Nursing Care Plans

Developing Nursing Knowledge (Second submission)

Introduction
Nurses have indeed been active in hospice care since the beginning of the 1970s. The nurse
practitioners are also establishing new responsibilities within this profession with the
introduction to palliative care of chronically sick and dying patients. Although there are hurdles
to practice, the job is promoted by new refund standards and educational possibilities. Doctors
treat the fragile old in various environments, including qualified nursing institutions,
ambulatory geriatric clinics or home care. Patients who have an advanced care plan alongside
their patients are well prepared; however, relatively few patients have an advanced nursing
care. A nurse helps patients manage physical requirements, prevent disease, and treat states of
health. To accomplish so, the patient must be monitored and monitored, with any information
relevant to the therapeutic decision-making process. The nurse monitors the patient's
development and ensuring adherence in the patient's best interest during the treatment
method. The nurse's care extends beyond the use of medicines and other treatments. They are
responsible for the integral treatment of patients, which includes individual psychological,
developmental, spiritual and cultural requirements. The primary concern of the nurse is the
patient (Williams, 2021). The nurse's job is to defend the best interests of the patient and to
preserve the dignity of the patient during care and support. This might also involve making
proposals in the patient treatment plan, together with other health care experts. This is
especially crucial because sufferers who are uncomfortable, often cannot understand or
respond like typical medical circumstances.
Case Scenario
Talking about the case scenario is that the patient has been diagnosed previously as a bladder
outflow obstruction and stroke. The problem of Bladder outlet obstruction in males is a slowing
or stopping the urine from flowing out of the bladder. Bladder outlet obstructiveness may
cause the system to restore urine and create urinary problems and other unpleasant urinary
symptoms. Urinary incontinence among stroke survivors is high, which is related to the extent
of the infarct or brain hemorrhage and the survivor's death, morbidity and expulsion. Such
urine incontinence generates significant discomfort to both stroke survivors and cares,
exacerbating moral standards and affecting the capacity to achieve optimal rehabilitation.

Discussion and Analysis

A urinary system evaluation is performed to collect information about urine and urinary
structures. Adult nursing student evaluates elements that might influence a patient's normal
urination. It is vital to evaluate the patient's history of elimination, probable symptoms and
complaints of a urinary issue. Recall that disposal is a personal and private action, which most
patients do not feel comfortable disclosing while completing a urine examination. Make Adult
patient as comfortable as possible and explain the procedure before and through the
evaluation. A common health authority of 250,000 people may expect 500 new instances of
stroke and 1000 repeated episodes of stroke every year roughly 1,500 stroke survivors will live
in the community during any time, about 750 of whom will suffer from substantial levels of
disabilities. In fact, stroking is the primary cause of severe chronic impairment in the United
Kingdom. It accounts for 4% of the entire budget of a National Health System, 89 stroke
patients consuming 12% of beds plus 12% in general health facilities (Akbas, 2020).

Monitoring and treatment of neurological state are a key function for stroke nurses. This is
typically extremely common in hyperacute stroke treatment with observations every 15
minutes. So, in order to prevent long term effects, the objective of neurological monitoring is to
recognize early deterioration and to prevent institutes. The stroke nurse seems to be the first to
evaluate the patient in the emergencies department in the UK as in many other countries and is
crucial to recognize the acute therapies available for reperfusion and to know whether to begin
the thrombolysis and thrombectomy process quickly. Adult nurse must be aware of important
criteria for inclusion and exclusion and must be able to do a basic neurological evaluation
including Glasgow Coma Score (or equivalent screening tool for the awareness level) as well as
the National Stroke Score Institute for Health (NIHSS). They need to be aware of the evidence
supporting therapy, including risk, such as bleeding, so that they can explain what they are
proposing to their patients and families and why. Therefore, they also require strong
communication skills and comprehend the mental ability evaluation to determine how much
decision-making is assigned to the family and to the professional team. The deteriorating
patient, who is typically caused by the development of septic disease, is an important function
for a stroke nurse. Infections of the chest and of the urinary tract are frequent. The early
diagnosis of dysphagia can avoid chest infection and the nurse plays a vital role in
swallowing screening of dysphagia.

