The aim of this essay will be focused on Mrs Perkins health outcome and response to holistic management. The health care plan of Mrs. Perkins is planned with respect to personalise values, custom, family decision, and spiritual beliefs which should be done appropriately not neglecting the importance of patient expressing her basic human rights despite her health condition. These factors will be considered and included into patient’s health care plan in other to improve the quality of health. This essay will further explain how the health care plan is drafted making it possible and flexible for patients with stroke will have the ability to adapt or cope and interact with the environment bringing maximum health satisfaction, stability and growth. And also make decision about care and treatment collaborating with health care practitioners.A Brief Discussion of the Theory of Decision Making. Using Tanner. There is a well-built strong form on conclusion and decision-making. Efforts has been drafted in order to describe the concepts of human clinical judgment. (Chapman 2000). Different demonstrations of the theories of judgment and decision making include: Clinical decision-makingClinical judgmentClinical inference Tanner (2006) explains the inefficient use of time in clinical teaching as one of the problems of current clinical education models. It is believed that students should be guided to understand the patients needs, develop appropriate responses, and adjust care plans.Tanner’s Theory on Clinical JudgmentClinical judgment is one of the most essential skills for nurses to acquire in order to achieve quality-nursing care, which is rendered to patients. The four (4) dimensions of Tanner’s theory are 1. Noticing2. Interpreting3. Responding4. ReflectingThis describes the ability of the nurses’ thinking and decision process when faced with complex care situations.Mrs. Perkins health plan is structured in a pattern that will be able to discuss in details the biological, social and psychological factors affecting her health and how as a nurse implement interventions prioritizing her needs. Biologically she suffers from hyperlipidemia, which is managed by the administration of atorvastatin 10mg daily taken orally. Also she suffers from hypertension, coronary artery disease, arterial fibrillation which is controlled by taken diltiazem hydrochloride 60mg to be taken three times daily to prevent chest pain (Wattanasun 2001). Considering that Mrs. Perkins has suffered TIA; she also takes Apixaban 5mg to be taken 2x daily to prevent stroke and for patients who suffers from arterial fibrillation.Making decisions in medical care can be quite challenging. Decision-making is known to be the process examining possibilities, risk, uncertainties and options comparing them and choosing a course of action. Some decisions may result in incorrect patient and family expectation and treatment. (Croskerry 2003)Essentially, there are 2 major types of decisions.1. Programmed: A decision that is repetitive, automatic and routine and can be made using a systematic approach.2. Non – programmed: a decision that is unique, individual or requires a thoughtful analysis.Decision-making concerning patients health will touch all aspect of patient life to promote wellbeing.What is a Stroke?Stroke is defined by the world health organization as a “clinical syndrome consisting of rapid developing clinical signs of focal disturbance of cerebral functions lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin”. Mrs. Perkins had and Ischemic Stroke which is when blood supply to a part of the brain is decreased, leading to dysfunction of brain tissue in that area this happens due to thrombosis, embolism, systemic hypo perfusion e.g shock (Shuaib 1991).Systematic Assessment Knowing the patients, their narration and analysis is important in trying to find crucial report.(Smith 2003). The ABCDE approach is an assessment. The purpose is to detect critical ill patient who will need emergency medical care. Airway assessment: is done to ensure patency of airway. Patients tongue, foreign body, vomit or blood secretions or swelling can cause airflow obstruction (mallet 2013)Treatment of airway obstructionAccording to the resuscitation council (2011) airway obstruction is considered an emergency which will need immediate attention, any loss of time can lead to fatal consequences for example brain damage.Give oxygen at high concentration using a mask with oxygen reservoir, ensuring its sufficiency to prevent collapse of reservoir during inspiration.Assessment of breathing is designed to detect signs of respiratory distress or inadequate ventilation (Smith 2003). The following are used to Asses breathing• Starting with looking for the most common signs of respiratory distress for example sweating. • Counting patients respiratory rate. • By observing the rise and fall of patient chest count the number of breaths that the patient takes over a minute to measure the respiratory rate. Assess the depth of each breath the patient takes.• Each breath will have a different depth, assess it• Using pulse oxymeter Measure patient’s peripheral oxygen saturation• Percuss the chest.• Blood gas examination: this runs a consistent respiratory calculation on the level of oxygen carbon dioxide in the blood and the blood ph (mallet 2013).