This assignment will focus on a patients journey and the impact of

This assignment will focus on a patients journey and the impact of a chronic condition in their life and the different signs and symptoms leading up to their condition, followed by the current care they were receiving, up to and during my involvement while on placement. In accordance with the Nursing and Midwifery Council (NMC, 2018), the patient chosen for this essay will be named Robert, to protect his identity and maintain confidentiality. Informed consent will be attached. Robert is a 55 year old patient who had suffered a stroke following a traumatic brain injury 2 years ago. Previous to Roberts stroke he had a past medical history of chronic obstructive pulmonary disease (COPD), with the use of inhalers to treat his symptoms. From an insight of Roberts background he was unemployed, an alcoholic, lived alone, and was an excessive smoker. Roberts habits of binge drinking lead to a series of multiple falls and injuries, later resulting in a hemorraghic stroke. From the beginning of Roberts long term condition was when he suffered from a serious fall after a binging of alcohol. From Roberts well documented nursing notes it was apparent that the cause of the fall was from him blacking out while he was on his way out the back door, hitting his head going down the steps. His symptoms after gaining consciousness was an experience of a severe headache, dizziness and the feeling of wanting to vomit. Lucky for Robert, a neighbour was there to phone for help. On arrival at A&E, Robert was rushed for a CT (computed tomography). Doctors soon discovered a bleed on his brain, in this case it was a subarachnoid hemorrhage. A decision was made that the best option for Robert would be to undergo surgery for coiling. This is where a thin tube called a catheter is inserted into an artery in the leg or groin, it is guided through the network of blood vessels into the head where it reaches the aneurysm, small platinum coils are passed through the tube, once the aneurysm is full of coils, blood can no longer enter (NHS, 2019). Despite the astonishing efforts of the nursing and medical team that saved Roberts life, he had still suffered from damage to his brain. This was the start of his patient journey to the point of our meeting where he was now a patient with the district nursing team, where he would have regular bloods taken for a precaution from further strokes.Soon after Roberts life saving surgery it was obvious he needed much more after care to reduce his symptoms from the stroke. After someone has suffered a stroke the multidisciplinary team (MDT) all comes together in providing intense treatment. A core multidisciplinary stroke rehabilitation team should comprise the following professionals with expertise in stroke rehabilitation: consultant physicians, nurses, physiotherapists, occupational therapists, speech and language therapists and social workers. Throughout the care pathway, the roles and responsibilities of the core multidisciplinary stroke rehabilitation team should be clearly documented and communicated to the person and their family or carer (National Institute for Health and Care Excellence [NICE] 2013). From looking back on Roberts nursing notes it was clear to see every interaction he had from different members of the MDT and what purpose they served for Robert personally. A study has found that people who suffer from SAH are known to recover to functional independence however experience a reduced quality of life (Passier et al., 2012). There are many different contributing factors that can reduce a persons quality of life after suffering a subarachnoid haemorrhage, cognitive impairment is one of them, and is widely considered the main cause of disability. A recent study from NIHR Dissemination centre, 2017 has found that a staggering third of the UK’s 1.1 million stroke survivors experience communication difficulties. With treatment excelling for stroke survivors there is much more needed input from other professions to ensure survivors are living their life to the fullest and remaining as much independence as possible. NICE guidelines recommend that a person is screened within 72 hours following a stroke and referred for speech and language therapy if required. In Roberts case this was one of his biggest set backs of regaining his independence, having being left with a prominate slur in his speech he struggled to communicate his basic needs and became frustrated and angry, however his worries were put at rest when he was introduced to a specialist in speech and language therapy. Speech and language therapy aims to help the person make the most of their communication abilities, by teaching them and family members different methods such as gestures, writing and using props to maximise their communication potential. They help stroke survivors with aphasia relearn how to use language or develop alternative means of communication. They also help people improve their ability to swallow, and they work with patients to develop problem-solving and social skills needed to cope with the after-effects of a stroke. This provides them with the help to rebuild their confidence and regain their identity. After one month of therapy Robert started to feel confident in his speech. However this intense course of treatment can be exhausting for someone, this was especially experienced by Robert, after conversations with him, it was clear the way he felt after his stroke. He talked about how he felt very low and anxious about his future. Robert didn’t have much contact with family at the time, meaning the only support he was receiving was from staff at the hospital. It was not long after the stroke he was clinically diagnosed with depression.Mood disturbance is common after stroke and may present as depression or anxiety. 