Nursing Case Study Analysis of Harold Blake

This paper discusses the nursing diagnosis, interventions, and priority-based care for Harold Blake, an 83-year-old patient with angina and cerebral vascular accident. It also identifies the multidisciplinary team involved in his healthcare improvement and the ethical and legal standards for his care process.

Running head: NURSING ASSIGNMENT
NURSING CASE STUDY ANALYSIS OF HAROLD BLAKE
Name of the student
Name of the university
Author note

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Introduction
While working with critically and terminally ill patients, it is important to implement
the priority based care so that with accurate categorisation of the care depending upon the
need of the patient, effective interventions could be applied (Papastavrou et al., 2014).
Priority based nursing care depending upon the needs and requirement of the patient also
helps the nursing professionals to comply with the patient/person centered care (Li & Porock,
2014). As mentioned by Kogan, Wilber and Mosqueda (2016), application of person centered
care helps the patients to be an effective part of the nursing process and allows them to
express their feelings, needs so that they could reflect on their own care process and develop
a self-awareness. This would help patients after their discharge from the healthcare facility
and with the help of the self-awareness and healthcare literacy achieved in care process, they
would be able to maintain the improvement in their health condition (American Geriatrics
Society, 2016).
In this paper, one such health condition of Harold Blake would be discussed who is 83
years old and has been admitted to the healthcare facility after an episode of angina and
cerebral vascular accident (CVA). However, on day 2, the patent has shown signs of
improvement and hence, a proper nursing diagnosis, nursing interventions and priority based
care should be provided so that effective care improve his healthcare condition.
Therefore, this paper would identify the primary nursing diagnosis so that with
identification of two nursing diagnosis process, the multidisciplinary that would be employed
for the effective care for the patient could be included. Besides these, the ethical and legal
standards for the application of such diagnosis and intervention strategy would also be
provided in the paper.

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Five sequential nursing process and nursing diagnosis of Harold Blake
According to Ball et al. (2014), nursing care plan is a strategy application of which in
care process helps to include the evidence based and standardised care in the holistic and
person centered as well as family centered care for the patients wellbeing and recovery. There
are five aspects of a nursing care plan that helps the nurses to categorise the care for the
maximum benefit of the patients. These are assessment, diagnosis, planning,
implementation and evaluation (Boersma et al., 2015). All these steps are interlinked with
each other as application of patient assessment helps to collect the patent data and symptoms
so that depending upon the vital signs and symptoms, accurate diagnosis interventions could
be applied in the care process (Ausserhofer et al., 2014). Further, with diagnosis, all the
information is collected and then a care plan is developed so that all the healthcare gaols
developed for the patients could be implemented and archived. In this case of Harold Blake,
application of five nursing process aspects would be done so that with the application of
effective care process, the patient could be provided with effective interventions for health
improvement (Ball et al., 2014).
It was seen on the day two that the Mr. Blake is drowsy, drooling and suffering from
difficulty of speech. Further, it was also observed by the healthcare professional that
compared to his state last night, he has lost his orientation of time, person as well as place.
This indicated towards the loss of reflexes and lack of self-care deficit as these aspects would
affect his activities of daily life. Further, if Mr. Blake’s past healthcare condition is observed
it could be said that angina and CVA are among the critical healthcare condition, recurrence
of which are among the primary risk for the patient. Besides this, his past occurrence of
Hypercholesterolemia and hypertension could also be adverse for his current health condition
due to which he should be provided with effective intervention or it would gradually decrease
his wellbeing. The third concern of patient that is observed in the care process is his

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incontinence and inability to perform activities of daily life such as hygiene and sanitary
actions and always requires a helping hand for cleaning and other purposes. Therefore, these
are the three primary aspects which could be collected and assessed after the application of
assessment.
As the above-mentioned aspects are found after patient assessment, the next step
should focus in the nursing diagnosis and hence, application of two type of diagnosis process
should be applied to comply with the person centered and priority based nursing care
(Sharma & Klocke, 2014). As per Komatsu and Yagasaki (2014) nursing care is the process
which helps the nursing professional to understand the degree and extent of the intervention
which could improve patient condition. In this Actual Diagnosis is the process that is
conducted so that all the current ailment of patient could be assessed and then depending
upon the defining symptoms, effective intervention could be applied in the care process of the
patient (Kotronoulas et al., 2014). On the other hand, the Wellness Diagnosis is the process
which is applied on the care process with the help of patient, their family and community
members to provide the patient with holistic care to increase their coping skills and spiritual
wellbeing (Komatsu & Yagasaki, 2014). Therefore, depending on these diagnosis process,
code stroke, GCS assessment and patient’s risk of fall would be assessed so that all the
critical aspects of his care could be addressed. As per the case study of Harold Blake, he has
suffered from Cerebro- vascular accident twice and due to his Hypercholesterolemia and
hypertension condition, his risk of myocardial infarction has increased. Therefore, it could
increase the patients stay in the healthcare facility. Therefore, assessment of code stroke
would help the nursing professionals associated with the care process to evaluate the care
process provided to the patient in healthcare facility. Hence, Kotronoulas et al. (2014)
mentioned that application of such assessment helps the nursing professionals to focus on the
critical aspect of the healthcare and provide holistic care to the patient. Further, in this aspect,

