THE PATIENT AND SOCIETY: IT’S IMPACT ON OUR DIAGNOSIS
MaryGrace P. Haydock
Utica College
Abstract: OBJECTIVE: Review and the understanding of the make-up of the WHO ICF model. Application of WHO ICF model in stroke management (WHO, 2006). Case Presentation: This is a case of 60-year-old African American widowed female( 5years) presented with a medical diagnosis of cerebrovascular disease secondary to right intracerebral hemorrhage and found to have right arteriovenous malformation .No residual AVM post op. Onset date was April 11/2014.Past medical history of depression is otherwise patient without significant past medical history. Family History: Diabetes and hypertension. The previous level of function: the patient was independent w/ her
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functional mobility such as bed mobility, transfers, stair negotiation, and ambulation to a community without the device. Previous living situation: Pt lives alone in an apartment with 1 flight of steps w/ one rail. Patient’s daughter lives with her husband with two kids (8 and ten years old) in the same apartment building, located on the third floor. Social background: patient attends social gatherings with her daughter and enjoys traveling with her family. The patient was referred for PT evaluation and treatment due to general weakness and gait dysfunction. Overview about above medical Diagnosis: Intracerebral hemorrhage and arteriovenous malformation (AVM). The World Health Organization (WHO) defined stroke as: a clinical syndrome typified by rapidly developing signs of focal or global disturbance of cerebral functions, lasting more than 24 hours or leading to death, with no apparent causes other than of vascular origin (WHO, 2006).Summary of review System of my case presentation: Medication Review: Remeron for depression, Lovenox- to help reduce the risk of deep vein thrombosis (DVT) blood clots. Pt with severely restricted mobility during acute illness. Vital signs: blood pressure: 130/70; Heart rate: 65 bpm; SPO2: 98% (room air). Cognitive status: Confused. disorientation, bewilderment, and difficulty following command. (Tindall SC, 1990) Alert, keenly responsive, answered, severe dysarthria (slurred speech questions due to aphasia); obeys one task correctly. Visual field assessment Partial hemianopia, which includes quadrantanopia (visual loss in a quadrant of the total visual field); Level of Consciousness; Overall impression of alertness. Correctly or are unable to speak due to intubation or the patient's ability to follow one-step commands. Tactile sensation is evaluated by pinprick: RLE – Normal /no sensory loss; LLE- mild to moderate sensory loss. (Adams HP Jr, Brett TG, and Crowell RM et al…, 1994). Motor function: left upper extremity (LLE): 90% impaired. Right LE (RLE): grossly graded 4 /5. Range of motion: UE/LE grossly graded within functional limits. Muscle tone: RLE: normal, LLE: 1+: 1+ Slight increase in muscle tone (Bohannon, R. et al, 1987). Functional Mobility: Balance Test: Using Functional Balance Grades by O’Sullivan. Sitting Balance static a dynamic= poor: standing balance: static and dynamic (parallel bars) = poor. Poor (Static): Patient requires handhold support and moderate to maximal assistance to maintain position ;( Dynamic): Interpretation: Patient unable to accept challenge or move without loss of balance (O’SulO’Sullivan, S.B. an liven, S.B. and Schmitz T.J. (2007).BERG Balance Scale: Result = _0__patient with high risk of fall and wheelchair bound :The Berg Balance Scale (BBS) was developed to measure balance among older people with impairment in balance function by assessing the performance of functional task Berg, K.,Wood-Dauphinee,S.,Williams.J.I. &Gayton,D.(2007).Functional Mobility: The Functional Independence Measure (FIM) scale assesses physical ability. This scale focuses on the burden of care – that is, the level of disability indicating the burden of caring for them Total assists: 1. Eating, grooming, bathing/showering, dressing upper body, dressing lower body, toileting; transfers, bed/chair/wheelchair, toilet transfers: bathtub/shower transfers: car, walking/wheelchair and stairs Transfers: Total assist; bed/chair/wheelchair2. Transfers: toilet3. Transfers: bathtub/shower4. Transfers: car5. Locomotion: Total assist; walking/wheelchair; Locomotion: Total assist: stairs (Hamilton BB, Granger CV, Sherwin FS et al, 1987). Below is Figure 1: The Rehab Problem Solving Form is based on International Classification of Functioning, Disability and Health (ICF) (Steiner, W., 2000).