30% of patients will suffer from depression at some point post stroke and a high number of these patients remain undiagnosed or inadequately treated. Depression and anxiety is associated with higher rates of mortality, long term disability, higher suicide rates and reoccurring hospital admissions (Blake, 2011). There is a wide variations of tools and assessment measures that professionals use to diagnose and treat patients severity of mood levels such as an algorithm adapted from a mood screening protocol developed by Ian Kneebone et al (2010). This tool prompts a set of questions that follows a pathway for an expected outcome for a patient and gathers information, it is simple yet effective. According to NICE Quality Standards for Depression 2011, all patients are screened within 6 weeks of diagnosis using a validated tool, to identify mood disturbance and cognitive impairment. These tools should be initially used by nurses and developed into the nursing management care plan. With depression on the rise, another vast concern is mobility, with the majority of stroke survivors having problems with movement. For Robert, he was diagnosed with hemiplegia, this means the right side of his brain was damaged from the stroke therefor the whole left side of his body was left paralysed (Nih.gov, 2014).The likelihood of improvement after stroke varies with the nature and severity of the initial deficit. Approximately 35 percent of survivors with initial paralysis of the leg do not regain useful function, and 20 to 25 percent of all survivors are unable to walk without support or aids. 6 months after stroke 65% of patients struggle to involve the use of the affected hand into usual daily activities (Dobkin, 2005). Physical rehabilitation helps stroke survivors relearn skills that are lost when part of their brain is damaged, for example there are various exercises such as coordinating leg movements in order to walk or carrying out the steps involved in an activity. Patients may have to learn how to wash, dress and groom themselves all from the beginning again depending on the severity of. damage caused by their stroke (Nih.gov, 2014). Occupational and physical therapists play a major part in a stroke patients recovery. Along Roberts journey he had heavy input from physical therapists, with up to 2 sessions a day, involving a pattern of different exercises, mainly focusing on 1 goal each time. Physical therapists specialise in treating disabilities related to motor and sensory impairments. They are highly trained in all aspects of the human body’s anatomy to movement. During Roberts first few sessions in physiotherapy, he felt the extreme pressure to get back to normal, finding he was pushing himself too far too fast, but with the help of experienced staff they were able to guide and support him to reach his goals. Within 4 weeks Robert went from not being able to pick up objects with his left arm, to combing his hair. He further went on to focus on getting back on his feet, he was determined to keep going. Over-ground training is one method therapists use to improve dynamic balance and ensure safe ambulation. The first method of practice is trunk and head control, sit to stand balance, and eventually taking controlled and supervised steps with the aid of parallel bars (Dobkin and Dorsch, 2013). Within 3 months of intense therapy, Robert was able to walk short distances with a Zimmer frame while supervised by staff. Robert also was seen by the occupational therapists to get him ready for going home. They helped him by reintroducing what life would be like at home, such as basic skills around the house, wether it was making a cup of tea, to brushing his teeth.Alongside the input from crucial members of the MDT in Roberts recovery, he was started on lengthily list of medications, ranging from pain relief to anticoagulants. Anticoagulants are a type of drug used to prevent future forming blood clots, this works by changing the chemical composition of the blood in a way that stops the clots from forming (NHS choices, 2019). The chances of a stroke reoccurring are 25%-35% (Brody, 2017), this signifies the importance of medications and goal of prevention. The nursing team was responsible for ensuring Robert had each medication with the right dose and right time, from doing this correctly the nursing team were crucial in preventing another stroke (NMC, 2018). Rehabilitation nurses specialise in helping stroke survivors with personal and skin care, this care was very valuable to Robert initially after his stroke as he struggled to sit himself up. He needed help from the nursing team to get washed and dressed, however, from being so immobile, Robert suffered from a grade 2 pressure sore. This is when there is damaged caused to the skin from prolonged pressure on a specific area, for Robert it was his sacrum. Reading back through his notes it could have been avoidable, however Robert subsequently refused to alternate positions while in bed. It is very important to treat pressure ulcers quickly and effectively as they are painful and debilitating and, if left untreated, can lead to serious harm and death (National Patient Safety Agency, 2010). This is when the nurses introduced a SSKIN bundle into Roberts care plan. The aim of a skin bundle is to reliably implement prevention strategies, identified by the National Institute for Health and Clinical Excellence (NICE, 2005). This tool is very effective as it is key in documenting when a patient was last turned, to then which side and also their level of continence. It is an excellent communication tool for nurses. There was also a wound chart placed in Roberts care plan for his pressure ulcer, this is a tool for the location, what products were used for cleansing and dressing. This tool allows for nurses to follow on with the wound management, without any changes, providing a more effective treatment.Going on forward with Roberts care, after spending 9 months in hospital, he was assigned a social worker who organised a care package in order for him to be discharged home. Since Robert had next to no input from family it was decided that a care package of 4 times a day would be best for him. Physiotherapists also were arranged to go and visit Robert at home twice a week to carry on with with his rehabilitation. Also during his time in hospital Robert was introduced to a stroke support group where he made friends who were living with the same long term condition, this provided him with stability and support. In conclusion, Roberts long term condition has been a long road to recovery to get him up to where he is now. However he would not have made it alone without the astonishing help and support from the nursing and multidisciplinary team. There are many different ways stroke can impact on a persons life, this assignment has outlined different ways of managing and over coming these effects of stroke. Such as improving when communication has been impaired, or gaining the physical strength to allow movement and mobility again. The most crucial factor in nursing is to remember the importance of prevention. Every aspect in a patients care is to ensure full quality of life is reached and is after all the reason for treatment.

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