Question

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1. The nurse is collaborating with the health care team to create a plan of care for a client following a stroke. Explain the nurse's role in continuity of care.

Answer 1

Ans) Nurses role in Continuing care of strike patient:

-Altered tissue perfusion
-Impaired physical mobility
-Disturbed sensory perception
-Impaired communication
-Impaired swallowing
-Risk for impaired skin integrity
-Altered urinary elimination

Musculoskeletal interventions:
-Positioning
-position on weak or paralyzed side for only 30 minutes
-turn every 2 hours
-position with pillows
-good skin care with emollients
-special care mattress/cushions
-prevent pressure sores-do not massage areas of redness

Activity post CVA care:
-Up as soon as possible when patient has a sense of balance
-Splints, braces for contractures-avoid traditional slings
-Get patient up on strong side
-Start with strengthening, balance, then ambulation

GI system interventions:
-Constipation, most common problem
-Assess for gag reflex (tongue blade)
-Speech/OT for swallowing exercises
-High fowler's 30 minutes after feeding to prevent aspiration
-Food in unaffected side of mouth (watch for pocketing of food in affected side)
-1800-2000 mL o fluid
-25 g per day of fiber
-Use of assistive devices for eating

Impaired urinary elimination interventions:
-Initially have flaccid bladder then functional incontinence related to communication, mobility, and dressing difficulties

-Clear path, loose clothing, commode or urinal, scheduled toileting

-Assess for bladder distention, toilet every 2 hours in the day and every 4 at night, focus intake 08-1900, use clothing easy to manipulate

-Avoid foleys (intermittent cath if retention)

Communication interventions:
-Decrease environmental distractions
-Treat pt as an adult-if don't understand, tell them
-Use normal tone and volume
-Yes/no questions, stay on same topic
-Communication board
-Give patient time to process and finish words they're saying
-Use gestures and facial expressions and teach patient to do same, use body contact as appropriate
-Aphasia worsens with tiredness and anxiety-work on communication when pt rested

Affect interventions:
-Distract client when they become suddenly emotional
-Explain to client and family reasons for suddenly having emotional outbursts
-Maintain calm environment
-Avoid shaming/scolding during emotional outburst

Coping interventions:
-Losses
-Family/pt goes through grief and mourning associated with losses
-Long term depression: anxiety, weight gain, loss of energy, poor appetite, sleep disturbances
-Support communication between patient and the family
-Discuss lifestyle changes resulting from the CVA
-Discuss changing roles/responsibilities within the family
-Active listener (allow expression of fear, frustration, anxiety)
-Support family conferences
-Include pt, family in ST and LT goal setting
-Behavioral changes from the CBA not changeable (permanent loss of brain tissue)
-Responses to the multiple losses
-Support groups
-Spiritual needs
-Family therapy