The WHO ICF model is being used to provide a common framework to deliver and study the efficacy of rehabilitation outcomes across rehabilitation settings. The WHO ICF model can be used to facilitate for management of professional decision-making, communication, and collaborative efforts among nursing and other interdisciplinary team members and professional colleagues. The WHO ICF model as a framework for management of documentation relating to patient care and determining payment for services required. The WHO ICF is valuable in rehabilitation, research and education. It assists professionals to look beyond their own areas of practice, communicate across disciplines, and think from a functioning perspective rather than the perspective of a health condition of the …show more content…
patient(WHO,2006). Health Condition Medical diagnosis: Intracerebral Hemorrhage (161.9):Treatment Diagnosis: left hemiplegia169.954; gait dysfunction: R26.8 Body function Structure Activities Participation Environmental: (Family support (+); Support from third party payor for in-patient rehab(+); stress if family about illness (-); living situation(-) I61.9 Intracerebral Hemorrhage is a billable ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes Bleeding into one or both cerebral hemispheres including the basal ganglia and the cerebral cortex.
The WHO ICF model can be used to assess the quality of rehabilitation care and the impact of loss of body functions and structures, activities limitations, and contextual factors include the unique personal and environmental variables of each stroke patient in a sub-acute setting. The WHO ICF model defines activity and participation dimensions separately, and applies these dimensions as a singular construct when clinically qualifying and quantifying the consequences of a health condition (WHO,
2006). . References: Adams HP Jr, Brott TG, Furlan AJ et al: Guidelines for thrombolytic therapy for acute stroke: A American heart association.Stroke Association.org)Types of Stroke -American Heart Association.(n.d.).Retrievedfromhttp://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-St) Berg, K.,Wood-Dauphinee S.,Williams.J.I. &Gayton,D: Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41:304-311, 1989 Hamilton BB, Granger CV, Sherwin FS et al. A uniform national data system for medical rehabilitation. In: Fuhrer MJ, editor. Rehabilitation Outcomes :analysisandMeasurement. Baltimore, MD: Brookes; 1987. pp. 137–47. O’Sullivan, S.B. and Schmitz T.J. (2007). Physical rehabilitation: assessment and treatment (5th ed.). Philadelphia: F. A. Davis Company. p.254 Spilker JA, Semonin-Holleram R: Injury, potential for, related to sensory or motor deficits: Using the stroke scale to validate defining characteristics of this nursing diagnosis. Pages 247-252 in: Classification of Nursing Diagnoses Proceedings of the Seventh Conference of North American Nursing Diagnosis Association, McLane AM (editor). CV Mosby, 1987. Stineman MG, Jette A, Fiedler R et al. Impairment-specific c dimensions within the Functional Independence Measure. Arch Phys Med Rehabil. Tindall SC. Level of Consciousness. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 57. Available from: http://www.ncbi.nlm.nih.gov/books/NBK380 WHO (World Health Organization) 2006, International classification of functioning, disability and health, WHO, Geneva.
Mr. Fix-it is a 59 year old man with a history of alcohol abuse and diabetic hypertension. Mr. Fix-it has been currently experiencing symptoms such as: rambling speech, poor short-term memory, weakness on the left side of his body, neglects both visual and auditory stimuli to his left side, difficulty with rapid visual scanning, difficulty with complex visual, perceptual and constructional tasks, unable to recall nonverbal materials, and mild articulatory problems. The diagnosis for Mr. Fix-it’s problem is most likely a right-hemisphere stroke. A right-hemisphere stroke is occurs when a blood clot blocks a vessel in the brain, or when there is a torn vessel bleeding into the brain. “A right-hemisphere stroke is common in adults who have diabetes and who are over the age of 55”, similar to Mr. Fix-it (Kluwer, 2012). In addition, Mr. Fix-it has a history of alcohol abuse in which it could have also increased his chances of experiencing a right-hemisphere stroke.
