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Care of a CVA Patient
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Introduction Jean was admitted to us following a stroke. The nursing care required during the acute phase of her illness was complex. I found looking after Jean very rewarding. Her care on the ward was based on the Roper Logan and Tierney Activities of Daily Living Model and I felt that it would be beneficial to reassess her care using a different Model such as Orem’s Self-Care Deficit theory which is frequently used in dedicated stroke units (O’Connor, 1996). Throughout this essay a pseudonym will be used to protect the identity of the patient. This is in keeping with the Nursing and Midwifery Councils code of conduct on confidentiality as stipulated in clause 5.1 of the code of professional conduct (NMC, 2002). In this essay I will introduce my patient and discuss her background and reason for admission. A brief overview of the model will be given. I will complete a full and accurate assessment using Orem’s model and one of the problems identified will used as a focus of the care plan. A description of the process will then follow with interventions and rationales for the expected outcome. I will conclude with a reflection on this process and the patient. The Patient Jean is an 89 year old housewife. She is married and has one grown up son. She lives with her husband, who himself is in good health, in a single storey bungalow. Jean is a non-smoker and very rarely drinks alcohol. Jean is registered blind and also suffers from blepaharitis and low-tension glaucoma for which she has been prescribed Timolol 0.25% eye drops. Jean suffers from unstable angina. From her notes it can also be seen that she had an myocardial infarction in 1985 and had another incident in late 2002 with raised Troponin-T levels of 0.25. Under current guidelines a Tn-T >0.2ng/ml indicates MI (Fagan, 2002). There is no family history of heart disease and no documentation which would relate to other risk factors. Jean and her husband are quite independent and manage to do all their own housework and shopping. Their eldest son visits regularly and does odd jobs around the home. Jean was found on the kitchen floor by her husband who then called the ambulance which took her to casualty. It was initially assumed that she had fainted and struck her head when she fell. She had been loading the washing machine at the time. However CT brain-scanning investigations indicated that Jean had suffered from a massive stroke with left hemiparesis. Jean was admitted from casualty to a female general medical ward. Nursing models Models of nursing provide bases for the development of nursing theories and knowledge (ref). According to Aggleton & Chalmers (2000); “Without knowledge about the nature of people and their health related needs, nurses would be unable to go about their work in anything but a haphazard way. Nurses working together should ideally practise with shared understandings about people (that is, with the same model of nursing) to ensure continuity of appropriate nursing care” Other advantages of using a model of nursing are: • Acts as a major guide in decision and policy making • Enables a criteria for choosing new team members. • Other health care professionals of the multidisciplinary team can understand the logic of the nursing care. (Pearson et al 2000) I will be using Orem’s self-care deficit theory (SCDT) to guide care planning. The SCDT consists of three related sub theories of self-care, self-care deficit and nursing systems. The self-care theory proposes that self-care is a learned behaviour that individuals perform on their own behalf to maintain life, health and well being (Orem 1991). There are three essential areas of self care: Universal requisites. These are common to all people. There are eight universal requisites which form a basis for the assessment of the patient. Developmental requisites are associated with conditions that promote developmental processes throughout the lifespan. Health deviation requisites are concerned with defects and deviation from the normal structure and integrity of human life.
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