Case Analysis Evaluation Rubric

CASE ANALYSISI RUBRIC

Introduction
Present section is based on case of Mr Orkins who is 84-year-old man suffering from bad
health. He was admitted to the hospital after meeting with accident and it was identified that he is
behaving aboriginal. He is taking several medications: diamicron, Amlodipine, Simvastatin etc.
His wife stated that after his accident, he was unresponsive and nurses have started examining
his situation. He has hyperlipidaemia and suffering from type 2diabetes ((Elshiekh,El-
Dakhakhny & Moustafa, 2016).
Primary assessment
When Mr. Orkin gets admitted in hospital then nurses have observed his situation and firstly
medical profession has introduced herself with him. When nurses greet him then nurses has
notices impassive behaviour of Mr. Orkins. It was observed that entire room is smelling which
was due to urinary incontinence (Kalb & O’Conner-Von, 2019). Primary assessment is the
starting stage in which situation of person is tested by observing the mental status, breathing and
circulation (Munro & et.al., 2016).. By observing physical appearance of person primary
assessment can be done. AVPU scale is helpful in order to know more about health condition of
patients, nurses use alter, verbal, painful and unresponsive aspects that help in finding problems
in patients (Primary Survey and Secondary Survey, 2018). Nurse has used Airway, breathing and
circulation (ABC) approach, Nurses has identified consciousness issue in Mr. Orkins, it was
noticed that patient is conscious and his respiration rate was very high. He also had high BP as
his pulse rate was high. which was 98 beats.
Secondary assessment
Secondary assessment can be done through examining blood pressure, heart rate respiratory
rate etc. Nurses takes support of medical history of person and observe vital sign of particular
disease within them, this aids in analysing them properly and examining their actual health status
(Elshiekh, El-Dakhakhny & Moustafa, 2016). It is done in the situation if nurses or medical
professional find positive sign in ABC approach. In order to check conscious level of patient
many test is done such as Alter, unresponsive, pain and voice. It was identified that Orkins was
suffering from slurred speech, it is dysarthria issue. In addition, blood sugar level was measured
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which is found 10.4mmol/L. is to check the patient body from head to toe and reviving from
unconsciousness (Scirica and et.al., 2016). When mobility level was examined then it is found
that right side of person is bad as there is weakness in right side. By checking the glucose level it
is found that blood sugar level of Mr. Orkin in high (Elshiekh, El-Dakhakhny & Moustafa,
2016).
Focused assessment
Focused assessment is another method which is used to identify the neurological status of
particular person (Husebo, 2015). Nurses has applied Glasgow coma scale (GCS) method, this
has helped in determining the consciousness level of Orkin. Scoring of eye response is 4, verbal
response found at 3 level and his motor response is 6 hence it is identified that GCS level of Mr.
Orkin is 13/15. (Ferrell & et.al., 2018).. Test results found that strength is 3/5 (right upper and
lower extremities) and 4/5 (Left upper and lower extremities).
It is observed that all these signs are warning sign for stroke. And Orkin may get suffer
from stroke soon in near future (Edvardsson and et.al., 2017).
Nursing intervention
Holistic
Relaxation training: Nurses have to provide them relaxation training so that Mr. Orkins
can feel relax and his mobility level can be improved. As there is issue of consciousness which
can be resolved by getting relaxation training. This will help in making his right side strong and
improving the vision, eye capabilities (Kalb & O’Conner-Von, 2019).
Culturally safe
Creating spiritual environment and involvement of patient: Nurses can create spiritual
atmosphere and can involve Mr. Orkins in small discussions with other patients. This will
enhance mobility level of person and will help in improving his speech issue as well. He will feel
confident and this will resolve conscious issue of him (Elshiekh,El-Dakhakhny & Moustafa,
2016.
Evidence based best practices
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Maintaining saturation of oxygen is the best intervention strategy that may aid in
minimising risk of stroke which may turn into brain damage if there is inadequate oxygen level.
Furthermore, nurses are required to maintain blood glucose level as well, this would be helpful in
minimising risks of post stroke hyperglycaemia which is very common in diabetes patients.
Nurses have to take care of his diet as well so that his blood sugar level can be controlled
(Dunphy & et.al., 2015).
Monitoring signs: Medical professional has to monitor signs of patient regularly as
hypertension can cause stroke hence nurses have to monitor person remain away from
hypertension otherwise risk of stroke can be increased.
Exercise: Nurses have to arrange physiotherapist which can make his done exercise for
making his legs or right side stronger. Fall prevention is another great intervention technique
which may help in patient in preventing from fall (Elshiekh,El-Dakhakhny & Moustafa, 2016).
Administer medications need to be given timely and have to create culturally safe
atmosphere in hospital so that health of patient can be improved. Nurses will regularly monitor
the progress in patient and will try to maintain blood sugar level. This will assist in influencing
behaviour of care users and individual will get recover soon (Dunphy & et.al., 2015).
From the above scenario it can be concluded that stroke is common problem in the people
now a days and most of the patients are suffering from hypertension and diabetes. nurses have to
ensure taking correct action so that concerns of patients can be resolved soon (Bethel and et.al.,
2017). Primary assessment can be done by observing impression of person and looking at their
mental status. In order to do secondary assessment care providers, have to examine physical
condition and medical history of individual. These approaches are helpful in determining the
appropriate nursing intervention that supports in improving health status of care user.
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REFERENCES
Books and Journals
Bethel, M. A. and et.al., 2017. Assessing the safety of sitagliptin in older participants in the
Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes
Care. 40(4). pp.494-501.
Dunphy, L. M. and et.al., 2015. Primary care: Art and science of advanced practice nursing.
FA Davis.
Edvardsson, D. and et.al., 2017. A person-centred and thriving-promoting intervention in
nursing homes-study protocol for the U-Age nursing home multi-centre, non-equivalent
controlled group before-after trial. BMC geriatrics. 17(1). pp.22.
Elshiekh, D. E., El-Dakhakhny, A. M. and Moustafa, K. Z. E. A., 2016. Assessment of Maternal
Care Provided to Their Epileptic Children at Zagazig University Hospitals. Zagazig
Nursing Journal. 395(3596). pp.1-16.
Ferrell, B. and et.al., 2018. An Innovative End-of-Life Nursing Education Consortium
Curriculum That Prepares Nursing Students to Provide Primary Palliative Care. Nurse
educator. 43(5). pp.242-246.
Husebo, B. S., 2015. COSMOS—improving the quality of life in nursing home patients:
protocol for an effectiveness-implementation cluster randomized clinical hybrid
trial. Implementation science, 10(1), p.131.
Kalb, K.A. and O’Conner-Von, S., 2019. Holistic Nursing Education: Teaching in a: Holistic
Way. Nursing education perspectives. 40(3). pp.162-164.
Munro, M. and et.al., 2016. The Prince Edward Island conceptual model for nursing: a nursing
perspective of primary health care. Canadian Journal of Nursing Research
Archive. 32(1).
Munroe, B. and et.al., 2015. HIRAID: An evidence-informed emergency nursing assessment
framework. Australasian Emergency Nursing Journal. 18(2). pp.83-97.
Scirica, B. M. and et.al., 2016. Prognostic implications of biomarker assessments in patients
with type 2 diabetes at high cardiovascular risk: a secondary analysis of a randomized
clinical trial. Jama cardiology. 1(9). pp.989-998.
Online
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Primary Survey and Secondary Survey. 2018. [Online]. Available through
<https://chemm.nlm.nih.gov/appendix8.htm>
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