Case Study 1 –Mr Paul Stevens Paul is a 48 year old man who had an accident at work, resulting in a Traumatic Brain Injury (TBI). Paul has significant leftsided weakness, severe dysphagia and dysphasia. He has been discharged from the acute setting to impatient rehabilitation for intensive therapy to help with his mobility, feeding and speech. Paul’s husband Gary is very supportive and has assumed primary caring responsibilities for their 8 year old daughter, Rosemary. Paul and his family previously led a very active lifestyle that included regular outdoor activities such as hiking, horse riding and camping. Paul was in hospital for over 4 weeks prior to rehabilitation admission and is expected to spend a significant amount of time in rehabilitation to try and regain as much function as possible. Paul is currently unable to transfer himself and requires significant assistance with all ADL’s. Paul has tried using a 4 wheel walker in the hospital physiotherapy sessions but has not been successfully able to mobilise without significant support and assistance. Prior to the accident Paul was active with no significant medical history but does have a family history of bowel cancer, hypertension and cardiac issues. Paul is expected to be in rehabilitation for up to 8 weeks depending on his progress. Paul has not been able to express how he feels regarding his accident due to the dysphasia, but his partner Gary feels that he is not coping well with the possibility of significant long term changes to his lifestyle if he is not able to fully recover. Rosemary has been visiting Paul daily but is reluctant to stay for long because the hospital “smells funny”. You have just admitted Paul to the rehabilitation centre. You are his assigned primary nurse.
Kylie is a 29 year old woman who was in a car accident and has sustained a severe burst fracture and spinal cord compression at T9. This has resulted in paraplegia below T9 and limited function and strength in her upper body. Kylie has been admitted for rehabilitationto learn how to manage her mobility and to function as independently as possible. Kylie’s injury has resulted in complete lack of function inher lower limbs as well as loss of bowel and bladder control. Kylie has limited family support, with her mother being her only living relative. Kylie and her mother have a difficult relationship and her mother has expressed a belief that Kylie will never be independent again, and that she will need to move home to be cared for. Kylie does not want to move home with her mother. Kylie is currently unable to manage transfers herself. She is wearing continence aids at present due to lack of bowel and bladder control. She is able to move herself around short distances with her wheelchair, but does struggle with other ADL’s due to tiredness. Kylie is not particularly good at being able to judge her limits in terms of energy expenditure. Kylie was moderately active with regular yoga sessions prior to the accident and works at a financial institution in the city. Her work have been helpful and are willing to modify her workplace for her when she returns. Kylie previously lived alone in an apartment that does not have disabled access. Kylie has a past history of anxiety and depression that was treated with medication and counselling. On admission to the unit, Kylie appears quite flat in her affect and does not seem to engage with you as her primary nurse. You have just admitted Kylie to the rehabilitation centre as her assigned primary nurse.
Sam is a 62 year old man being admitted to cardiac rehabilitation following emergency CABG and aortic valve replacement 2 weeks ago following a cardiac arrest at the cricket. He was unresponsive and was defibrillated early by first responders at the ground. Sam has a past history of type 2 diabetes, hypertension, obesity (BMI 42), ETOH and currently smokes ½ pack of cigarettes per day. Sam previously owned his own business, but has just sold this and is planning to retire with his wife, Janet, and to travelextensively. Sam has been non–compliant with his diabetes and antihypertensive medication over the last ten years and has 2–3 drinks per day but states that he has been planning to cut down now that he doesn’t have the stress of the business. Sam’s wife Janet tried to get Sam to change his lifestyle when he was first diagnosed as diabetic and hypertensive, but Sam was resistant and felt that the tablets were bad enough. Over the past ten years, Sam has been reluctant to check BGL levels on a regular basis and has refused to see an endocrinologist or his GP regularly. Since his heart attack, Janet has been firm with Sam that changes will need to be made once he returns home, but Sam is resistant and doesn’t believe that his condition was that bad and that “life isn’t worth living without a good steak and a beer”. Sam believes that his condition isn’t that serious and dismisses his wife’s fears that it may happen again. Sam feels that he is at rehab for a bit of “rest and relaxation” before he can resume his retirement plans. Sam is able to manage his ADL’s at present but becomes tired after very little exertion and is currently unable to ambulate more than 50m without requiring a rest. You have just admitted Sam to the rehabilitation centre as his assigned primary nurse.
PART 1: CARE PLAN PRESENTATION (Equivalent 500 Words)–15% marksNOTE: References are expected throughout this paper using APA 7threference guideYou are required to complete the PowerPoint template provided in relation to your chosen case study. The template is uploaded toBrightspace in the Assessment 2folder. An example template is also provided for you.You will not be required to presentthis Powerpoint face–to–face, but you will need to upload it as Part 1 of Assessment 2.In dotpoint form, you will need to:Identify the nursing diagnoses for your case studypatient,Identify the nursing Interventions and justify your decisions using evidence based practiceIdentify other members of the Multi–Disciplinary Team who may be involved in the care of your case studypatientPlease note the words already in the template are not included in the word count PART 2: WRITTEN COMPONENT (1500 words)–35% marksNOTE: References are expected throughout this paper using APA7th Reference guide Using the Case Study patient you have completed the nursing care plan presentation for, explore and critically analyse the goals, interventions and support needs and requirements for your patient in the rehabilitation and community setting.Critically analyse three key goals of rehabilitation that your case study patient wants to achieve at the completion of their inpatient journey. In doing so,consideroThe relationship between nursing care/interventions and the patients identified goals in the rehabilitation setting o Collaboration within the multi–disciplinary team oWhat support other team members will offer during rehabilitationProvide a comprehensive discussion related to discharge planning that identifies appropriate interventions and support services your patient will require when discharged home to the community. You should research the literature to provide an evidence based discussion that offers the reader:
