Criteria HD D C P F Mark (%)

Criteria HD D C P F Mark (%)

Demonstrates the ability to analyse the assessment findings with the case presentation. Demonstrates expert analysis and clinical reasoning within the process of interpretation of all relevant assessments for the case presentation Demonstrates comprehensive analysis and clinical reasoning within the process of interpretation of all relevant assessments for the case presentation

Demonstrates some interpretation and clinical reasoning of the analysis of the patients assessment which is presented in the case.

OR

Demonstrates expert analysis and clinical reasoning within the process of interpretation of some of the relevant assessments for the case presentation. Shows an understanding of the assessment process however is lacking in analysis and clinical reasoning within the case presentation.

OR

Demonstrates comprehensive analysis and clinical reasoning within the process of interpretation of some of the relevant assessments for the case presentation. Insufficient evidence of assessment and the required analysis from the presented case.

OR

Discussion on assessment process is very Unclear and inaccurate and limited analysis and clinical reasoning is demonstrated.

OR

Shows an understanding of the assessment process however is not linked to the case presentation. /30

Interprofessional health care related to provision of person centred care. Identifies and succinctly discusses 3 healthcare issues in which the interprofessional healthcare team are effectively incorporated into the management of the patient to provide person centred care. Identifies and succinctly discusses 3 healthcare issues in which the interprofessional healthcare team and incorporates them into the management of the patient to provide person centred care. Identifies and discusses 3 healthcare issues in which the interprofessional healthcare team can be incorporated into the management of the patient to provide person centred care. Identifies and discusses healthcare issues in which the interprofessional healthcare team is incorporated them into the management of the patient to provide person centred care

OR

Discussion succinctly discusses 3 healthcare issues in which the interprofessional healthcare team are effectively incorporated into the management, however this is not relevant to the case study. Identifies healthcare issues in which the interprofessional healthcare team can be involved in

OR

Discussion is unclear and vague and not related to the case study /30

Ethical and legal considerations Legal and ethical issues are integrated and concisely discussed throughout the paper. Legal and ethical issues are integrated and discussed throughout the paper. Legal and ethical issues are discussed throughout the paper. Legal and ethical issues are included in the discussion within the paper. Legal and ethical issues are not mentioned within the paper. /13

Health Promotion and reflective practice Expertly demonstrates an understanding of Health promotion throughout the discussion on interprofessional healthcare management.

The use of reflective practice has been demonstrated. Comprehensively demonstrates an understanding of Health promotion, throughout the discussion on interprofessional healthcare management.

Some reflective practice has been demonstrated. Health promotion has been appropriately demonstrated throughout each of the healthcare issues identified within the case.

Limited reflective practice has been demonstrated. Health promotion has been demonstrated within some issues identified within the case.

No reflective practice demonstrated or is unclear and vague.

Health promotion has not been effectively and appropriately demonstrated throughout each of the healthcare issues identified within the case. The use of reflective practice has been demonstrated. /12

Demonstrated ability to review the literature and select appropriate sources

Extensively and accurately integrates literature that is current (within 5 years) and highly relevant to the topic, demonstrating an ability to review the literature.

Accurately integrates literature that is current (within 5 years) and highly relevant to the topic, demonstrating an ability to review the literature.

Extensively and accurately integrates literature that is current (within 5 years) but not always clearly related to the topic

AND

Some demonstration of an ability to review the literature.

Integrates literature that is current, however is not clearly related to the topic

OR

literature is not current but clearly related to the topic

AND

Limited demonstration of an ability to review the literature Little to no review of recent and relevant literature from peer reviewed and reputable sources. Use of less credible sources evident. /10

Follows requirements for structure, presentationgrammar and spelling.