• Check airways are functional to make sure there is proper sequence entry and to be listen for any abnormal breathing. (mallet 2013) Circulatory Assessment: this assessment is done once patient airway and consciousness have been weighed and cured. Mallet (2013) said, “the aim of measuring the circulatory structure is to establish the efficacy of the cardiac productivity”. Cardiac productivity is the blood emitted from the heart each minute.Jevon (2012) stated that the possible causes of poor circulation include shock, cardiac arrhythmias, heart failure, and pulmonary embolism.Assessing circulation• Blood pressure: it is an indication of the effectiveness of the cardiac output. • Gauge the patient’s peripheral skin temperature by feeling their hands to determine if they are warm or cold.• Feel and measure the patient’s heart rate relative to their normal physiological condition. • Patient’s temperature: if the patient has a raised temperature.• Capillary refill time (CRT): it is a simple measure of peripheral circulation. • Assess the state of the veins, they may be under filled or collapsedTreatment According to the resuscitation council 2011, the right treatment for proper flow problem varies on what its actual cause is, lots of fluids should be administered to enable tissue stability.• Insert an intravenous cannula to ensure that medications and fluids are administered efficiently.• Blood samples can be taken for routine hematological investigation.Disability assessment This assessment involves reviewing the patient’s neurological status and it should be done once assessment ABC has been established.Assessing neurological functionLevel of consciousness: conduct a rapid assessment of the patient’s level of consciousness using the AVPU system (smith 2003)1. Awake: observe if the patient can open her eye and response to the environment.2. Examine the pupils (size, reaction to light)3. Voice: patient’s response when spoken to.4. Pain: asses patient’s response to pain when a painful stimuli is applied e.g trapeziums sgueye5. Unresponsive: when patient does not respond to pain (mallet 2013)6. Glasgow coma scale assessment can also be done to assess patient’s level of consciousness. Treatment Patients machine chart for reversible medicine induced causes of altered level of consciousness and call for expert help (thini T et al. 2012)Assessing exposureConduct a thorough examination of the patients body although, respecting patient’s dignity by exposing patient minimally.Assess patient looking out for presences of rashes, swelling, bleeding or any excessive loss of drains.Study patient’s medical notes, medicine charts, observation chart and result from investigations for an evidence or proof that will affect the ongoing plan of care.Document all assessment done, treatment and response to treatment in patient’s clinical notes.Nursing assessment Is used to identify present and future health status of a patient. The nurse will be able to recognize the normal or abnormal body physiology in other to achieve health goal, professional and therapeutic means of communication. It creates the foundation of trust and assurance to Mrs. Perkins where she feels comfortable to reveal other personal information.Physical examination includes checking her vital signs which read T:37.6 c, P: 86b/m, R: 24c/m, Bp: 172mmhg. Inspection was done in which it is noticed that Mrs. Perkins face is drooling on the right side; following the normal brain physiology, this indicates the left part of the brain is affected. Her temperature should be observed. This is done to evaluate the sensory, circulatory and molar function.For neurological assessment a Glasgow coma scale can be used (Teasdale 1974).It has different elements. The elements are eye; patient is assessed to see if eye does not open (1), opens eye in response to pain (2) and opens eye on response to voice (3).The values separately as well as their sum are considered. The lowest possible GCS sum is 3, which indicates deep coma or death, while the highest is 15 (fully awake).Mrs. Perkins who has transient Ischemic attack is prone to having a stroke. After the assessment carried out, it is noticed that Mrs. Perkins has right facial slump; indicating that her left side of the brain is affected. She also has difficulty in speaking well. Her vitals read T:37.60c, PR: 86 b/m, R: 24 c/m, Bp: 172/100, Spo2: 95% Mrs. Perkins presentations with these should initiate the activation of an emergency response too the nearest hospital. Stroke specific therapies includes position of patient during transport, use of oxygen therapy and airway management, placement of intravenous line, administration of IV fluids, electrocardiographic monitoring, blood glucose monitoring, correction of hypoglycemia, administration of aspirin and close monitoring of vital signs. Administration of IV fluids to Mrs. Perkins will be essential. The management of hypertonic saline has been suggested to door ease Intra-cranial pressure in the setting of acute stroke (Schwarzs 2002). However, IV fluid should be used cautiously with patients with underlying medical conditions such as heart failure like Mrs. Perkins or patients with Renal failure in which volume overload could be detrimental patients who are dehydrated should be given boluses of balanced salt solutions to improve circulation and cerebral blood flow. (Kelly 2004).ECG monitoring is a vital assessment to be carried out.