Updated: Mar 17, 2020
Published Oct 30, 2008
Hey hopefully you guys can help me in writing my synthesis paper on stroke. Here is a little background on my guy: he is a 79 year old white male with a diagnosis of acute ischemic stroke. He presented with right hand numbness for 24-36 hours, right facial droop, difficulty swallowing, slow gait, and difficulty with his thought processes. He has a history of diabetes type 2 which is not controlled well and carotid stenosis.
I need to identify nursing diagnoses for the population of stroke patients, which I have the following so far (I have to limit to 10) and then identify which are appropriate for my patient.
Finally I have to prioritize the top 3 nursing diagnoses for my patient and give rationale for my prioritizing....which is what I need the most help on.... Thanks to anyone who has advice
Ineffective cerebral tissue perfusion related to decreased cerebral blood flow; unilateral neglect related to perceptual disruption; impaired verbal communication related to cerebral speech center injury; impaired swallowing related to neuromuscular impairment; risk for aspiration; risk for infection; anxiety; compromised family coping related to critically ill family member; and deficient knowledge
I was thinking my top 3 should be:
1) Impaired swallowing related to weakness of affected muscles as evidenced by drooling and difficulty swallowing secondary to stroke; 2) impaired physical mobility related to generalized weakness and paresis as evidenced by flaccid upper extremity, limited range of motion, decreased muscle strength and decreased physical activity; and 3) risk for aspiration related to dysphagia, impaired swallowing, and depressed gag reflex.
But not sure on the prioritizing and rationale for why!
I would list the following most important three..
1. Perfusion, ineffective cerebral
2. Aspiration, risk for
3. Swallowing, impaired
Because it's an actual problem
Because it's airway and is a potential problem...if the patient does actually have trouble with swallowing, then it would become actual and become "swallowing, impaired".
Because 2 and 3 are the difference between actual and potential and are of equal importance in maintaining airway...and then nutrition.
From there, I would address physical safety such as physical mobility, impaired.
Daytonite, BSN, RN
What is a synthesis paper? I've never heard that term before.
I care plan following the nursing process because a care plan is the determination of a patients nursing problems and the nursing process is the tool we use to solve problems. It is used in care planning like this:
Assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
Planning (write measurable goals/outcomes and nursing interventions)
Interventions are of four types
Implementation (initiate the care plan)
Evaluation (determine if goals/outcomes have been met)
Prioritization is most often based on Maslow's Hierarchy of Needs, but also check with your instructors since sometimes they want certain other factors to take precedence.
I went through the information you posted about your patient and organized it.
Step 1 Assessment - Collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - acute stroke patients are at risk for breathing problems. Is this patient on oxygen or having any trouble breathing? I saw he drools, has a facial droop and you are concerned about aspiration. Did you assess his ability to perform his adls (bathing, dressing, mobility, eating. Toileting and grooming) and what kind of help and assistance is needed with those? How is he getting his food? How is he getting to the bathroom? Is he now incontinent? Does he have a foley catheter in place? How does he get in and out of bed, or is he bedridden? I saw the diagnosis of anxiety and unilateral neglect...what are the signs and symptoms that the patient has of these because you don't mention them? What knowledge is the patient lacking? Who in the patient's family is failing to provide supportive care that will support the compromised family coping diagnosis you want to assess here--no evidence supports this. What is going on with the patient's diabetes and is he receiving any kind of treatment for it? Is it influencing his diet? Do you think his stroke is a complication of the diabetes?
Step #2 Determination of the patient's problem(s)/nursing diagnosis part 1 - Make a list of the abnormal assessment data - this list is based on what I was able to pick out of everything you posted
Step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - Match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use - all actual nursing problems have signs and symptoms. The nursing diagnosis is merely a shorthand label. The problem is more clearly described in the definition of the nursing diagnosis. There are also defining characteristics (signs and symptoms) which should be present as evidence to support the existence of the problem when you are assigning any diagnosis to a patient. This information is contained in the nanda taxonomy which should be used as a reference when assigning diagnosis. Based on the evidence you actually have, these are the diagnoses I know I can assign without hesitation:
I took the 10 diagnosis you came up with and prioritized them by Maslow (gave you the Maslow Classification) and added comments about them. I think you need to add self-care deficits. Stroke patients require a lot of rehabilitation and the care plan should reflect that:
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