Mrs Alice Palmer is suffering from Ischemic stroke. With this condition, the female patient has also been experiencing poor memory as a result of the condition that is presumably worsening with the situation. The detected condition provides some leads to other health problems that Palmer could be suffering. Previous incidences of hypertension are critical leads that demonstrate some of the common causes of the current condition in the event that such problem was not treated effectively. Hypertension is principally a condition as opposed to a disease. It demonstrates a situation of derailed normalcy in the undertaking of the body processes and may dictate a major impeding problem. Ischemic Stroke that Palmer had been suffering from refers to deprivation of oxygen in the brain which could be caused by a series of factors such as poor blood circulation. It can be manifested through thrombotic or embolic perspectives. Her visual abilities had also been challenged as per the initial clinical report. Celebral arteries may become blocked by clots of blood hence resulting in poor circulation of blood throughout the body (Adams & Marsh, 2013).
The brain suffers as a result due to lack of sufficient oxygen supply and forms a fast reaction to reduced affinity to oxygen supply before other organs responds. The analysis of the actual conditions of the patients based on the perceived and the reported symptoms form the basis upon which the nurse makes deduction through the process of clinical reasoning cycle. The process involves analysis of the routine signs on a patient that leads to the determination of the clinical problem associated with the respective patients. Through a clinical reasoning cycle, nurses are able to understand the health problem and make decisive measures from an informed point of view (Coulter, 2011). The basic steps involved in this process are: consideration of the patients situation, collection of evidence, process data gathered, identify the problem of the patient and create a detailed report of the assessment. This procedure aims at developing a solution to a patients health problem.
Mrs Palmers Situation
Mrs Plamer is reported to have experienced Ischemic Stroke besides having suffered hypertension. In addition, Palmer The condition of Ischemic Stroke has been associated with influencing Palmers health situation including an influence on her visual abilities. Hypertension is a major challenge to the functioning of the blood vessels and the entire circulation (Ottomanelli, 2011). The blood vessels run throughout the body including the brains. When the brain is affected by hypertension, high pumping mechanism of the blood into the brain may cause sudden rapture of the brain vessels which is quite fatal to the victim (Willmot & Bath, 2004). Sustained high blood pressure perpetrated through avoidance of precautionary measures such as medication or otherwise resuming healthy lifestyle may deteriorate the condition leading to severe damage on the circulation system on general (TrialistsCollaboration, 2011). In this regard, the prolonged stay of Mrs Palmer with the condition of hypertension without taking any form of medication of lifestyle change may have resulted into rapture of the brain vessel thus, the stroke. Prior to this level of damage, the constrained vessels experienced poor flow of blood through them hence poor supply of oxygen in to various parts of the body. The head was the most affected part of the body with the restrained blood flow (Rogers, 2008). As a result, this condition could explain the experience low vision by Palmer during the clinical analysis. The prolonged stay without medication may dictate the shift of events where the nurses transfer Palmer from first unit to the next for intensive analysis due to possible accumulation of the problem.
Cues and Information
From the initial assessment, it is not possible to determine the actual problem which leads to Palmer being transferred to the acute stroke unit which was detected based on initial cues. Her blood pressure is very high measuring at BP 155/90 against a normal case of 120/80 mm Hg (Wright & Bykonich, 2015). This result provides a critical consideration of the elements that predisposes this condition on the basis of the causes that are presumed to lead to it. This level of blood pressure may only be acceptable at lower level for children or teenagers. Nonetheless, the present Palmers condition presents a stage 1 case of hypertension whose range is approximately 140-159/90-99. This implies that despite the condition, hypertension was graduating to the upper fatal limit of stage 2. The Glassgow Comma Scale measure the conscious level of an individual as a result of traumatic brain injury. The recorded level of 15 for Palmer indicates a minor brain injury measured at the range between 13 and 15. Mild injuries of the brain may create a scenario of temporary or permanent neurological as the case of Palmer manifested through slowed memory abilities. Normal individuals typically measure at level 5 of the Glassgow Comma Scale (Roberts & Sheehan, 2011).
