Role of Cva

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This essay, will discuss a recent clinical experience where a patient was diagnosed with cerebral vascular accident (CVA). The main focus of this essay will be about pressure sores management and prevention. Additionally, the conclusion will discuss the learning achieved in wound care and its management process. In adherence to the NMC code of professional conduct (2012) and confidential provision, I would like to identify my client with a pseudo name (Mary). Mary is a 74 year old woman whom is a resident of a nursing home. We had previous knowledge of a history of left cerebral vascular accident with left hemiparesis due to hypertension on 20th September 2004. See ‘appendix one’ for the clients profile. At work, I have observed many clients with CVA who are at higher risk of developing a pressure ulcer. This makes me enthusiastic to learn more about the holistic approach to this problem. In order to assess fully a client’s needs, a holistic and humanistic approach should be taken, looking at the physical and psychological aspects of the patient, rather than just the patients’ actual health problem. According to Holland et al (2003) “Assessment is the gathering of information and formulation of judgements regarding a person’s health, situation, needs and wishes, which should guide further action”. Its purpose is to provide an accurate picture of patients, including both their capacity to perform activities of daily living and the stability of their condition. The action was taken to maintain a safe environment because Mary was in shock, in pain and unconscious. She was also at risk from injury due to her weakness and being in a strange environment. Due to the result of CVA she had developed severe cognitive and motor speech problem. She was unable to communicate verbally therefore she used a communicating board to express her feelings. Tracheotomy was inserted to maintain her oxygen saturation level and to prevent a chest infection. Providing adequate oxygenation to the tissues is a nursing priority, as reduced levels of oxygen will influence tissue perfusion (Walsh 1997). She had a very poor appetite due to an acute phase of sudden illness. Therefore feeding is staged, first on a puree diet, and then she also had a problem with drinking as she could only consume 500ml a day. This was thickened to various consistencies using thickening agents. During an episode of illness Mary’s habit of eliminating was changed and she is now incontinent of urine because of increased frequency of micturition due to deterioration in cerebral function in the brain. Therefore she started to wear disposable pads to keep her dry and comfortable. Poor appetite, lack of movement, exercise and low fibre diet intake has resulted in constipation. Therefore, she takes laxative Senna twice a day as prescribed by the doctor to ease the discomfort. Due to weakness results from CVA Mary has poor strength in the right side of her body. She required assistance from a care provider for all her transfers. She can walk 100-200 yards distance with one assistant also using a Zimmer frame. Mary preferred to have a wash in the bathroom and likes to have a shower twice a week. She can wash her face and front, just needed help to wash her back and legs. Every morning she loves to brush her teeth, clean her face and apply makeup n perfume if possessed. Mary’s body temperature is under normal range; the body’s internal temperature remains remarkably consistent at around 37.5 degrees Celsius. Jamieson et al (2002) suggests the average temperature of an adult should be 36-37.5 degrees Celsius. She sleeps 7-8 hours a night and expresses no issue of dying. She doesn’t want to discuss this issue further as she is willing to achieve as much independence as she can whilst on her own conditions. During the assessment on her admission to the hospitals, sacrum pressure ulcer was identified as an actual problem. The aspect of care, I have chosen for the above client was...
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