Harold Blake Case Study

This case study explores the nursing process and person-centered care in the context of Harold Blake, an 83-year-old patient with cerebral vascular accident and angina. It discusses the importance of nursing diagnosis, the role of a multidisciplinary team, and the ethical considerations in nursing. The study also highlights the need for proper diagnosis and planning for the patient's care and discharge.

Running head: HAROLD BLAKE CASE STUDY
HAROLD BLAKE CASE STUDY
Name of the Student
Name of the University
Author Note

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HAROLD BLAKE CASE STUDY
Introduction
Nursing process is a five phased system in which the nurse needs to assess, diagnose,
plan, implement and evaluate the patient’s condition and treatment procedure on the basis of the
doctor’s consent. Person-centred care model on the other hand depends on the prioritisation of
the patient health condition over any other possible aspects. The person centred care plan relies
on the relationship between the nurse and the patient and the prioritisation prospect of the nurse
(Eaton, Roberts & Turner, 2015). On the basis of this model it can be seen that the diagnosis and
planning phase of the nursing process would be helpful in the person centred care as these phases
depends on patient’s need assessment and also help in the patient care in a proper planning. On
the other hand the discharge plan would be the step in which the patient’s further care would be
evaluated and planned prior to the time when the patient leave the hospital. Thus the evaluation
phase and the person centred care would be helpful in devising a proper discharge plan for the
patient. Here, Harold Blake a 83 year old patient experiencing cerebral vascular accident and
angina in day two of his admission in the hospital. In the following sections the nursing
diagnosis for Harold Blake’s intervention would be discussed with the focus on the person
centred care and also the ethical issues of the nursing and the multidisciplinary team for the
treatment.

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Discussion
Nursing diagnosis
Nursing process is comprised of five primary stages and collectively they are called the
five sequential stages of nursing which are assessment, diagnosis, planning, implementation and
evaluation. Here, nursing diagnosis can be marked as the most important aspect of all the
sequential steps as on the basis of the diagnosis process the nurse can be able to plan the nursing
care for the patient and the diagnosis process helps in the proper understanding of the patient’s
current condition and provide the idea about the patient’s actual needs. The diagnosis process
although depends on the assessment process as it helps in the assessment of the past medical
history of the patient and also the primary knowledge about the patient and on that assessment
the diagnosis process can be directed and thus the treatment planning and implementation of
those planning could be possible (Udod & Wagner, 2018). Nursing diagnosis could be
differentiated into four types that are the actual diagnosis, wellness or health promotion
diagnosis, risk diagnosis and the syndrome diagnosis. The actual diagnosis process helps in the
identification of the current condition of the patient, wellness diagnosis helps in the
determination of the increasing decreasing future treatment or wellness of the patient, risk
diagnosis assesses the risk factors of the patient’s disease or the condition and finally the
syndrome diagnosis helps in the determination of the symptoms of the patient (Pati & Arstall,
2017). Here in the day two of Harold Blake’s admission it has been seen there is a phase of nose
bleed in the morning and the consciousness of the patient is in a negative condition as he was
nauseas and dizzy and could not recognize or talk properly as the cardiology registrar found.
Harold was not properly oriented and also could not recognize people properly however, he

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could follow simple commands. As a result of past cerebral vascular accident his right hand and
leg was not working properly and ate the day two of admission after angina attack he could only
lift his left hand when asked. This can be the indication of his cerebral vascular accident and also
his pain in the chest for 20 minutes which was prevented after two times charging of glycerol
trinitrate spray. On the other hand observation process highlighted that his drowsiness and the
nauseas condition getting to normal points and his blood pressure was nearly normal as well with the
increasing heart beats per minute within a period of time from 47 to 62 however, the beat per minute
ratio was lower in terms of an average person. His nose bleed and the cerebral vascular accident
would be the cause which would affect the heart beat rate of his and the lower blood pressure as
well which was ranging from 148/70 to 138/65 thus the lower blood pressure imbalances the
mechanism of the cerebro spinal fluid and the blood pressure in the brain and it leads to the
manifested haemorrhage and it can be able to describe the causes of the nose bleed of Harold and
also the drowsiness and unconsciousness of the patient. His GCS range was from 12/15 to 14/15
from the first hour to the last observation and it was determined on the basis of his confused
verbal communication and responses to the simple commands. On the basis of the condition the
unstable angina was related to his lower blood pressure and lower breathing rate as well and the
saturation level of oxygen as well. These conditions were found the assessment on the past
medical history of the patient and the current observation as well. His past
Hypercholesterolaemia and also the extreme smoking habit depicts the current condition and also
age of the patient also affects the condition. On the basis of the past medical history of Harold
and the assessment of the cardiology registrar the nurse could lead to the diagnosis of the
patient’s cerebral haemorrhage and also the assessment of the type of the angina of the patient.
The nurse should be able to talk the patient and understand his discomfort and the needs as well