Evaluation as a vital nursing skill has been stressed for over 50 years by nursing education. And
over years, the meanings of critical thought have changed. A number of essential definitions
must be considered for analytical analysis. Critical thinking was defined as an objective, self-
regulatory evaluation using cognitive tools such as interpretation, analysis, evaluation,
inference, and explanation for the evidence, concept, method, criterion, or subjective
consideration on which decision was made. That was a definition of the American Philosophical
Association (APA). The evaluation method consists of three key principles - reliability, validity
and standardization. These three are actually crucial for science as a whole. First of all, we
desire a trustworthy or uniform evaluation. Apart from the clinical testing we want to make
sure that, if our automobile has a problem and we take it to the technician, what one mechanic
says problem with our car is the same as that which the other or two of the other mechanics
say. Otherwise, the measuring equipment used to evaluate automobiles are defective. The
same applies to a patient with a mental illness (Martin, 2020).

Sometimes, it is clear to differentiate a clinical intervention as well as a healthcare study

operational intervention - what is other times even uncertain is in there. Different types and
degrees of ambiguity can occur. Grayness can also be due to an inaccuracy of idea; in this
instance, existing memantine definitions might be used to support researchers and doctors. As
this debate demonstrates, however, the links between a therapeutic intervention and also an
implementation intervention may lead to a possible greyness. These linkages can at times be
reconciled and it can be determined if the results are connected to the therapeutic intervention
or the operation. At other instances there is a persistent grey between a clinical intervention
and a study implementation procedure based on the research design, theoretical or scientific
proposals or the study method. There can therefore be ambiguities with regard to the
therapeutic intervention, the operation, or one or both in a specific scenario. A purposeful
activity aimed at a result is defined as a clinical intervention. Clinical interventions therefore
determine the extent of the health effects of a treatment. The effect of the study or synthesis
(for example, systematic reviews) may be measured by individual research and knowledge
instruments which are supported by a synthesis of the most effective evidence available.
Treatment programs have implications on individual clinical practices and programs, health care
systems and even health policy or legislation (Rylance, 2021).

The basic objective of clinical research is to assess the efficiency or efficacy of a therapeutic
procedure, whereas implementation science takes into account the efficacy of behavioral
change methods, in accordance with evidence of clinical effectiveness. Some kind of approach
to support a therapeutic intervention may be extended to include the idea of the intervention.
Interventions are generally complicated in implementation, with strategies or approaches
intended to modify conduct on an operational level, on a practitioner level, or in patients’ level.

Training in ADL throughout the home environment is the top priority for a person with a stroke
that has a residual limit in daily activities (ADL); proof is as valid for this therapeutic procedure
as for the beginning of intravenous thrombolytic therapy within 3 hours from the beginning of
the strokes. There is a significant danger of activity degradation, a detrimental influence on
quality of life and a requirement for symptom treatment without rehabilitation. The ADL
training should be carried out most importantly at the home of the stroke patient.
A Therapeutic Treatment for Prevention and Stroke Rehabilitation has
been Implemented
Health care decision-makers are essential to changing clinical practice and taking new
innovations in terms of priorities, commitments and support (Mecieire, 2020). Thus, a
management capacity development implementation intervention may help successfully use
evidence-based practices; in this case the preventive and stroke rehabilitation practices will be
involved. In keeping with prior research and leadership theory for change, a leadership-
oriented implementation intervention may include:

● generating an urgent need to deal with the clinical problem 

● Comprehending the gap between existing and efficient practice (e.g., evaluations, drug
review and exercise plans including methods and frequency) and establishing changing
priorities;
● Development of an implementation strategy and selection of measures that match the
present environment and impediments to change (e.g., education, audit and feedback)
● Visibly and symbolically support the implementation 

Health care is the process of knowledge-based management and so the tools for knowledge
management in the health industry are becoming increasingly important. According to
Hongsermeier et al technology plays an essential role in the KM system in enabling the flows of
knowledge through its life cycle (KMS). IT offers a technical basis for facilitating the deployment
of KMS (informatic technology). It also provides a method to provide a solid theoretical basis for
KM, since it is employed in all phases of the project of KM. Clinical decision-making usually
follows a procedure from the collection of the essential data to the final conclusion. This should
not be viewed as a completely linear process since one stage can inform another, and adult
nurses can proceed to a different phase based on new knowledge. Systematic use of
information and patient data collection and analysis through direct observations, patients'
stories and worries, patient recordings review, laboratory findings examine, decision-making
instruments and evaluation data use, and unusual reactions (Ballantyne, 2020)
Making assessment of the patient data of stroke and bladder outflow obstructive on what adult
nurses believe could happen, look for models, evaluate data needs and who can provide the
missing information; look for evidence to support what adult nurses think could take place,
evaluate who adult nurses want to involve or consult; use Adult own intuition, the 'red' flags,
the feeling of wellness based on the experience in the field. Decisions are taken by determining
what to do and how and who should be informed and advised. Assess the result of the choice
to assess whether the anticipated result has been obtained. In this step, subsequent
judgements and choices might include consultations with people or finding out new facts.
Throughout the past, patients of stroke and bladder outflow obstructive have had a passive part
in the decision-making process and are responsible for all decisions taken with the healthcare
professional as an expert.