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the healthcare professionals should also include factors associated with myocardial infarction
and others so that the risk and severity of the risk could be understood (Kotronoulas et al.,
2014). Hence, the blood test for heart muscle cell damage, ECG and CT scan would be
conducted so that accurate results for the healthcare complication for the patient could be
assessed. This assessment would be the Actual Diagnosis process for Harold Blake.
Besides this, as the patient is improving his health condition and neurological
complications effectively, his future health improvement, his dignity and ability to perform
activity of daily life should be assessed (McGlynn, McDonald & Cassel, 2015). This is
because in person centred care, it is important to focus on the holistic approach of care to
manage both the physical and mental health of the patient. Hence, in this case, the Wellness
Diagnosis would be applied so that his self-confidence and self-care knowledge could be
increased with effective interventions. In this diagnosis his mobilisation ability, speech and
cognition level as well as his ability to perform critical activities would be assessed (Kakria,
Tripathi & Kitipawang, 2015). Further, as the patient has a catheter inserted to overcome his
incontinency of urination, he would be assessed for his ability to learn self-care and self-
hygiene abilities. Hence the GCS assessment, pain assessment and the Allen Cognitive Level
Screen (ACLS) would be applied in the care process of Harold Blake.
Therefore, these are the two diagnoses process that would be applied as per the five
nursing process. So that with assessment, diagnosis, planning, implementation and
evaluation, all the critical aspect of the patient could be addressed and then implemented in
his care process for improve of his health condition and reduce the hospital stay of the
patient.

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Identification of multidisciplinary team for the healthcare improvement of the patient
According to Weller, Boyd and Cumin (2014), multidisciplinary team is a group of
healthcare professionals that belongs to different healthcare disciplines such as dieticians,
nutritionists, psychiatrists and occupational therapists that helps to deliver specific care to
each patients. As per Owiti et al. (2014), these are the healthcare professionals that are
involved in the collaborative care of patient and to achieve that they also involve patient and
their families to comply with the person centered care. Therefore, in the care process for
critically or terminally ill patients application of multidisciplinary team could help to increase
patient’s ability to comply with the interventions as proper health education is provided to the
patient (Weller, Boyd & Cumin, 2014).
In this case study of Harold Blake, application of multidisciplinary team should be
inclusive of registered nursing professionals and pathologists so that all the diagnosis related
to Actual Diagnosis process could be conducted accurately (Owiti et al., 2014). Further, with
that the patient should be provided with a community nursing professional to provide hum
support for activities of daily life. Further a dietician or nutritionist would also be included as
the patient has a history of Hypercholesterolemia and the diet should be able to prevent the
occurrence of such risk factors that could lead to myocardial infarction in the patient (Kakria,
Tripathi & Kitipawang, 2015). To understand the mental concerns of the patient, a
psychiatrist would be included with a speech therapist and occupational therapist who would
help the patient with his weakness in hands and his inability to speak in affluent manner.
Hence, these are the healthcare professionals of occupational therapy that would be provided
to the patient so that he could develop self-care, self-confidence to overcome critical
healthcare conditions effectively (Weller, Boyd & Cumin, 2014).

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Key ethical and legal standards for the care process of Harold Blake
In this care process for Harold Blake all the nursing ethics and the nursing standards
should be implemented so that compliance with all the ethical and legal aspects could be
achieved. The ethical code of nursing professionals are associated with quality nursing care,
respect and kindness for the patient, and respect the diversity of the patient as well as quality
nursing access for each member of the society (Nursingmidwiferyboard.gov.au, 2019).
Therefore, application of these with providing the patient with self-care and health literacy
would help the patient with effective interventions. Further as mentioned in Ahpra.gov.au,
(2019), application of these ethical aspects would help the patient to trust the interventions
and he would be able to comply with the processes effectively. Besides this, application of
effective ethical consideration would help the patient with informed care so that an effective
and sustainable environment could be created for the healthcare process. Besides the ethical
standards, the nursing standard for effective care should also be included in the care process.
As mentioned in the legislative care and effectively plan the care policy for the patient so that
accurate care could be provided to the patient (Ahpra.gov.au, 2019). Hence, as per the ethical
and legal aspect of the care and intervention, both the effective legislative and ethical aspects
help to increase the patient’s ability to overcome his health complications. However, with
application of ethical and legal aspect in the care process would help the nursing
professionals to understand the extent of interventions that would be beneficial for her health
condition. Further, it will also help the nursing professionals to understand the discharge
intervention that should be achieved and it would only be possible after complying with the
discharge policy mentioned in the legal aspect of the nursing profession
(Nursingmidwiferyboard.gov.au, 2019).

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Conclusion
While concluding the paper, it should be mentioned that application of priority based
nursing and patient centered care are interconnected with each other. While providing care to
terminally ill patients, nursing professionals should provide the patient with the ability so that
they could take part in their own care process and develop understanding of their self-care so
that self-management. The case study mentioned that Mr. Harold Blake is the patient who is
suffering from critical healthcare conditions and hence application of nursing priorities
should be done so that all the critical aspect of his healthcare condition could be understood.
Further, with application of multidisciplinary team the patient was provided with a group of
healthcare professional that helped him to overcome his healthcare complications and
develop ethical and legal aspects for the effectiveness of his care process. Hence, this paper
was able to mention all the important aspect that is necessary to provide the patient with
effective care and wellbeing.

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