Nursing the Patient with Complex Care Needs

1) Left sided ischaemic stroke For assessment of such problem some major test needs to be run for evaluating what type of stroke has been strike in patient by nurses and doctors. Some test are:

Physical exam – The doctor will examine the body by carefully listening to the heart beat and checking the blood pressure. Some neurological examination will also be conducted in order to monitor how does the stroke has affected nervous system (Song and et.al., 2015).

Blood test – Various blood test may be run for checking how quickly the blood of patient gets clots. Such test also help in determining the blood glucose level as well as the possibility of infection. Computerized

Tomography scan (CT) – Such type of scan utilises an array of X rays for building an image of brain. A CT scan show actual picture of bleeding in brain or reflects the condition of tumour or ischaemic stroke. A dye may be injected in patient bloodstream to view blood vessels of brain or neck.

Magnetic Resonance Imaging (MRI) – It is one of the most powerful technique which requires powerful radio waves and magnets which aids in creating elaborated view of brain. MRI can effectively detect damaged brain tissues which may be caused by ischaemic stroke or haemorrhages.

Carotid ultrasound – Sound waves are used in this test to create defined image of carotid arteries which are present in neck. Such test highlights the are which are being deposited by fats and may block blood flow.

Echocardiogram – In this also sound waves are used to make an image of heart, the image helps in identifying source of clot which may be a reason of causing stroke.

2) Type 2 diabetes For assessment of type 2 diabetes several test are being conducted for diagnosing by doctors as well as nurses. Some test are:

Blood sugar test – These test are expressed in milligrams or milimoles. The test is not relied on eating pattern rather it is a random blood sugar test which simply indicates the level when being tested.

Fasting blood sugar test – The blood sample is drawn out after overnight fasting. Less than 100 mg/dL indicates normal level of sugar. A reading above 100 to 125 mg/dL is pre diabetic while higher than this reading during fasting period is said to be diabetic.

Glycated haemoglobin test – By the help of this test, the average sugar level of past 2 to 3 months can be indicated. The test give a constant idea about the level of sugar determining whether a person is pre diabetic or fully diabetic.

• The nurses keep sure that the head of patient are little elevated as well as slightly in neutral position. The benefit of such intervention helps in lowering the arterial pressure by regulating the venous drainage and at the same time improving the perfusion level (Matney and et.al., 2016).
• Various factors are assessed for lowering the cerebral perfusion as well as evaluating the intracranial pressure. Such type of assessment will further aids in determining and at the same time affects the choice of intervention. Degradation in neurological signs for regulating after the initial consultation may reflect the lowered capacity of transferring the patients to critical unit of medical care for evaluating ICP. Progressive treatment is very essential in case of such patient who are deteriorating their health after stroke.
• Assessing as well as closely monitoring the neurological status frequently assist in understanding the level of consciousness and enhanced ICP. The location of exact damage can also be determined by comparing the baseline as well as the recent neurological state (Sheppard and et.al., 2015). Transient ischaemic attacks are also determined by such intervention which ultimately help in warning about stroke.
• Maintaining environment which promote bed rest and relaxing surrounding. Clustered nursing intervention can be employed in between the care activities which help in enhancing intracranial pressure.
• Nurses provide Clopidigrel with aspirin to patient for lowering the chest pain. It also assist in keeping the blood vessels wide which further prevent in formation of blood clots. Clopidigrel effectively block the creation n of harmful clots which can further help in managing risk.
• Errors which can be easily heard in conversation with patients should be carefully noted according to which feedbacks must be given. Such practice assist the patients in understanding that they are not interacting properly or clearly, due to this they try to maintaining a good verbal chat by clarifying meaning (McManus and et.al., 2015).
• Altering the position in every one or two hour minimise the chance of tissue injury. The affected side by stroke has poor circulation as well as less sensation. Such procedure can thus act as a therapeutic intervention.
• Nurses try to keep the patient in prone position for limited period of time, this help in regulating the hip extension and physical movement.
• Various props like footboards are utilised for supporting the head and making sure that blood circulation is not hampered by any sharp object (Doenges, 2019). Using arm sling in such cases also help in lowering shoulder pain and problem.
• Proper exercise should be engaged in daily routine by moving the hand and arm at different level for preventing the oedema. Hard hand rolls should be placed between palm and fingers for making high stimulation and it also aids in keeping the thumb in functional position. Such practice also help in coping up with the issue of sleeping problem.
• Vitals should be kept as same pace which aids in stabilising the blood pressure and eventually reduces the chance of getting injury. Pad chair seat and water filled cushions may be utilised for preventing skin breakdown.
• Ramipril is administered by nurses for maintaining the blood pressure at normal pace. Aspirin is provided to eliminate all kind of pain and to comfort the subject which consequence in sound sleep (Agyeman-Yeboa, Korsah and Okrah, 2017).
• Electrolyte balances and proper fluids must be kept in check which assist in removal of confusion and make the patient attentive. The nurse in such case should take help of whole family to make Mr. Charles feel comfortable in home environment for family coping and confusion.

• Signs of hyperglycaemia can be assessed which results in evaluating whether there is a adequate amount of blood insulin is present when compared to glucose. High glucose may imbalances the osmotic level which may disturbs the level of hunger, thirst and urination. For such reasons the blood glucose level should be monitored before and after eating meal in order to keep a balance in ration of insulin and glucose.
• Proper as well as balanced diet must be provided to the patient for eliminating the issue of weakness. Such issue makes a patient less effective in moving (Westra and et.al., 2015).
• Metformin is given to subject with managed exercising programmes and proper diet. It has been used for controlling high sugar level in blood. Type 2 diabetic patients, that is Mr. Charles has given such medication which altogether aids in preventing blindness, nerve issues, sugar level and many more.
• The signs of infection, fever, sputum and urine must be check time to time for preventing the spread of infection or injury. The nosocomial infection may also create problems which can be managed by maintaining proper health hygiene and promoting the value of hand hygiene.
• Asepsis condition must be maintained while administering the medicines and applying insulin injections, such practice assist in regulating sterile condition so that no infection can be initiated.
• Less mobility and poor attention made the subject to rely on assistance of nurse or any family member. Due to such circumstances, perineal or catheter care are provided so that the patient does not have to move from one location to bathroom. Such practice should be completed in most sterile way, thus nurses must clean devices carefully to eliminate the risk of urinary tract infection.
• Peripheral circulation may got impaired due to bed rest which can be managed by providing gentle massage in areas to make the skin dry free and allow the blood circulation to go through spontaneously. Massaging at night may also help in reducing the disturbed sleep cycle and further helps the client to sleep at night (Stade and Dykes, 2015).
• Eating habits must be discussed and nurses should encourage in relying on balanced diet so that all health needs and requirements are fulfilled timely and patient do not feel weakness at any point.
• The exact feelings of clients should be listened thoroughly. This practice aids in recognising the actual problems which are facing by client. All family members should express their thought and experiences with one another so that they can interact with each other on daily basis and patients can become clear about the motives.
• Light exercises is important not only to keep the blood glucose level to optimal rate but also to make light movements in order to make the clients make some physical moves.
• Pulse rate, glucose level, respiration rate, blood pressure must be evaluated on time for checking the fatigue condition. Uninterpreted sleep must be ensured by giving them sleeping pills or involving them in some activities which can make them physically and mentally exaggerated. All practice assist in preventing fatigue.
• By involving the subject in motor activities like walks and indulging them into playing broad games or drawings. Such roles are observed to prevent the issue of depression. The tension gets relieved and mood of such patients gets lighten and they are seen to manage the anxiety as well as stressed level optimally.