Stroke survivors or anyone with chronic illness and health providers remain hopeful and “realistic” by counting on each other. The patients while being realistic about the outcome of their disease, stay hopeful that each of their health care providers will give them the appropriate care and will make sure that they can live with their disease in the best way possible.
Lippincott, W. (2013). Management of Patients with Cerebrovascular Disorders. Brunner and suddarth's textbook of medical -surgical nursing 12th ed. + nursing diagnosis, (p. 1895). S.l.: Wolters Kluwer Health.
When performing evidence based practice research, the Iowa Model uses a team or individual approach to assist nurses in the journey to quality care. The Iowa Model begins by offering a process of selecting a proper clinical topic, which is often a recurring problematic issue (Polit & Beck, 2012). This topic is formulated as a question to improve a technique or procedure. Once the researcher determines that an ample amount of reported investigation exists on the desired question, information may be gathered and presented for approval (Polit & Beck, 2012). The research may lead to a gradual change in nursing practice.
The team needed depends on the individual patient’s needs and their family’s needs. All members of the interdisciplinary team have a variety of functions, to include: assessment of the individual, assessment of the home conditions, provide education to patients and families as well as to develop a plan of promotion of health and prevention. The key to the success of the interdisciplinary team is collaboration and teamwork. It is also important to follow the models of responsibility, communication, authority and competent in clinical resource management. All these models are important for the welfare of the patients and their families. As a hospice certified nurse assistant I experience in a daily basis how the team that I belong to is a great example of a comprehensive interdisciplinary approach. However there are multiple barriers that we need to manage to be able to accomplish our daily coordination of
Mr. X is 84 years old. He was admitted to the hospital on January 4, 2014, due to hematuria in his urine and a suspected Transient Ischemic Attack (TIA). After the admission, he was sent for a CT scan, which confirmed Mr. X’s TIA in his right hemisphere. On January 5, 2014 Mr. X was transferred to CP1, an acute care stroke unit. His first TIA episode had been on August 28, 2012. His comorbidities include hypertension and type II diabetes. His activities are limited to bed rest as he has risk of falls; also he is on input-output with a Foley catheter. He has left side weakness and mild facial drooping on the left side. He is alert and oriented; however, he has trouble focusing on many people at one time. His care plan state...
In this event, the matter that is unusual can be the fact that I have experienced and witnessed the process for interprofessional collaboration between the community nurse and other professionals that I have never knew about before. This event made me realize that there are many aspects of community nursing that I have knew about before where in this situation it is the importance and accountability of interprofessional collaboration. From my nursing theory course I have learned that interprofessional collaboration is when the nurse forms relationships with other professionals that enable them to achieve a common goal to deliver care and strengthen the health system and clients involved in it. (Betker & Bewich, 2012, p.30) In this event, our mutual goal is to provide the appropriate care for the patients/residents so they can restore their health after their hip or knee surgery. In the nursing leadership and management textbook it stated “interprofessional practice removes the gatekeeper and allows client access to all caregivers based on expertise needed.” (Kelly & Crawford, 2013, p.35) In this event, my preceptor and I gained knowledge about Revera and will pass on this information to patients who are interested in staying at a retirement home after they discharge from the hospital. One literature talked about how according to the Institute of Medicine, it is critical to have the capacity to work together as part of the interdisciplinary team to assist in delivering high quality, patient-centered care. In addition, effective collaboration among health care professionals results in improved patient care and outcomes. (Wellmon, Gilin, Knauss & Linn, 2012) This indicates the importance of interprofessional collaboration to provide...
