WESLEYAN UNIVERSITY-PHILIPPINES

Mabini Extension, Cabanatuan City

Bachelor of Science in Nursing

Theoretrical Foundation of Nursing

“CASE STUDY”

Sandara Poblete
Ryzza Cabute
Leimark Ashley Gonzales
Roland Kevin Dollente
Kim Zyrine Austria
Gwyneth Diazjuan
Ashley Ann Tanedo

BSN 1-7
Case study

Mr. Shoaib, a 62-year-old male patient, has been admitted to the ward with a diagnosis
of right ischemic CVA and resultant left side body paralysis. As a result of this condition, he has
lost all sensation and movement in the left side of his body. Additionally, he has lost his gag
reflex and is unable to swallow food, which has necessitated the placement of an N/G tube for
providing him with nutrition. Due to his condition, Mr. Shoaib is unable to change his position
and is completely dependent on caregivers for this task. Furthermore, he is unable to carry out
his routine daily life activities, which has caused significant distress to both him and his family.

The family of Mr. Shoaib is understandably worried about his condition and whether he
will be able to regain control of his life. They are also concerned about their ability to provide
him with the care he needs when he is discharged from the hospital. It is important to note that
the recovery process for patients with left side body paralysis can be a long and difficult one,
and it may take some time before Mr. Shoaib is able to regain any degree of independence.
However, with the right care and support, it is possible for him to make progress and
eventually regain some level of control over his life. It is important for his family to work
closely with his healthcare team to ensure that he receives the best possible care and support
during this challenging time

1.What strategies can be employed to apply Hall's theory to the given situation?

The primary concern in a hospital setting is the provision of attentive care by medical
professionals, including nurses, doctors, and physicians. Additionally, the support and
involvement of the patient's family play a crucial role in instilling confidence and promoting the
patient's path to recovery. When at the hospital, the professionals assist the patient in
achieving good health, but ultimately, it is the patient's choice if they wish to recover. This case
study involves a 62-year-old male patient who is experiencing a stroke and has difficulty
communicating. His disability makes it difficult for him to make decisions and communicate
coherently. The optimal approach to accomplishing this is to actively pursue the approval of
one's family. They possess superior knowledge of the patient's emotions and worth, making
them the most qualified individuals in this regard. Given the patient's state, it is imperative to
administer appropriate medication and provide suitable care, as relying just on the family will
not be enough to improve the patient's condition. The patient requires the assistance of a
physical therapist, as well as a nurse and a doctor, to facilitate their recuperation. Initiate
intravenous administration of clot-dissolving medications within 4.5 hours of symptom onset.
Administering these medications at an earlier time is more advantageous. Prompt medical
intervention not only enhances your likelihood of survival but also has the potential to minimize
consequences. This medication facilitates reperfusion by enzymatically dissolving the thrombus
responsible for the cerebrovascular accident. Swiftly eliminating the underlying factor
responsible for the stroke can perhaps facilitate a more comprehensive recovery after the
stroke. Initial treatment for the onset of symptoms may involve measures such as regulating
blood pressure, managing fluid levels, and occasionally administering anticoagulant
medications. These therapies have the potential to mitigate the detrimental effects of a stroke
and enhance the likelihood of survival. Following the initial phase of a stroke affecting the right
side of the brain, the subsequent course of action entails engaging in rehabilitation. These
interventions encompass physical therapy, speech and swallow therapy, cognitive therapy, and
occupational therapy, all aimed at optimizing mobility and self-care.

2.Explain the ways in which Henderson's theory of nursing can contribute to the client's
recovery and restoration of health.

According to Virginia Henderson's Nursing Theory, it accentuates the patients

independence importance to continue to progress after being released from the hospital. It is a
thorough framework that attends to patients' social, psychological, physical, and spiritual
needs. Using this principle in Mr. Shoaib's situation can help him recover and regain his health
in several ways. To prevent infections and encourage recovery, Mr. Shoaib and and his family
should also be knowlegable about the concept of components based on human needs by
Henderson. It is important to know the basic needs of care for Mr. Shoaib, like by eating and
drinking adequately to eliminate body wastes and by doing little movements to exercise the
patient's body and by puuting the patient in the comfortable position while at rest. 
Caregivers should also prioritize hygiene and preventive measures. Secondly, they ought to
provide a secure atmosphere and help avert additional harm. Addressing Mr. Shoaib's
emotional needs requires both effective communication and emotional support. It may bring
him spiritual consolation if his religious beliefs are respected. Getting him involved in modified
activities can help him regain his average growth and sense of accomplishment. Last,
concentrating on therapeutic activities and encouraging curiosity and learning can support his
recovery and general well-being. The caregivers and his family for Mr. Shoaib can make a big
difference in his recovery by implementing Henderson's Theory.

