Question

John Green, a 71-year-old male patient, is being discharged from the rehab unit 8 weeks after an ischemic stroke. The patient’s spouse stated that they used to enjoy going to golf outings with their friends, but the patient has not golfed since her husband had the stroke, and she does not want to try to golf once her husband is discharged home because he has to use a walker and can barely ambulate. She also states that her husband still has trouble speaking, and his short-term memory is not very astute (sharp) so it would be embarrassing to be on a golf outing with him. The patient’s spouse has worn the same outfit to the rehab unit the past 3 days, and the nurse notices her hair is unkempt and her affect is flat. The rehab nurse has made arrangements with the social worker for a physical therapist, speech therapist, and occupational therapist to provide three sessions of therapy at the patient’s home for the next 4 weeks, and then a reevaluation will follow to determine if the patient will need further therapy. The patient is able to sit independently, stand independently, and use a walker. The patient is able to ambulate 30 feet with the walker, and then he requires a short rest before he is able to ambulate another 30 feet. The patient slurs words occasionally and has hesitant speech. The patient has problems with short-term memory. Quedtion: What assessment of the spouse does the nurse need to make and what should the nurse suggest?

Answer 1

The nurse has to assess for the following in the spouce

• Whether she is maintaining personal hygiene because during her husband's treatment she was wearing the same outfit for three consequetive days
• Whether she helps Mr,John in performing his daily activity, as she seemed to be detached from him
• Can ask her about his progress ,to know about her involvement in care for him
• Assess for any physiological,psychological and socioeconomic behaviour and handling by her ,as she is also ageing

The nurse can suggest for the following

• To help him in his activity
• Report in case of any decrease in activity
• Encourage to spend valuable time together this creates a good psychological needs
• Health educate about the recovery status
• Health educate for proper follow up

Answer 2

a.- What education topics should the nurse provide the family about home care for the patient after stroke?

• Discuss what a stroke is, how to prevent, and the rehabilitation process used to help the patient regain as much self-care and independence as possible.

• Discuss the role of home therapy and what goals each therapist has for the patient and the role of the family member in the rehabilitation process.

• Discuss potential complications of the stroke and signs and symptoms of the complications.

• Identify safety measures in the home to prevent falls and injury

• Discuss ways to improve the patient's self-care in the home environment, such as installations of grab bars, raised toilet seats, and so forth.

• Discuss the role of the home health nurse and what the visits entail

• Discuss respite care available and the need for the family caregiver to take time for the self to energize and be able to connect with the social system.

• Discuss support groups available for the spouse to attend, the role of the support group, and the locations and availability of online groups

• Discuss ways to decrease social isolation for both
  

b. What assessment of the spouse does the nurse need to make, and what should the nurse suggest?

• The nurse needs to assess the spouse further to determine if the spouse is depressed and/or suicidal. Depression among the caregiver of stroke suvirvors is common. If the caregiver admits to depression, the nurse should suggest that the caregiver seek further medical attention from their own get medical attention for the caregiver. The spiuse should ve provided with information on respite care, support groups, and community resources.