and recovery.
• Referral for homecare maybe warranted to assess the home environment and the ability of the patient and to ensure that the family are able to manage at home..
• It is the dutyof the nurse to remind the patient and family of the importace of continiuing health promotion and screening practices.