TABIJE, ARVIE JAYSELLE P.

NCENH06

1. a. What principles of nursing management should the nurse provide the patient during the acute
stage of the ischemic stroke based on the assessment findings from the case study? Place the
assessment findings that are supported by the nursing principle(s) in parenthesis.

In order to assess the best strategies and treatment, all patients with neurologic deficits require a
careful history and examination. In this situation, the patient's necessary management speaks
plainly and in simple words, using images and gestures when the patient can best understand them.
This is one way to cultivate an alternate means of contact (global aphasia). Since the patient displays
motor deficiencies, it is best to assess the gag reflexes of the patient before providing food or fluids
(coughing regularly). Assisting the patient while feeding is one of the interventions to be carried out.
Place food on the unaffected side of the mouth and give enough time to feed to stop aspiration
(right side drooling). In order to better control oral secretions and avoid increased ICP (periodic
coughing, drooling on the right side, bilateral papillary edema), the patient with bed head raised to
30 degrees is also positioned. Teaching the patient to accept the body as a whole is one of the
management procedures to be undertaken as well. To stop unilateral neglect, instruct the patient to
constantly feel the correct side of the body (unilateral neglect-right side). It's better to put the
products in the perspective of the patient, which is the left hand, during feeding or if there is
anything to be done. It is also best to advise the patient during meals to look over the whole tray or
plate. Often approach the patient from the side of the unaffected visual field and use the same side
(right field homonymous hemianopsia) when teaching the patient. In dressing, teach the patient first
to wear clothes or put them on the side that is not affected. To improve strength and agility (right-
sided paralysis), range of motion exercises are also performed. Signs of bleeding such as easy
bruising should be detected by the nurse. Always make sure that the patient or patient watcher is
reminded not to use a hard-bristled toothbrush when delivering oral care. In case of toxicity
(heparin), always have protamine sulfate ready on standby as an antidote. Assess for symptoms of
any potential edema, vomiting, or nausea. If the patient complains of visual changes such as blurring
or halos, notify the physician. In case of overdose, always have Digibind prepared (digitalis).

2.
a. What educational topics should the nurse provide the family about home care for the patient after
stroke?
-Patient and awareness is one of the things to explain to the partner. Patients who have trouble
expressing themselves and are unable to respond correctly often appear to be irritated, upset, or
depressed. It is useful to talk in a quiet voice to the patient and to give the patient as much time as
possible to answer questions. The family will also strive to find alternative communication strategies,
such as using gestures and visual aids. The patient must also be kept clean on a regular basis and cared
for. It's essential to preserve skin integrity. Adequate nutrition and the use of lotions and gentle
massaging will aid circulation and prevent the development of pressure ulcers. Family members are
encouraged, among others, to take part in therapy so that they can become a strong support net for the
patient. The wife feels embarrassed in this situation and has trouble embracing the fact that her
husband is not the way he used to be. It is the duty of the nurse to inform the patient and the wife of
the anticipated results, as well as to ensure that the wife can play a huge role in the care of the patient
with love and affection, as well as compassion and understanding.

b. What assessment of the spouse does the nurse need to make, and what should the nurse suggest?
The nurse should examine the wife's understanding of the illness, the effects, her mechanisms
of coping, and her emotional reaction to the condition of the patient. The wife must be told that the
process can will take some time, but with excitement and a supportive and optimistic mindset, the
patient's caregivers, including the wife, must approach the patient. The wife must be equipped to be
prepared for the patient's potential emotional issues, such as anger or sorrow. Inform the wife that, as
therapy continues, this will go away in time. The wife must note that laughing does not always mean
pleasure for the patient, and weeping does not always mean sorrow for the patient. It requires immense
patience to care for the patient, and in order to help cope at home, the nurse must also provide details
on community services or mental health concerns.