Accurately and consistently adheres to essay format writing conventions, grammatical conventions with no errors and is a logical / well and succinctly structured assignment

Mostly accurate and consistent adherence to essay format writing conventions, adheres to grammatical conventions with few errors and is a logical and well-structured assignment

Partial but close adherence to essay format writing conventions, adheres to grammatical conventions, but with frequent errors, mainly a well- structured assignment, lacking cohesion in places

Minimal adherence to essay format writing conventions, minimal adherence to grammatical conventions with multiple errors, a weakly structured assignment, frequently lacking cohesion

Little attempt to adhere to essay format writing conventions, multiple grammatical errors with minimal attention to writing / spelling conventions that significantly distract the reader from the content. A poorly structured assignment, lacking cohesion

/5

Total /100

Student number: 220229552

Student name: AAYUSHA MAKAJU

Unit title and number: HSNS273

Integrated Nursing Practice 6

Written Assessment 2 (30%)

Assignment Due Date: 12 September, 2021

Unit co-ordinator: Fiona Barrett

Word Count: 2028

Cerebrovascular Accident (CVA), medically known as stroke, is the condition in which blood flow to part of the brain is stopped due to ischemia or hemorrhage (Brown et al., 2019). It is the third leading cause of mortality and the main cause of chronic disability in Australia (Australian Bureau of Statistics, 2019). In the given case study, Lara, a 78-year-old female, was brought into the hospital with right-sided hemi-paralysis, aphasia, and facial drooping. Her Computed Tomography (CT) scan result demonstrated probable left CVA. Thus, this essay will analyze and interpret the assessment findings of Ms. Lara from the given case study. It will then discuss the interprofessional care, management plan as well as discharge plan for providing quality care to Lara.

The neurons of the brain require a continuous supply of blood and oxygen to function properly (Brown et al., 2019). If the flow of blood in the arteries leading to the brain gets partially or completely blocked through either thrombus formation or embolus, then the part of the brain will lack sufficient oxygen and nutrients, resulting in ischemic stroke. Hemorrhagic stroke results from bleeding into the brain tissue (American Stroke Association, 2018). Risk factors of stroke include age, sex, family history, ethnicity, history of hypertension, coronary heart disease, atrial fibrillation, brain aneurysms, cholesterol level, and sedentary lifestyle. In the given case study, Lara was a regular smoker and had a history of hypertension, congestive cardiac failure (CCF), and type 2 diabetes mellitus.

High blood pressure damages blood vessels, making them harder and narrower. As it progresses, it blocks those vessels causing ischemic stroke. The increased pressure can also result in weakened blood vessels to burst inside the brain, causing a hemorrhagic stroke (Upoyo et al., 2021). Similarly, in diabetic patients with high blood glucose levels (BGL), fatty materials deposit in the blood vessels blocking the blood supply. Patient with congestive cardiac failure is unable to supply sufficient blood and oxygen to the body including brain (Kim & Kim, 2018). Cigarette smoke can increase cholesterol levels, blood pressure, and clot formation. All these factors increase the probability of having a stroke (Chen et al., 2019). Moreover, aging is the strongest non-modifiable factor of stroke as with aging, arteries become narrower and harder, with increased risk of atherosclerosis and ischemic stroke. Thus, Lara is 78 years old, with approximately 40 years history of smoking, blood pressure of 146/100, and BGL of 9.4 mmol/L increases her risk of having a stroke.

Since one side of the brain controls the opposite side of the body, a left-sided stroke results in neurological complications on the right side of the body and vice versa. Patients with left CVA may present with right-sided hemiplegia, aphasia, and trouble swallowing or walking, (Brown et al., 2019). Stroke can also cause facial drooping and visual defects due to impairment of facial nerves and damage of the visual pathways respectively. Lara was also experiencing similar signs and symptoms. She had right-sided hemi-paralysis, aphasia, homonymous hemianopia, and facial drooping. These symptoms indicate that she might have left CVA. Her CT scan had also demonstrated increased density in the left middle and cerebral artery. The middle cerebral artery (MCA) is the largest artery carrying oxygenated blood to the brain. The hyperdensity of MCA is the earliest visible sign of intra-arterial occlusion, mainly by a thrombus or embolus and thereby leading to acute ischemic stroke (Chieng et al., 2020). Thus, her increased density in the left MCA also supports left-sided stroke.

