A middle-aged male presented in the emergency department with a hemorrhagic stroke and was unable to speak for multiple days. He progressively became more verbal over the course of several days, at first they were simple yes or no responses however, by the time I had met him he was answering some questions with more than a one word response. This patient had not received medical treatment in over five years, was employed by a franchised pizza restaurant as a manager and had experienced headaches for over a month. Upon presentation in the emergency department his systolic blood pressure was in the 250’s.
As stated, the patient was hypertensive in the emergency department and his mother had reported that he was experiencing headaches for the past month. As we have learned the headache the patient was complaining of was in fact correlated to a hypertensive crisis. However, correlating back to the patient’s occupation: a manager at a pizza shop, the patient may be of low socioeconomic status which is correlated to a lack of education. The patient may not have had insight on this issue, and thus, that is why the patient did not seek the medical attention prior to the hemorrhagic stroke.
The background of the patient was hard to assess without the insight provided by the patient’s mother however, from assessing the patient and the tone in which the patient had provided answers the patient was clearly upset. The patient struggled with elaboration of ideas, and there was difficulty determining if the patient understood what was asked of him. For instance, I had asked the patient several times if he would like to bathe. The patient stated, “No”. However, after discussion with my instructor we determined the patient may not understand what was asked of him due to the fact that the patient’s thought process may have been impacted due to the hemorrhagic stroke. After this realization, I had handed the patient a washcloth with warm water and soap to see if the patient would wash his face, after cueing the patient he had done so.
To my insight, the patient had difficulty expressing himself and due to this the patient’s mood and affect were stunted. I had asked the patient how he was feeling, and there was no response. After rephrasing the question, “Are you happy with your discussion with the case manager, about potentially going to rehab?”. The patient had responded, “yes”. I then asked the patient, “I imagine this is a difficult time, are you upset with this situation”. He immediately stated, “no”. However, his tone did not match the answer. I am unsure if the patient had receptive aphasia, as the majority of our conversation was his response of yes or no however, the patient was enduring a difficult situation regardless of the ability to communicate, and the addition of this to my belief would only make this situation incredibly more difficult.
The patient was a single, middle-aged man, who worked as a manager of a pizza shop. This man lived on his own, and there was dispute that this man did or did not have insurance. This only increases my suspicion that he is of low socioeconomic status, that being said did he have a smoking history, what was his diet like, was he not seeking medical attention due to this lack of insurance and financial instability? This straining of his financial status and stability would only further increase stress within this patient as he has may bills to pay hospital, emergency department, ambulance, and a potential rehab bill to pay. To continue on, the patient would thus, not only be under increased stress due to this financial burden, but also due to his diagnosis, and the prognosis. Further assessment would be needed to determine his financial security, insurance, and his ability to perform activities of daily living.
This patient truly had an immense amount of burden in which he was enduring, this would impact the mental health of any person in some form or aspect. The addition of having difficulty in communication only further hindered his ability to receive this mental health treatment. Without this communication, there is difficulty in determination as to what this patient truly needed. Did this patient solely need company and due to the pandemic visitors were not being allowed at this time hinder that, or did this patient need more support than a companion?
In regard to nursing diagnoses, we can see for the biologic domain the patient has a self-care deficit. The patient was unable to bathe himself without cueing, as I had to hand him a washcloth in order for him to wash his face. Onto the psychological domain, the patient had ineffective individual coping as the patient was unable to communicate and thus, the patient was unable to cope through what had occurred. Without communication the patient would be unable to cope with the event which had happened. Finally, for the social domain, I would imagine that the patient would develop ineffective role performance in relation to the patient now being unable to perform the abilities he once could and thus, the patient would need to relearn activities in order to perform these activities required for his career. Promoting self-care for this patient is essential, ensuring the patient is receiving adequate nutrition (which was required to be ordered for the patient), hydration, and caring for basic needs such as hygiene. The patient had a recent diagnosis of diabetes which was needed to be explained to the patient in regard to carbohydrate counting, education will need to be reenforced for this patient in order to determine if the patient truly understood this information. Suicidal ideation should be assessed as well due to the fact that this is a difficult diagnosis and is demanding of the patient. The patient’s life has been altered gravely due to this diagnosis.
I believe this patient would be greatly benefited through the discharge to a rehabilitation facility to determine if this patient through the work of physical therapy and occupational therapy can regain the ability to walk on his own and take care of himself to a sufficient manner. I believe that this patient has the ability, and hopefully through instilling hope into this patient he will too. However, there are potential barriers to this, the socioeconomic status is the biggest barrier I can see. I am unsure of what offers are available to these instances however, collaboration with case management is truly beneficial in these instances and that being said, collaboration is an essential part of nursing and of health care as a whole. Thus, collaboration with case management to ensure this patient is able to go to a rehabilitation facility, to thus have nurses there collaborate with physical therapy, occupational therapy, and potentially even mental health providers to instill the hope within the patient that they can properly care for themselves even though they have undergone a difficult and demanding event will truly benefit this patient. After this, the next step would be to determine long-term needs for this patient. If the patient is able to care for himself on his own, potentially a support group would be beneficial for him to see that he is not alone, and others have also undergone issues similar to him. However, if the patient is unable to care for himself, then discussion of a long-term care facility or a caregiver will be essential.
