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According to the case study Ms Singh was a sixty nine years old woman. The four deficits she had are colostomy which was done due to large bowel infarction, cerebrovascular hemiplegia, dysphagia and dysphasia. According to Lim et al. (2013), Colostomy is an operation in which the colon is surgically shortened to remove the damaged part. This was done in order to protect her from large bowel infarction. Bowel infarction occurs from restricted supply of blood to the bowel. This quite often occurs due to occlusion of the intestinal obstruction. The cerebrovascular disease depends on the affected tissue location. Hemiplegia is a condition that can be described as affect in the one side of the body due to the internal injury of parts of brain that controls the movement of various location s such as face, limbs and trunk. In medical terms “Dysphagia” can be defined as difficulty in swallowing which is associated with pain. If dysphagia is persistent it indicates a serious clinical condition. Dysphasia is referred to the clinical condition where the individual experiences partial loss in the verbal communication skills. This might occur due to the degeneration of the cerebral language center (Bonilha et al., 2014).
The diets that are generally prescribed for dysphagia patient’s are divided into three levels.
Level 1- In level one the foods that are recommended are pureed meats, fish, poultry and scrambled eggs, baby cereals, mashed potato, pureed soups and cream soups and scalloped apples. The drinks include thickened juices and nectars, milkshakes, plain yoghurt and decaffeinated tea or coffee.
Level 2 – The level 2 diet include minced foods. Minced meat, fish, poultry, poached eggs, cooked cereals, cottage cheese, Alfredo noodles, margarine, semi-thickened juices, milk and mashed bananas.
Level 3 – The level 3 diet are generally grounded foods. For example ground meat, fish, ground soft French toast, crushed pineapples, smooth fruited yogurt and lemonade (SU & WANG, 2013).
The five strategies that are involved in order to assist the feeding of dysphagia and hemiplegia re as follows:
Use of “Percutaneous endoscopic gastronomy (PEG) tubes. This tube is referred method of providing long-term enteral nutrition.
Adaptive equipments such as modified cups, and straws are used as a strategy to assist such patients.
Assessment of adequate calorie and fluid intake must be done.
Training of the patient’s family to feed the can be another strategy.
The patient should be observed pouching. When the patient has a hemiplegia the head should be tilted slightly towards the stronger side to avoid pouching (SU & WANG, 2013).
The six main factors that nurses need to consider while mobilizing Ms Singh are:
Patient’s present medical condition and dependency.
The patient’s previous mobilization responses should also be taken into consideration.
A nurse should consider the respiratory reserve such as respiratory saturation, mechanical ventilation and oxygen saturation before mobilizing Ms Singh.
She should also consider the safeness of the environment and appropriate staffing for assistance.
Ms Singh’s appearance like shortness of breath fatigue and emotional stability should also be taken into consideration.
Conditions should be monitored until parameters are normal for mobilization (Enderby et al., 2016).
In this case the most effective risk assessment tool would be “Little Schmidy Falls Risk Assessment.” With this tool Ms Singh’s mobility, history of falls, toileting, mental state and medication can be documented and assessed. Ms Singh’s daily condition change can be documented and action plan can be developed in accordance to this tool (Enderby et al., 2016).
The steps involved in changing the colostomy bag are as follows:
Hands should be washed with antibacterial agent.
With the use of adhesive remover and support of one hand in the skin the pouch is removed.
The pouch is then emptied by cutting the bottom and rinsing the pouch.
The stoma region should be cleaned with warm water and then dried
A skin barrier is used for protecting the skin and then an adhesion base is used for the next bag.
A hole is made in the stoma pouch flange to make the size correct.
Then the adhesive is covered with hands for few seconds (ZHANG et al., 2016).
As stated by DANIEL (2012), nurses would play an important role in the discharge planning of Ms Singh. Firstly, nurses can establish patient referrals with various health care services such as physical therapy and carers. Secondly, nurses along with the physicians would plan for her time of discharge. Thirdly, they can initiate specific care plan with Ms Singh’s daughter. Fourthly, for a patient like Ms Singh nurses can verify that devices needed for home care and nursing. The discharge planning process should commence only when Ms Singh will be able to manage her ADLs. The multidisciplinary team should involve the nurses, physicians and also members from NGOs to assist Ms Singh (ZHANG et al., 2016).
Based on “The Australian Nursing and Midwifery Council (ANMC) the most appropriate code statement related to this case study is “Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues” (Shinde & Anjum, 2014).
As per the case study Ms Singh’s condition has deteriorated and she has developed decubitus ulcers. The intrinsic factors which lead to this condition might be medication, cerebral disease affects, lack of mobility, age and incontinence. The extrinsic factors involved are friction, shearing forces and pressure (Pelzer et al., 2016).
Decubitus ulcers, is a pressure or bed sore that develops as an open wound on the skin.
The six common areas where these ulcers occur are hips, back, ankles, buttocks, heels and tailbone (Pelzer et al., 2016).
The five strategies that could be implemented to promote healing of ulcer in Ms Singh are as follows:
Wound cleaning and repositioning could be one strategy.
Support surfaces and nutritional supplements could be provided.
Combined treatment modalities like comparison of two treatments rather than continuing with a single treatment.
Therapies can be used such as wound dressing, adjuvant therapies and topical therapies to address local wounds.
Infection management through medicines could be one of the most significant strategies (Pelzer et al., 2016).
The most suitable risk management tool in this case would be Waterlow pressure ulcer risk assessment tool. The scoring system in this tool is quite simple. However it is simplistic tools and therefore it can be the accountability of assessors to employ the risk assessment system and suggest on the assortment of preventative tools, in combination with their own skill and their own sector of care’s precise constraints. Such a tool can be used to calculate the improvement level of Ms Singh suffering from ulcer (Pelzer et al., 2016).
There are few factors that are contributing to Ms Singh’s poor sleep are as follows:
Firstly, aspiration pneumonia is lung infection that develops from inhalation of food, liquid or vomit via lungs. Such a condition might have disturbed the normal sleeping status of the patient.
Secondly, the pain resulting from the decubitus ulcer causes restlessness in Ms Singh which disturbs her sleeping habit.
Cerebrovascular disease such as Hemiplegia that has caused paralysis of one side of Ms Singh causes her discomfort and contributes to poor sleep.
Psychological factors that have developed due to her various illnesses might have reduced her sleep duration (Diendéré et al., 2016).
The four approaches that can be used by nurses to promote sleep in Ms Singh are as follows:
Firstly stimulation of the acupoints and providing relaxation to the patient can be a significant approach.
Maintaining hygiene in the sleeping area of the patient can promote the sleeping duration of Ms Singh.
Effective behavioral strategies such as encouraging the bed time routine can promote the sleeping process of the patient.
Educating the patient with evidence based nursing interventions can address the insomnia of Ms Singh (van der Maarel-Wierink et al., 2014).
An “Advanced Health Directive” is a form of a document which states the wishes of the patient or even their direction relating to the patients future health care in terms of several medical conditions. It helps the patient to take their decisions regarding medical treatment Eberlein-Gonska et al., 2013).
The three ways to show respect to Ms Singh’s decision to not actively be resuscitated by regular recording of observations of the medical condition, providing medical treatment and also following the “Advanced Health Directive” (Jawa et al., 2015).
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