3. Discuss the methods to sustain the client's self-promoting abilities and connect it to Pender's
theory of health promotion.

Sustaining his self-promoting abilities is critical for the general well-being and possible
recovery of Mr. Shoaib, a 62-year-old male patient whose right ischemic cerebrovascular
accident resulted in left side body paralysis. To support treatments meant to preserve and
improve Mr. Shoaib's capacity for self-care, Nola Pender's Health Promotion Model provides a
useful framework.

Health-Promoting habits: Pender's approach emphasizes health-promoting habits

heavily since it acknowledges their importance in generating wellbeing. Interventions for Mr.
Shoaib ought to center on tasks that improve his residual functional and physical abilities.
Even though he has left side paralysis, he can benefit physically from activities like passive
range-of-motion exercises for the unaffected side and encouraging participation in everyday
routines that are adaptive.

Perceived Self-Efficacy:
The idea of perceived self-efficacy, which emphasizes a person's confidence in their capacity to
take actions that promote health, is essential to Pender's approach. Setting realistic objectives
that are in line with his capabilities, such as taking part in mobility exercises or some areas of
his care, might help Mr. Shoaib feel more motivated and confident. His sense of control over
his health is increased by this empowerment.

Support Systems:
Pender emphasizes how important support networks are for promoting health. Including Mr.
Shoaib's family in the treatment process is essential in his case. Establishing a thorough
support network involves educating them on how to offer physical aid, emotional support, and
participation in rehabilitation exercises. In addition to improving Mr. Shoaib's general
wellbeing, this cooperative approach makes the transfer to home care go more smoothly.

Goal Setting:
Setting goals is essential to Pender's approach and supports Mr. Shoaib's demand for
methodical advancement. A recovery plan can be created by setting short-term, achievable
objectives, such regaining some degree of control over particular motions or reaching
milestones in everyday tasks. These objectives must to be customized to fit his particular skills
and desires.

Prioritizing Health:
Pender's approach recommends determining the areas of Mr. Shoaib's life that hold the
greatest significance for him, taking into account his incapacity to carry out regular daily tasks.
Talking with Mr. Shoaib about his values and objectives helps healthcare providers to identify
therapies that align with his internal motives and increase the probability of his continuing self-
care.
Interpersonal Influences:
The role of interpersonal relationships on health habits is acknowledged in Pender's approach.
Encouraging Mr. Shoaib, his family, and healthcare professionals to communicate openly
enables a shared knowledge of his expectations, worries, and preferences. This cooperative
strategy creates a positive atmosphere that supports Mr. Shoaib's capacity for self-promotion.

In conclusion, applying Pender's Health Promotion Model to Mr. Shoaib's care will
require customizing interventions that include health-promoting behaviors, increase self-
efficacy, make use of support networks, establish reasonable goals, give priority to things that
are important to him, and cultivate positive interpersonal influences. By adopting an all-
encompassing strategy, Mr. Shoaib's medical team can enable him to take an active role in his
treatment, resulting in a more thorough and patient-centered recuperation process. Involving
his family in this procedure also guarantees a nurturing atmosphere that improves his general
quality of life both during and after hospitalization.

4.Utilize Abdellah's ten steps to identify the patient's issues and develop a scenario that will
facilitate the patient's recovery.

1. Mr Shoaib is a 62 yearold man with the history of smoking and high cholesterole. eating a
lot of foods high in saturated fats and it mainly cause by not exercising enough, smoking, and
drinking alcohol. too much bad cholesterol in your blood can increase your chance of getting
stroke. The patient is anxious and depressed about his condition because he wasn’t sure that
he will be able to regain his old health.

2. A stroke ,sometimes called brain attack occurs when something blocks blood supply to part
of the brain or when a blood vessel in the brain burst .Dysphagia or difficulty swallowing is a
symptom of many different medical conditions. These conditions include nervous system and
brain disorders, muscle disorders and physical blockages in your throat. Treatment for
swallowing issues may include medications, changes to your eating habits and, sometimes,
procedures.

3. On march 17,2018 a patient named james was diagnosed with a left side paralysis he
described that his left face ,left leg,left part of the face is drooped down and has no control of
his whole left side of the body.but in his case james had no trouble swallowing while Mr. shoaib
is experiencing difficulty in swallowing which caused the insertion of the nasogastric
tube .comparing both their cases James case is more severe because after he had a stroke in
march 17 at night he also had one on march 18 morning.