From the above findings, high blood pressure results into potential damage of the blood vessels that may result into the condition manifested by Palmer through the resultant stroke. Similarly, the blurred vision could have been a manifestation of poor circulation of blood that limited oxygen supplies throughout the body. In this regard, low measure of blood pressure in adults cold dictates a dysfunction of some of the body structure including a condition of vassal dilation. However, lower blood pressure below the normal 120/80 levels with regard to systolic and diastolic functions may be a normal incidence for children but may be a manifestation of body dysfunction due to various challenges confronting the ideal functioning of the heart and the blood vessels such as clots among other hindrances to blood flows (Whelton & Karimbakas, 2012). On the other hand, the tampered blood flow and the overall supply of oxygen in the brain may instigate a condition of poor vision and loss of consciousness. However, the level of impact generated by this scenario depends on multiple factors such as the intensity of vassal constriction or dilation that influence the level of pressure in the blood. The mild effect on consciousness as manifested in the Glasgow Coma Scale of 15 unit is a manifestation of low level of damage on the typical blood pumping mechanism despite the invasion with hypertension for a long time (Belar & Reed, 2013).
In order to undertake a comprehensive review of the condition of the patient, I will prepare a comprehensive health assessment questionnaire including all the relevant measures that I intend to evaluate. In particular, I will consider some of the eminent measures as shown below:
Issue of Assessment Yes No Narration
1. Have had hypertension before current examination 2. What are the main routine physical activities - -
3. Do you have a history of hypertension/diabetes in your family? 4. What health activities do you engage routinely? 5. Medical Examinations: (Lab Report 1)
Measure of Blood pressure:
Against Normal/In tandem with Normal
5. Medical Examination (Lab Report 2)
Measure of Consciousness (GCS)
Between 13-15 Explanation:
6. Patients Perspective of her condition (if&only if possible- Voluntary) In this regard, the health assessment will be a combination of both clinical laboratory examination as well as the adoption of observable features in the determination of the clinical challenge associated with the individual patient. In this regard, the patient must develop a concurrent view of her condition with the view perpetrated through the health case file from the lab. In order to enhance patients participation in the treatment program by increasing their ability to take safety precaution towards enhanced health condition, I will sensitize the patient (Palmer) on the need for frequent medical checkups in order to identify and resolve potential harmful insurgences that ma impound and develop complication as a result of delayed attendance by a specialist. In particular, I would evaluate some of the hindrances to her seeking medication despite her prolonged stay with hypertension and create the best possible level of awareness of the damage that the long stay has inflicted on her health including creating a safe haven for other conditions such as stroke. The routine development of a correction program that patient should follow include use of well-crafted healthy lifestyle will be a critical ingredient of my proposal for the patient to adopt towards realizing a healthy lifestyle in future.
Finally, this case study provides a critical review of the important role of clinical reasoning cycle as a prospective mechanism of drawing up the important cues to a patients condition that provides important leads to resolving their health problem. Clinical reasoning based on the physically identifiable features and the clinical lab reports may generate an important avenue for the determination of a given health challenge and further create sound solutions to the problem from a knowledgeable point of view. In order to realize these benefits, this case study assignment sought to manipulate the essence of clinical assessment through a physical patients scenario in order to derive the ultimate role of clinical assessment in development a sound and informed clinical reasoning scenario devoid of generalization. The process also demands careful consideration of the actual attributes of a patients health condition towards developing sound clinical solutions.
Adams, H. P., & Marsh, E. (2013). Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in AcuteStroke Treatment. Stroke, 24(1), 35-41.
Belar, C. D., & Reed, G. W. (2013). Self-assessment in clinical health psychology: a model forethical expansion of practice.
Coulter, A. (2011). Engaging patients in healthcare. Berkshire, England: Open University Press.
Ottomanelli, G. (2011). Assessment and treatment of chemical dependency. Westport, Conn:Praeger.Roberts, R. J., Roberts, M. A., & Sheehan, W. (2011). Mild traumatic brain injury: Episodicsymptoms and treatment. San Diego: Plural Pub.
Rogers, R. (Ed.). (2008). Clinical assessment of malingering and deception. Guilford Press.
TrialistsCollaboration, S. U. (2011). How do stroke units improve patient outcomes? Acollaborative systematic review of the randomized trials. Stroke, 28(11), 2139-2144.
Whelton, P. K., & Karimbakas, J. (2012). Primary prevention of hypertension: clinical andpublic health advisory from The National High Blood Pressure Education Program.Jama, 288(15), 1882-1888.
Willmot, M., & Bath, P. M. (2004). High blood pressure in acute stroke and subsequent outcomea systematic review. Hypertension, 43(1), 18-24.
Wright, D., & Bykonich, J. (2015). The ultimate guide to competency assessment in healthcare.
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