Concurring with other studies (Carod-Artal et al., 2009; Castellanos-Pinedo et al., 2012; Dhamon et al., 2010; Haacke et al., 2006; Owolabi, 2010; Rønning, & Stavem, 2008), we found that initial stroke severity, functional status, and disability determine the HRQoL in stroke survivors. These factors mainly affect physical domains of HRQoL.
There are six set standards of the nursing practice; assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ANA, 2010; pp. 9-10). Throughout a typical shift on the unit I work for, I have set tasks I am expected to complete in order to progress the patient’s care, and to keep the patient safe. I begin my shift by completing my initial assessment on my patient. During this time, I am getting to know my patient and assessing if there are any new issues that need my immediate intervention. From here, I am able to discuss appropriate goals for the day with my patient. This may come in the form of increasing mobility by walking around the unit, decreasing pain, or simply taking a bath. Next, I plan when and how these tasks will be able to be done, and coordinate care with the appropriate members of the team; such as, nursing assistants and physical therapists. Evaluating the patient after any intervention assists in discovering what works and what does not for the individual. “The nursing process in practice is not linear as often conceptualized, with a feedback loop from evaluation to assessment. Rather, it relies heavily on the bi-directional feedback loop...
long-term rehabilitation services, and onset severity (e.g., extent of an inflammatory process).” (Thomasos et al., 2015, p.40).
Stroke not only affect the life of the patient but also their significant others, especially the caregiver. Caregiver is identified as the “hidden patient” (Andolstek et al, 1988). Families maintain the primary care responsibility for elderly with chronic illness and disability (Montgomery et al, 1985). The effects of caregiving span across physical health (Grafstrom et al, 1992; Kiecolt-Glasier et al, 1991), mental well-being (Cochrane et al, 1997) and social life (Luterman, D. ,2008; Bakas et al, 2006).
This module has enabled the author to understand the concept of vulnerability, risk and resilience in relation to stroke. Therefore, it will contribute to her professional development and lifelong learning (NES, 2012). Additionally, the author has gained evidence based knowledge of person-centred care, compassion and self-awareness; all of which can be used to inform future practice (Miller, 2008). Consequently, she will be able to provide the appropriate level of care that can make a difference to a person’s recovery.
The goal for nurses as a profession is not only to be “patient advocates” but also assist the patient to learn and gain the necessary skills to achieve the best level of functioning for the patient based on their current illness. In order to help a patient achieve their optimal level of functioning the nurse must work with the patient and the interdisciplinary team to create a collaborative plan that is logical for the patient. Through examining a musculoskeletal disorder case study #35 from Preusser (2008), one can create a critical pathway for the patient, S.P. a 75 year old female, with severe rheumatoid arthritis (RA) and admitted to the orthopedic ward for a hip fracture status post fall (p. 183). Since the patient’s needs is unique and complex the nurse must tailor a plan with the patient which will include “…assessments, consultations, treatments, lifestyle changes, disease education…” in order for the patient have the most appropriate evidence-based care and make informed decisions when it is necessary (Oliver, 2006, p. 28). The aim for the nurse caring for the S.P. is to help prepare the patient for an upcoming procedure and focus care to the patient by gathering necessary information about her while. Collaboration with the patient, family members, rehabilitation, medical and surgical team about the treatment plans can help us provide proper patient’s care by utilizing actions and interventions within the scope and standards of the nursing practice.
McDonnell, M.N., Bryan, J., Smith, A.E., & Esterman, A.J. (2011). Assessing cognitive impairment following stroke. Journal of Clinical & Experimental Neuropsychology, 33(9), 945-953.
Stroke has been classified as the most disabling chronic disease, with deleterious consequences for individuals, families, and society1. Stroke impacts on all domains in the ICF. The body dimension (body functions and structures), the individual dimension (activity), and the social dimension (participation). All domains influence each other2.