4. The main treatment for an ishemic stroke is a medicine called tissue plasminogen activator .
it breaks up the blood clot that block blood flow to your brain. A healthcare provider will inject
tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke
symptoms. Nasogastric (NG) feeding is where a narrow feeding tube is placed through your
nose down into your stomach. The tube can be used to give you fluids, medications and liquid
food complete with nutrients directly into your stomach. NG feeding can provide you with the
fluids and nutrition your body needs while you are unable to eat or drink adequate amounts.
This may be because you have swallowing problems or you have a poor appetite, amongst other
reasons. You will receive a prescribed, commercially prepared liquid feed which contains all
the essential nutrients you will need on a daily basis. You may receive part or all of your daily
nutrients through your NG tube, depending on your specific medical conditions and needs and
may also be given extra fluids through your tube. Your dietitian will prescribe the volume and
rate of your feed to suit your needs.

5. NG tube feeding is a safe procedure; however it may carry certain risks as the tube could be
misplaced when it is being inserted and may enter the lung or the tube could be displace once
it is inserted. Which means the tube would need to removed and reinserted. Displacement is
when the tube moves out of the stomach because you may have been coughing vigorously or
vomiting or the tube may have slipped for other reasons. Displacement can happen anytime but
the risks are reduced by routinely checking that the tube is in the correct place by checking
the pH (acidity) levels in your stomach- you will be taught how to do this. To reduce the risk of
the tube being misplaced when it is inserted, the placement of the tube should always be
checked before feeding starts.Can I still eat or drink whilst on tube feeding? A speech and
language therapist will assess your swallowing and will determine whether your swallowing is
safe. You may be able to still eat and drink whilst you have NG tube as long as you do not have
any swallowing difficulties.

6. Identification of Goals: Establish short-term and long-term goals, including improving

mobility, ensuring proper nutrition via the N/G tube, and addressing emotional distress for
both Mr. Shoaib and his family.

7. Plan of Action: Develop a comprehensive care plan, involving physical therapy, nutritional
support, and emotional counseling. Educate the family on Mr. Shoaib's needs and potential
challenges.

8. Problem Resolution: Regularly assess Mr. Shoaib's neurological and physical status,
adjusting therapies and interventions as needed for optimal recovery.
Follow-up: Schedule frequent follow-up appointments to monitor progress, address concerns,
and provide ongoing support to Mr. Shoaib and his family.

9. Evaluation: Continuously evaluate the effectiveness of the care plan, making modifications
based on Mr. Shoaib's response to treatment.

10. Termination: Conclude care when Mr. Shoaib achieves a level of independence that allows
him to manage daily activities with minimal assistance.

How long is the feed attached for? You may be fed during the day and night or just overnight.
The dietitian will discuss this with you.

Will I still be able to move around? You will still be able to move around and your movement
should not be restricted too much. The pump and feed will hang on a mobile stand, and the
pump will have a battery facility that will last for several hours, however ideally it should be
plugged in at all times.

Will I be able to take a bath or shower? You will be able to have a bath or shower but should
make sure that the tube end caps are closed and the dressing is secure and dry your nose and
dressing thoroughly afterwards.
 REFERENCE

Moawad, H. (2021, December 17). Right-Sided Strokes: What to Expect. Verywell Health.
https://www.verywellhealth.com/right-sided-stroke-5212614#:~:text=These interventions can
reduce the,maximize movement and self-care.

Stroke - Diagnosis and treatment - Mayo Clinic. (2023, July 8).

https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-
20350119#:~:text=To treat an ischemic stroke,first started if given
intravenously.https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-
20350119#:~:text=To treat an ischemic stroke,first started if given intravenously.

Henderson, V. (1966). The Nature of Nursing: A Definition and Its Implications for Practice,
Research, and Education. In Nursing Theories: Conceptual and Philosophical Foundations (pp.
33-40). Springer Publishing Company.

Alice P. (2023) VIRGINIA HENDERSON - NURSING THEORIST

https://nursing-theory.org/nursing-theorists/Virginia-Henderson.php

James' Story: Recovery from Left Side Paralysis After Stroke (Oct 10, 2019)

Sandwell and west brimingham hospitals (2011)

Sara minnis,M.S ,CCC-SLP- By yim newman kn December 21 2017

https://www.nhlbi.nih.gov/health/stroke/treatment#:~:text=The main treatment for an,hours
after stroke symptoms start.