Many patients and customers of stroke and bladder outflow obstructive may nonetheless
prefer to participate actively and make their choices themselves. This common or negotiated
model of decision-making with an active partner, the patient/client, involves informed consent
and comprehensive explanation of risks. A decision-making process is a special one, involving
the interaction of knowledge of pre-existing diseases, explicit patient information, nursing and
experience education. In the past, the data processing model and the intuitive humanist model
have become recognized by two types of clinical decision making. In connection to the
provision of care and related outcomes, the usefulness and the implementation of both models
were assessed. A third clinical decision-making paradigm was recently suggested. Such a
multidimensional model includes parts of the information treatment model, but also looks at
patient aspects essential for the identification of cues and trends. A theoretical,
multidimensional model was recently added to the clinical decision-making process, and the
evaluation was conducted by evaluating the literature and a small amount of research studies
that focused on the clinical decisiveness of novice nurses in pseudo clinical situations. Clinical
decision-making is supposed to develop when a nurse acquires expertise in a specialized area of
healthcare and experience, so that the nurses gain a sense of excellence about decision-making
(Rio, 2020). These three clinical decision-making forms can be used separately and
simultaneously by experienced nurses to resolve challenges connected to nursing. It is
proposed that educators and experienced nurses should evaluate the usefulness of this hybrid
approach to decisions in the clinical decision-making framework of O'Neill.

Types of Intervention
In terms of patient self-care management, training and awareness initiatives (individual or
group-based):

Factors of lifestyle: exercises in food, body, and posture, etc.

 Massages
 Therapy for cold heat, e.g. ice packs
 Techniques for teaching relaxation
 Free time social activities, relationships, etc.
 Family intervention training for nurses:
 Improved understanding and/or modified attitudes about the condition and the suffering
that results.
 To effectively treat chronic pain for cares

The health care provider as well as stroke and bladder outflow obstructive patient can benefit
from a full grasp of health behavior change theoretical views. Behavioral science theory may
give a conceptual framework for patient behavior, lead research on determinants of health
behavior and the provision of health services and offer alternative ways to nursing practice,
which can enable patient care to be improved efficiently. The objective of this study is to
present some examples of conduct theories that may be utilized in nursing and in nursing
practice, and to offer an overview of how one concept, Phases of Change, might be applied to
avoidance of the fall of elderly adults. Empathy is a crucial element in therapeutic interaction
and allows patients' feelings and views to be objectively recognized and understood (Tori,
2020).
Conclusion
In summary, stroke and bladder outflow obstructive patients require excellent quality care
through following their policies and roles. This means equipping them with the necessary skills
to provide a healthy work ethic so that patients are adequately cared for and have a positive
effect on their experiences. Patients must at all times remain within their professional limits in
order to enhance their treatment quality in hospital and home, while preserving the autonomy
and dignity of patients at all times. In the healthcare industry, seeking consent is crucial. It is
vital for all health professionals to realize at all times the significance of following the method,
because else legal consequences may occur. The core of every decision chosen should be
respected on account of both the patient and the specialist. Clarity of explanations is crucial to
enable the patient to make an educated decision, or someone responsible for governance.
Health care providers as well as stroke and bladder outflow obstructive patients have a major
obligation to ensure that the information they provide patients is factually exact and that
variations of opinion, race, age of belief or other characteristics are taken into account.
References
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 Nursing Care Plan

Date Nursing Goal/ expected outcome Interventions Outcome evaluation

diagnosis/problem/n
(short term /long term
eed
SMART)

17/05/2021

If the desired
outcome is achieved
ADPIE To examine the problem Identify the root cause
and identify any
and act accordingly and working on it and
potential concerns
improvising the plan
provided.

