Nursing Processes: From Admission to Discharge

Shan Jiang

Develop an understanding of the nursing process from admission through to discharge of a client in a health care facility

My patient is Mr. Peter William, 71 years old male, was found slumped in the shower accomplishing flaccid right limb and mouth and face drooping. In addition, this client also had slurred speech, and urine incontinence problems.

In my care plan, I will outline the specific assessment tools and major health problems on Peter and present outcomes and interventions.

There are two assessment tools that a nurse needs to do. One of these is the acute falls risk assessment tool. The main reason is that this client has right side weakness. This means that older people with limb flaccid contributes to high risks of falls. Nystrom and Hellstrom (2012, P. 473) state that the falling incidence of elderly with limb weakness is two times the number of those who are the same age without limb flaccid. Furthermore, Braden risk assessment scale also should be considered as a significant tool for this patient. The main reason is urine incontinence and limb weakness could lead to the impaired skin integrity and even pressure ulcer. Therefore, those two tools would be implemented due to urine incontinence and right side weakness.

Peter has three main health problems, which are the guidelines to offer safe and high quality of care. The first and most urgent health problem is the risk of aspiration manifested by slurred speech and face and mouth drooping. The reason is that swallowing dysfunction contributes to high risk of aspiration and the difficulty of moving foreign materials from the airway (Garcia and Chambers 2010). As a result, this patient could not clear the airway effectively, leading to high risk of death. Another significant health problem is the risk of falls because of right side weakness. The reason is that this client would have high risk of injuries such as fracture even death, due to the high incidence of falling (Hindmarch et al. 2009 & Naqul et al. 2007). The third health issue is risk of impaired skin integrity caused by urine incontinence and limb weakness. The reason why impaired skin integrity should be a priority is that broken skin contributes to various infections. All those evidence demonstrates that the key health problems are the risks of aspiration, falls, skin integrity and the prioritization bases on severity of threatening life safety.

Relatively desired outcomes could be achieved by means of nursing interventions basing on the two priority health problems. Firstly, the incidence of aspiration is minimized and relevant complications would be prevented by multiple interventions. Rofes et al. (2011) report that food modification and other swallowing function rehabilitation contribute to preventing aspiration-related malnutrition and pneumonia and improving dysphagia. Furthermore, the falling rate decreases during hospitalized time attributes to professional nursing care. In other words, the falling rate of inpatient would decline dramatically due to the implement of multiple prevention methods. Therefore, professional and effective nursing interventions facilitate desired outcomes in terms of effective airway clearance and reducing falls rate.

There are two interventions could be implemented to reduce aspiration. One of these is postural strategy. This means that modifying body and head position could minimize the incidence of aspiration and relevant respiratory complications. Rofes et al. (2011) report that postural approaches are easy and effective to be performed due to little fatigue and those involve head extension, turning head towards the unhealthy side and so forth. Those strategies could prevent residues from aspiration, such as titling head to the health side before making bolus directly to the stronger side through the gravity (Rofes et al. 2011). Another one is dietary modification. According to Garcia and Chambers (2010, p. 30), appropriate food texture according to the patient’s swallowing capacity contributes to ingesting foods sufficiently and thin liquids should be avoided due to fast transiting and solids. As a result, aspiration would be minimized. Therefore, postural methods and food modification could minimize the occurrence of aspiration.

After discharge, various issues this patient might meet and relevant strategies could be implemented to combat those problems. Firstly, risk of falls still exists after hospital discharge. The main intervention is combining environment modification and education (Lord, Menzand & Sherrington 2006; Hill et al. 2011). According to Lord, Menz & Sherrington (2006, p. 58), there are a variety of factors associated with high risk of falls, such as home surroundings and falling incidence could be decreased to 31% in one year by assessing home hazards and educating the use of multiple mobility aids. Moreover, communication barrier is also a significant issue for this patient after discharge due to poor verbal communication. The reason is that aphasia would lead to low quality of life even depression (Hilari and Byng 2009). Therefore, relevant efforts should be taken to resolve this problem. According to Lanyon, Rose & Worrall (2013, p. 360), aphasia groups contribute to promoting friendship and social issues through different modality communication activities, such as regaining meaningful interactions and communication skills. As a result, depression is minimized due to communication effectively and confidently.

In present-day society, multiple chronic diseases are very common among the elderly and the clinical manifestations are complicated comparing to adults. This care plan indicates that the whole nursing procedure of an old patient with slurred speech, right side flaccid and urinary incontinence, which involves using assessment tools to identify major health problems: ineffective airway clearance and risk of falls and impaired skin integrity. Professional care could be applied to solve those problems including in hospital and post discharge.

References

Nystrom, A, Hellstrom, k 2012, ‘Fall risk six weeks from onset of stroke and the ability of the prediction of falls in rehabilitation settings tool and motor function to predict falls’, Clinical Rehabilitation, vol.27, no. 5, pp.473-79.

Garcia, J M, Chambers, E 2010, ‘Managing dysphagia through diet modifications’, American Journal of Nursing, vol. 110, no.11, pp. 26-33.

Hindmarch, D M, Hayen, A, Finch, C F, Close, J C T 2009, ‘Relative survival after hospitalization for hip fracture in older people in New South Wales, Australia’, Osteoporosis International, vol.20, no. 2, pp. 221-29.

Rofes, L, Arreola, v, Almirall, J, Cabre, M, Campins, L, Peris, P G, Speyer, R, Clave, P 2010, ‘Diagnosis and management of oropharyngeal dysphasia and its nutritional and respiratory complications in the eldly’, Gastroenterology Research and Practice, vol.2011, viewed 7 May 2014, <http://dx.doi.org/ 10.1155/2011/818979>

Lord, S R, Menz, H B, Sherrington, C 2006, ‘Home environment risk factors for falls in older people and the efficacy of home modifications’, Age and Ageing, vol. 35, no.2, pp.55-59.

Hilari, K, Byng, S 2009, ‘Health-related quality of life in people with severe aphasia’, International Journal of Language & Communication Disorders, vol. 44, no.2, pp. 193-205.

Lanyon, L E, Rose, M L, Worrall, L 2013, ‘The efficacy of outpatient and community-based aphasia group interventions: a systematic review’, International Journal of Speech-Language Pathology, vol.15, no.4, pp.359-74.