Patients with possible stroke are also at greater risk of developing aspiration-related pneumonia. It is because the stroke patients are dysphagic and their muscles used for swallowing are weak. So, they might accidentally inhale foreign objects leading to pneumonia. This can cause cough, difficulty in breathing, and crackles. Laras basal crackles on auscultation and early signs of edema can be related to pneumonia-related stroke. Thus, Lara was kept nil by mouth (NBM) until she was reviewed by a speech pathologist to prevent aspiration and its related complications (Armstrong & Mosher, 2017). With the history of CCF, her heart is unable to deliver oxygen-rich blood to the body, resulting in hypoxia and hypoxemia. Her increased heart rate, respiration, and decreased oxygen saturation support her hypoxic condition. Thus, she has been placed in 2 liters/ minute oxygen via nasal prongs. Also, the team was unable to dissolve the clot, so she was repositioned every two hours to keep blood flowing and to prevent bedsores (Latimer et al., 2015). As stroke impairs mobility, an indwelling catheter (IDC) has been placed to prevent any risk of falls. Also, she was receiving crystalloid fluids as stroke patients receiving intravenous crystalloids fluids have a low risk of getting pulmonary edema and secondary brain injury from cerebral edema (Visvanathan et al., 2015). All these observations are her objective data. She does not have any subjective data due to her aphasic condition.

With a stroke, the patients may experience many changes in physical, functional, and cognitive abilities. They may also experience changes in their personalities and social roles (Rannikko et al., 2018). Moreover, it can include loss of decision-making capacity due to impairment in cognition and increased dependency on others for mobility and all activities of daily living. The overall changed lifestyle in stroke patients requires a greater deal of adaptation. Thus, it is the responsibility of nurses to recognize any ethical issues affecting the patients. They should have the feeling of care, empathy, respect, beneficence, and non-maleficence. Thus, nurses with a better understanding of the ethics of stroke guarantee better care to the patients as well as their families. Similarly, some of the legal obligations under the Standards of Practice include respecting each other, complying with policies and guidelines of the organization, working within the scope of practice, taking consent from patients, maintaining their privacy and confidentiality, and so on. In stroke patients, consent may be required before performing any procedure, treatment, or surgery (Fisher & Schneider, 2014). Even if the treatment is intended for benefit of the patient, consent must be received. But, in the stroke patients like Lara, it may be difficult to communicate and take consent. So, simple language with a closed question can be preferred so patients can respond by nodding their heads or even by blinking. A communication board can also be used as a tool for communicating. Similarly, the privacy and confidentiality of all patients, as well as co-workers, must be highly maintained (Dimond, 2017). It is the legal duty of all health practitioners to protect patients from inappropriate disclosure of their personal information. These legal and ethical factors can be used to deliver person-centered care to patients. It is because both the legal and ethical practice, as well as the patient-centered care, focuses on including the patients in making all decisions about their health and also treating them with dignity and respect.