Achieving the desired

To assist you through the goals
SMART Goals Critical thinking process
stages to achieve your
and to complete the task
goals i.e career etc
in the given time frame

Fatigue might
Make sure you have
Keep the patient upright exacerbate
enough relaxation time
1. Care plan for the for 30–45 minutes after swallowing problems.
before your meals comes.
diagnosis/nursing eating.
problem with stroke
related to weight loss Remove external
Remove any and all
related to Dysphagia Food stays in the stomach stimuli and the
ambient stimulation (e.g.,
longer and reduces sufferer can focus
TV, radio)
aspiration after meals better.
when standing up.

Before eating, brush your

Oral hygiene
teeth thoroughly.
Look out for aspiration improves eating and
Dentures should be
and pneumonia. Exhale appetite.
cleaned and inserted
before each meal.
If a patient has difficulty
swallowing, call a speech
pathologist very once. If
the patient has had a CVA,
make sure they see a
speech pathologist within
72 hours after arrival.
Use a dysphagia team
consisting of a
rehabilitation nurse,
speech pathologist,
dietician, physician, and
radiologist.
Suction as needed with
suction equipment by the
bed.
Do not feed a patient with
difficulty swallowing until
a proper diagnosis is
made. Consult a doctor for
enteral feedings, usually
via a PEG tube.
If reduced salivation is a
factor:
1. Before feeding,
provide the
patient a lemon
wedge, pickle, or
tart-flavored hard
candy.
after feeding. Make a
note of any new crackles
Speech therapists
or wheezing, and any
work with those who
changes Notify your
can't chew
doctor as needed. A
Shortening hospital
change in sputum or new
stays, speeding up
crackles or wheeze could
recovery, and
suggest food aspiration.
lowering total
expenditures are all
benefits of early
Explain and demonstrate
speech pathologist
to the patient or
referral and
caregiver:
nutritional support
for CVA patients.
Patients can learn to
eat safely and
Food or fluid avoidance maintain good
nutritional status
while receiving
Standing while eating dysphagia support
from the dysphagia
team.
Allowance for leisurely
eating and chewing
Slurred or decreased
swallowing reflexes
High-calorie meal increase the chance
provision of post-nasal and
post-tongue
secretions
Consumption of fluids to accumulating in the
aid with meal digestion posterior pharynx
and upper trachea,
which increases the
Weight loss and risk of aspiration.
dehydration monitoring
A patient who is
To optimise safe unable to swallow
nutritional intake, both food may aspirate
the patient and caregiver and die. Studies have
may need to be involved demonstrated that
in the treatment process. enteral feedings via
 2. Use artificial
saliva.
If a patient's swallowing
reflex is intact, feed them.
Follow these feeding
guidelines:
Position the patient at a
90-degree angle with a 45-
degree flexed head.
Before feeding, make sure
the patient is alert, awake,
and able of following
orders.
Start with an applesauce.
Allow enough time to
masticate.
Serve food on the side of
the tongue that has not
been affected.
While feeding, tell the
patient which direction to
open their mouth, how to
chew the food, and when
they are ready to swallow.
The patient should be
kept in the high Fowler's
position while eating, with
the head curved slightly
forward.
Weekly weigh patients.
So it can assist assess
nutritional status.
Regularly assess nutrition.
A dysphagia team can
help you decide if your
patient needs to avoid
oral intake or enteral
feedings until they can
swallow properly.
Enteral feedings can help
patients who can't
swallow enough food.
Discuss the benefits of
exercise for improving
facial and tongue muscle
strength. Exercises that
develop muscles can help
improve chewing and
food placement in the
mouth.
Educate family,
caregivers, and patients
on the benefits of meal
consistency.
Unnecessary dietary
restrictions are
sometimes overlooked,
and patients may be
given improper meals
that could lead to
aspiration.
PEG tube results in
better nutritional
status and probably
better survival rates.
Meal that is wet and
loaded with sweet
and sour flavours
stimulates saliva
production,
facilitates food
ingestion, and
enhances
swallowing.
In this position, the
trachea can close,
keeping food in the
stomach, and the
oesophagus can
open, helping with
swallowing.
The swallowing
reaction weakens
with age, increasing
the risk of aspiration.
Introduce 1/3
teaspoon applesauce
to the patient. Allow
enough time to chew
and swallow.
Gravy or sauce added
to dry foods
facilitates
swallowing.
Have the patient refrain Instruction and focus
from speaking while on specific steps
eating. Indicate directions lessen dangers.
verbally if necessary.