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and provide him with patient centered care which would be dependent on the diagnosis of the
condition. Here the diagnosis process would be used for the patient code stroke and the routine
observation of the patient and assessing the deterioration or positive changes in the patient’s
condition (Moore, Britten, Lydahl, Naldemirci, Elam & Wolf, 2017). On the breathing condition
of the patient the nurse should also administer the medication and the oxygen and also try to ease
the patient’s mouth medication administration. The diagnosis process would also be comprised
of the blood pressure, GCS scaling and other than all these needed blood tests and other tests for
the determination heart condition of the heart condition of the patient. The neurological
observation would also be a diagnosis of the patient that holds the stake of the betterment of the
patient’s GCS rate and also the command responses measuring along with the observing in the
characteristic change of the patient by means of time and medication through the liquid pathway
(Bieleninik, Posserud, Geretsegger, Thompson, Elefant & Gold, 2017). All these aspects needed
to be reported to the doctor as well in order to devise the further treatment process of Harold.
The proper medication administration and the assessment of the changes on the basis of the
observation or other blood, cardiac or neurological tests would be the actual diagnosis process of
the general nurse and the neurological nurses assigned for the patient. These assessments would
be possible if the person centered care would be implemented and with the help of this care
model the nurse would be able to determine the needs of the patient. In this case the nurse should
be able to converse with the patient and also try to ease his communication confusion in this way
the disorientation of the patient would also be lessened as well (Guan et al., 2015). However, the
whole process would be based on the knowledge and the approach of the nurse. The person
centered care would be implemented to the care process of Harold as his condition needs serious
attention and also he needs help in the regain process of consciousness. Thus on the basis of this

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discussion it can be pointed out that the actual diagnosis would be needed as the need of the
patient here is the proper medication administration along with the observation for the changes of
the patient’s health condition (Berre, 2019). Other than this the wellness diagnosis for the
patient’s discharge would be needed as the future medication administration and the daily life
style and dietary planning also needed for Harold. On the basis of the actual diagnosis the doctor
and the nurses would be able to assess the betterment or the deterioration of the patient’s
condition that is the time to time observation, clinical tests such as the blood tests, ECG, CT scan
and others. On the other hand the wellness diagnosis would help in devising the after discharge
observation, medication and the intervention for the patient (Pires et al., 2018).
Multidisciplinary team
Harold needs acute and person centered care for the betterment of his current condition.
His severe condition comprises of different aspects of neurological and the cardio logical
treatment and observation. After the cardiology registrar assessment she called the other medical
treatment unit in the treatment process. The multidisciplinary team of this treatment would be
comprised of stroke medical consultant, stroke unit nurse coordinator, stroke medical officer
along with the general nurse and the cardiology specialist as well. The members of this team
need to focus on the different aspect of the treatment of the patient and determine the different
problems of him as well. On the basis of the patient centered care the nurses should be observing
the patient in a routine basis and needs to device different GCS tests in order to find out the
patient’s condition and the consciousness level of the patient. Other than this the neurology
specialist and the coordinator should be focused on the treatment of the patient and finding the
changes of the patient by the effect of the treatment as well. The speech therapist and the

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physiotherapist would be needed in terms of the ease in the communication of the patient and
also help the patient as he lost the control over his right hand and the leg after the cerebral
vascular accident. This multidisciplinary team also needs the cardiac observation of the patient as
his angina rate and the heart condition is not in a good condition as well. The actual diagnosis
and the wellness diagnosis of the patient would be possible on the basis of the collaboration of
all the team members of this multidisciplinary team (Reeves, Pelone, Harrison, Goldman &
Zwarenstein, 2017).
Law and ethics of nursing
The following are the 8 ethical factors needed to be considered by a professional nurse in
Australia Nurses value quality nursing care for all people, Nurses value respect and kindness for
self and others, Nurses value the diversity of people, Nurses value access to quality nursing and
health care for all people, Nurses value informed decision-making, Nurses value a culture of
safety in nursing and health care, Nurses value ethical management of information and Nurses
value a socially, economically and ecologically sustainable environment promoting health and
wellbeing. Other than these the nursing standards also have stake in the nursing treatment
procedure which are the codes of conduct, standards for practice, and codes of ethics
(Nursingmidwiferyboard.gov.au, 2019). All these aspects needed to be incorporated in the factor
of the person centred care and also the nurses should follow the doctor’s consent as they do not
have the permission for the decision making on behalf of the patient or the family or the doctor
(Kangasniemi, Pakkanen & Korhonen, 2015). Other than these ethics and standards of nursing
the nurses should follow the Health Practitioner National Law regulation 2018 in terms of the
person centred care for the patient Harold (Ahpra.gov.au, 2019). With the consent of the

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legislative act and the proper nursing ethics the nurses should follow the doctor’s consent and
diagnose the Harold in terms of his acute condition. The nurses should be able to plan the care
policy of the patient and also plan the discharge policy for the patient with the proper context of
the diagnosis (Grace, 2017). In providing the person centred care the nurses should not break or
hamper any kind of ethical code of nursing and also the law of care as it would be punishable
concern (Cashin et al., 2017).
Conclusion
On the basis of the above discussion it can be concluded that the patient centered care
should be comprised of the proper diagnosis of the patient’s condition and also the proper
medication and the prioritization of the patient health factors. In the process of the diagnosis for
Harold the nurses should be able to diagnose the condition of the patient by the help of the actual
diagnosis and also plan the discharge plan of the patient on the basis of the wellness diagnosis.
Other than these factors the nurses should focus on the condition of the patient and follow the
doctor’s consent for the treatment procedure along with the ethical code of nursing and the
nursing standards. The nurse should also follow the nursing care law of the country in order to
provide a safe and positive care to the patient. However, all these factors need to be followed
along with the prioritization of the patient’s physical and mental condition. In this case Harold’s
condition would be stabilized with proper observation, tests and also proper medication process
which are the steps of the actual diagnosis process which would be most relevant diagnosis
method for this case.

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