HNN319 Lecture Notes - Lecture 3: Stroke, Palliative Care, Blood Vessel
9 Jun 2018
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WEEK THREE: CARE PARTNERSHIPS AND SUPORTIVE CARE.
• Define the terms care partnerships and supportive care
• Describe the pathophysiology of TIA and stroke
• Identify cues from the data presented and group in systems
• Identify potential and actual problems related to altered neurological function: stroke
• Implement nursing interventions for potential and actual problems related to altered
neurological function: stroke and evaluate care
• Describe, perform and document changing of an indwelling catheter (IDC)
• Implement enteral nutrition and medication administration via PEG tube
• Perfor a ursig hadover of a patiets stroke aageet usig the ISBA‘ tool.
CARE PARTNERSHIPS AND SUPPORTIVE CARE.
• Development of therapeutic relationship.
• Supportive care: provision of support at stages of diseases.
• Care; pt centred care.
- Understand core values and strengths in communication processes.
- Verbal and non-verbal-active listening, empathy, etc.
- Care, compassion and empathy.
- Relationships: two- way exchange of values, needs and achievement of goals ie short
hospital stay.
- Impact health outcome: empathy encourages + interaction; achievement of goals,
empowerment, self-care.
• Supportive care: a process where the healthcare team supports pt family and friends
throughout all stages of their illness.
- Often palliative care and bereavement.
- Stages: pre-diagnosis, diagnosis, treatment, cure/ bereavement.
- Empathy, open communication, goals, symptom management, provision info and
services.
- Impact: longer wellness and improved quality of life, + outcomes, satisfied nurses.
THE LIVED EXPERIENCES OF CARE PARTNERSHIPS.
• Experiences of lack professionalism, staff taking their time, inadequate pt education=
disappointed experiences, complaints, negative memories, worry about future healthcare.
TYPES OF STROKE.
• Occurs due to interruption to the blood supply to the brain.
• Sometimes brain lacks too much O2 and brain swells> effects of stroke are worse at
beginning> inflammation decreases and some cells will rejuvenate but those cells that do
not rejuvenate are those that create symptoms such as impaired speech> other areas may
take over.
• Ischemic stroke:
- Clot blocks artery to brain> lack of O2 as there is a lack of haemoglobin> stroke
(necrotic damage).
- Clot: blood clot, plaque that narrows and eventually blocks blood supply.
• Haemorrhagic stroke
- Rupture of blood vessel in the brain.
- Can be inside the brain, inside the blood-brain barrier, bleeding into brain,
find more resources at oneclass.com
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• Effects will be dependent on the part of brain, how much damage.
• Hemispheres: base controls nerve conductions and
STROKE RISK FACTORS.
• Involves management of atherosclerotic symptoms.
- Hypertensions, diabetes, fatty diet.
• Establishing high risks:
- Previous history, coronary artery disease, asymptomatic carotid stenosis, artrial
fibrillation.
• Secondary prevention:
- History of stroke/TIA= anticoagulant medications unless contraindicated.
- Long term Warfarin if previous stroke is definite cause second stroke.
- Carotid interventions ie surgery through stents.
STIMULATION: MEDICATION ADMINISTRATION VIA A PEG TUBE.
• Consider drug, interaction, tube type, placement, drug absorption.
• Upright semi fowlers.
• Check pt ID ad 6 rights> crush medicine finely> add water via syringe and mix in with
medicine> pull back on syringe and allow water and medicine mix to be in syringe> clamp of
PEG tubing> with 2nd syringe with just water, flush the PEG line> add medicine with 1st
syringe> unclamp and continue feed.
SEMINAR NOTES.
• Trust, empathy, active listening, compassion.
• Care partnership: trusting, therapeutic relationship with patient.
- Understand own beliefs, values, use reflective practice.
- Patients need: respect, nurse present.
• Supportive: systems and interventions to help pt and family cope.
• Quality of life: how do you find value in life?
SEMINAR GUIDE: REFLECTION.
• What is the most important thing you learnt regarding psychosocial impact of chronic illness
and disability?
• What question(s) remain uppermost in your mind?
• What learning resources do you have?
CASE STUDY. *see also simulation guide and assoc forms.
Ellen Simmons aged 68 admitted to the medical ward with deteriorating mobility, excoriated skin to
groin due to increasing urinary incontinence.
• Left sided ischemic stroke (18 months ago) spent four months in rehabilitation before
discharge to home
• Dysphagia (Peg insitu for nutrition and medication)
• R) sided hemiplegia with spatial-perceptual problems
• Expressive Aphasia- can communicate one-word answer requires time to respond- uses a
pictorial communication board to communicate requests
• Hypertension- Perindopril 5mg
• Past smoker for 25 years
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Week three: care partnerships and suportive care: define the terms care partnerships and supportive care, describe the pathophysiology of tia and stroke. Identify cues from the data presented and group in systems. Identify potential and actual problems related to altered neurological function: stroke. Implement nursing interventions for potential and actual problems related to altered neurological function: stroke and evaluate care: describe, perform and document changing of an indwelling catheter (idc) Implement enteral nutrition and medication administration via peg tube: perfor(cid:373) a (cid:374)ursi(cid:374)g ha(cid:374)dover of a patie(cid:374)t(cid:859)s stroke (cid:373)a(cid:374)age(cid:373)e(cid:374)t usi(cid:374)g the isba tool. Care partnerships and supportive care: development of therapeutic relationship, care; pt centred care. Supportive care: provision of support at stages of diseases. Understand core values and strengths in communication processes. Relationships: two- way exchange of values, needs and achievement of goals ie short hospital stay. Impact health outcome: empathy encourages + interaction; achievement of goals, empowerment, self-care.