A stroke patient may present with many complex challenges, so a multidisciplinary team needs to be involved in the care of the stroke patient. Similarly in Laras case, different team members like doctors, nurses, stroke neurologists, occupational therapists, physiotherapists, pharmacists, speech pathologists, dieticians, and social workers will be involved in her management plan. They will address different individual concerns of the patients and work together to ensure holistic and quality person-centered care (Nogles & Galuska, 2020). A team with stroke specialists, stroke neurologists, and trained nurses and therapists to care for stroke patients is very important (Nogles & Galuska, 2020). Stroke physicians will help in diagnosis, management of diagnosis, and treatment plans while nurses will be providing nursing care as well as monitoring, recording, and responding to the clinical status of the patients. Nurses can also involve in nursing assessment and provide referrals to required professionals on time. Since stroke can affect mobility, a physiotherapist can be involved in retraining lost motor skills, while an occupational therapist can be assisting in all areas of daily living in stroke patients like Lara (Hewitt et al., 2016). They also help by providing massages, active and passive exercises mainly on the affected side to recover the normal power and strength of the limbs. Similarly, the social worker can help in the adjustment process and discharge planning like arranging accommodation, community nurse, and counseling. The neuropsychologist can be involved in assessing the memory, thinking, and personality of the patient. Since most of the stroke patients will have aphasia and communication difficulties, speech and swallowing problems, a speech therapist can assist with speech therapy and swallowing exercises (Northcott et al., 2017). In the case of Lara, since she is a diabetic patient, the diabetic educator can also come into play. They can provide education, motivation, confidence for self-management of diabetes (King et al., 2017). Lara is also experiencing homonymous hemianopia; thus, an eye specialist can also be involved in her interprofessional care. Hemianopia is not a progressive disease, but lack of sufficient knowledge and proper treatment can lead to lifelong dependency (Goodwin, 2016). Thus, an eye specialist can help by monitoring her visual ability and its related effects. Therefore, the collaborative effort from all disciplines can help in stroke rehabilitation therapy.

All team members of interprofessional care should work together to provide the best care to the patients and to achieve their maximum independence. Thus, they should have effective communication strategies. There should be open communication, mutual respect, and understanding among all members. It helps to promote communication, cooperation, and coordination in making relevant health decisions (Cazeau, 2021). Also, the communication between health professionals and patients and their families must be clear to avoid any misinterpretation, lack of critical information and to ensure patient safety. Similarly, reflective practices have been an important skill for all health professionals. They are the fundamental component of continuing professional development (CPD) (Davey et al., 2021). These practices allow health staff members to share their knowledge and experience with others. They also help in improving their work practice as well as their interprofessional relationships. These reflective practices as well as the intra and interprofessional communication strategies are registered nurse standards of practice and they help in critical thinking and to engage in professional relationships (Nursing and Midwifery Board of Australia [NMBA], 2016).

Health promotion focuses on enabling people to take control over their own health (World Health Organization [WHO], 2019). Health promotion strategies for stroke will be focusing on the prevention of primary stroke and reducing the risk of reoccurrence after a stroke, also called secondary stroke prevention. Primary stroke can be minimized by determining and preventing the risk factors of an individual patient (Jnsson et al., 2018). As a sedentary lifestyle with an unhealthy diet is the major cause of stroke, lifestyle modification can be one of the effective health promotion strategies (Kalkonde et al., 2018). Patients can be encouraged to eat food with low saturated fat, cholesterol, and salt. Low cholesterol and low blood pressure also reduce the risk of stroke. Similarly, cigarettes and alcohol greatly increase the chance of having a stroke. Quitting smoking and avoiding drinking too much alcohol at any point in time is beneficial. So, patients can be educated about the importance of smoking and alcohol cessation as a health promotion strategy. Since diabetes and hypertension are directly associated with stroke, prevention and management of these diseases are substantial (Jnsson et al., 2018). Also, patients with a history of stroke can be educated about the causes, risk factors, early signs, and symptoms, and what can be done immediately. Similarly, encouraging people at risk of having a stroke to take preventative medications like anticoagulants, antihypertensive can be a crucial step in primary and secondary prevention of stroke (Kalkonde et al., 2018).

In conclusion, stroke is a medical emergency characterized by a lack of blood supply to the parts of the brain. Hypertension, diabetes, heart disease, smoking habits are the main risk factors for stroke. In Laras case, she also had all these risk factors. Her presenting symptoms and the CT scan result were also supporting her probable left cerebrovascular accident. Different interprofessional teams can work together to provide the best holistic care to the patient and to improve their health outcome. Health promotion strategies can be followed to prevent primary and secondary stroke.

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