In this position,
The following signs and aspiration is unlikely.
symptoms may indicate
silent aspiration: sneezing
while eating;
uncoordinated
chewing/swallowing; Focus on the task at
delayed coughing (greater hand.
than 1 second); or a
change in respiratory
patterns. This, together It's an indication of
with the presence of one difficulty swallowing
or more of these and aspiration.
indicators, should warrant
you to wear gloves,
eliminate all food from
the oral cavity, and
These instructions
discontinue feedings. Also,
help keep one
seek the advice of a
focused.
speech-language
pathologist and a
dysphagia team.
Knowing the food's
consistency can help
the patient chew and
Consistency is important,
swallow properly.
so encourage the patient
to swallow frequently if
additional saliva is
This strategy helps
produced. Give the
prevent food waste.
patient encouragement or
direction until each
spoonful is swallowed.
Dairy products can
lead to thickened
secretions.

Classify food given to the

patient before each
spoonful if the patient is
being fed.
Foods placed on the
unaffected side of
the mouth promote
Advance slowly, giving
more complete
small amounts; whenever
chewing and
possible, alternate
movement of food to
servings of liquids and
the back of the
solids.
mouth, where it can
be swallowed. These
strategies aid in
Encourage a high-calorie cleaning out residual
diet that involves all food food.
groups, as appropriate.
Avoid milk and milk
products.

The dysphagia team

If patients pouch food to
one side of their mouth,
encourage them to turn
their head to the
unaffected side and
manipulate the tongue to
the paralyzed side.
should determine the
appropriate diet for
the patient on the
basis of progression
in swallowing and
ensuring that the
patient is nourished
and hydrated.

If a patient tolerates
single-textured foods such
as pudding, hot cereal, or
Massage aids
strained baby food,
stimulate the act of
advance to a soft diet with
swallowing.
guidance from the
dysphagia team. Avoid
foods such as hamburgers,
corn, and pastas that are
difficult to chew. Also,
avoid sticky foods such as
peanut butter and white
bread.
If the patient had a stroke,
place food in the back of
the mouth, on the
unaffected side, and
gently massage the
unaffected side of the
throat.
Place whole or crushed
pills in custard or gelatin.
(First, ask a pharmacist
which pills should not be
crushed.) Substitute
medication in an elixir
form as indicated.
Encourage the patient to
feed himself as soon as
possible.
If oral intake is not
possible or inadequate,
initiate alternative
feedings (e.g., nasogastric
feedings, gastrostomy
feedings, or
hyperalimentation).
Mixing some pills
with foods helps
reduce the risk for
aspiration.
With self-feeding, the
patient can establish
the volume of a food
bolus and the timing
of each bite to
promote effective
swallowing.
Optimal nutrition is a
patient need.
Use of straws can
increase the risk of
aspiration because
straws can result in
spilling of a bolus of
fluid in the oral cavity
as well as decrease
control of posterior
transit of fluid to the
pharynx.
Praise reinforces
behavior and sets up
a positive
 atmosphere in which
learning takes place.
For many adult patients,
avoid using straws if
recommended by a
You may have BOO if
speech pathologist.
you:

Have pain when

passing urine.

Have trouble starting

Praise patient for
successfully following
directions and swallowing
appropriately.
your urine stream.
Feel like you have a
full bladder but
cannot empty
completely.

Feel like some urine

BOO is treated in line with
remains in your
the cause of the problem.
bladder after voiding.
A thin, flexible tube
(catheter) is inserted Pass urine frequently
through the urethra into during sleeping
the bladder, in most hours.
cases. The placement of
Have pain in your
the catheter can relieve
abdomen.
the blockage.
Have urine flow that
starts and stops.
In some cases, a tube is
Have a urinary
placed into the bladder
stream that is slow.
through the belly area.
This tube, called a Void often with small
suprapubic catheter, will urine volume.
drain the bladder.

For the long-term care of

BOO, medical treatments
for the various diseases
causing BOO are available.
In some cases, however,
the long-term treatment
of BOO requires surgery.
 The timely treatment of
the disease can reduce
problems. If BOO is not
diagnosed right away,
bladder and kidney
problems are more likely
17/05/2021 2. Bladder Outflow to develop.
Obstruction relation
to long term
maintenance

BOO may be suspected if

there is abnormal
abdominal growth or a
larger than normal
bladder. Also, men with
an enlarged prostate
gland or women with
cystocele (prolapsed
bladder) can be
diagnosed with BOO.

Tests may include:

Blood tests to check for

kidney damage.

Urine cultures to test for

infection.

Ultrasound of the kidneys

and bladder to find where
the urine blockage is
occurring.

Urine testing to look for

blood in the urine.

X-rays to look for

narrowing of the urethra.