Tonight, I'm going to share a clinical experience w/ you. Now, this clinical day was special b/c it was my last one for the term. Yay!!! :-) that means I finally get to take a breather, right? WRONG!!! Rule #1: In medicine, there are no breaks; You have patients lives in your hands. With that being said, I anticipated that I would have a busy day ahead of me. And guess what? I was right. Go figure, right? lol. They gave me an 80 y.o. client diagnosed with CVA w/ aphasia.
CVA (Cerebrovascular disease) is also known as a stroke. A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack." Approximately every 40 seconds, someone in the United States has a stroke. A stroke can happen when the following occurs:
* A blood vessel that supplies blood to the brain is blocked by a blood clot. This is called an ischemic stroke.
* A blood vessel breaks open, causing blood to leak into the brain. This is called a hemorrhagic stroke.
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
Stroke usually affects one side of the brain. Movement and sensation for one side of the body is controlled by the opposite side of the brain.
This means that if your stroke affected the left side of your brain, you will have problems with the right side of your body.
Some problems that happen after stroke are more common with stroke on one side of the brain that the other.
* The left side of the brain controls the ability to speak and understand language in most people.
* The right side of the brain controls the ability to pay attention, recognize things you see, hear or touch, and be aware of your own body.
Therefore, based on this info, we can conclude that the left side of my client's brain was affected b/c he was aphasic, meaning, he lost his ability to speak and understand language. To what extent, depends on the type and severity of brain injury. Things I found difficult and/or challenging for my client included:
* speaking
* listening
* reading
* writing
* dealing with numbers
* understanding speech
* thinking of words with talking or writing.
Based on some research I did, I learned that these difficulties are common for clients suffering from aphasia. With that being said, I was faced w/ a major dilemma. That being... How do I communicate w/ my client? and How do I know if the care I am providing is beneficial and/or theraputic to my client? As I sat and pondered upon these questions, I came to the realization that I should ask my primary nurse. DUH!!! lol why didn't it come to me earlier? I mean who better to go to than a health care professional with experience w/ all types of patients. So I went to my primary nurse and she explained to me the importance of formulating a care plan with the primary goal being to establish a relationship w/ the client and encouraging different methods of communication such as visual cues, encouraging client to write in a notepad, expressive behavior, etc. So...I took her advice and did just that. I formulated a care plan and it went as follows:
My Plan Of Care:
-Assessment
-Nursing DX/Clinical Problem
-Client Goals/Desired Outcomes/Objectives
-Nursing Interventions/Actions/Orders and Rationale
-Evaluation
Subjective Data:
Client has expressive aphasia and was unable to communicate subjective information r/t verbal communication.
Objective Data:
The right lower hemisphere of the patient’s face is flaccid.
Problem: Impaired verbal communication
Long Term Goals:
-Client will express desire for social interactions by 17:00 [Month] 10, [Year].
Nursing Interventions:
-Use presence, spend time with the client and allow time for communication and understanding. Leave the call light within reach. Time with the nurse has a positive effect on the healing process and recovery (Carroll, 2002).
Evaulations:
Goals:
-Evaluation of this goal is set for 12:40, [Month] 8, [Year] 2009. Client was making eye contact, utilizing notebook and pen to communicate, and waved goodbye at the end of the shift. Progress made towards goal.
Interventions:
-Evaluation of this intervention is set for 12:40, [Month] 8, [Year] 2009. Spent several hours with the client to establish relationship and communication methods. Some progress toward goal.
As you can see, medicine is much more than making diagnosis, prescribing medications, and/or administering medications. You have to formulate care plans and work w/ different members of the health care team to establish positive therapeutic outcomes for clients. Then, you have to apply that plan of care and evaluate its outcome (being whether or not it's helping you're client or not) If it is effective, you find ways to perfect that care and if not, you formulate a new care plan and see if that works. Medicine in my opinion is all about trial and error b/c not everyone responds to a certain disease or condition the same way. With that being said, you can have clients w/ the same condition but you can have different care plans for each. And in essence, that's where the beauty of medicine lies. It's a progressive profession where you are constantly having to learn new things b/c everyday there are new diseases, new treatments, and new forms of care occurring. That's why I always say: "Alot of people may say they want to be doctors but few are chosen. I believe I am among the chosen."
With that being said, thank you for taking the time to read this post. I hope you enjoyed it. Be on the lookout for more clinical experiences in the near future. Have a good night everyone! Peace, Love, and God Bless. This is 'thedoc' and I'm signing out. 1.
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