Integrated Nursing Practice Case Study: Mr. Kwon's Assessment and Plan

This case study provides an integrated nursing practice analysis of Mr. Kwon, a 74-year-old patient with a history of hypertension, congestive heart failure, and type 2 diabetes, who presented with right-sided hemiparalysis, aphasia, and facial drooping following a probable left cerebrovascular accide...Read More

Integrated Nursing Practice
Student’s Name
Institutional Affiliations
Date

Integrated Nursing Practice
Analysis and interpretation of Mr. Kwon's Assessment Findings
The findings from the assessment of Mr. Kwon's condition are based on the
consequences of his lifestyle and the neural accident in the brain. The paralysis of the rights
of cerebral hemisphere resulted in aphasia and facial drooping. Some of the implication of the
right-sided hemiparalysis include stroke that has been shown to affect the majority of elderly
people (Baron et al., 2015). Some of the problems resulting from right-sided hemiparalysis
are normally common with stroke affecting one part of the brain. A critical analysis and
evaluation of the functions of different parts of the brain provide succinct information on how
Mr. Kwon's accident affected his physiological functions in the body. The left
cerebrovascular accident affected his speech and ability to understand language. The left side
of the brain is responsible for controlling the ability to understand language and speak
(Anderson, Malone, Shanahan & Manning, 2015). Oedema in the left cerebral hemisphere
resulted from the build-up of fluids after the accident.
A critical analysis and interpretation of Mr. Kwon’s assessment findings are also
pivotal in determining the relationship between the brain and normal physiological conditions
in his body. His body temperature is within the normal ranges of 36.5 to 37.5 degree Celsius.
Hypothalamus is performing well because it is the part that regulates body temperatures. His
heart rate of 98 beats per minute is within the normal range of 60-100 beats per minute;
therefore indicating that the incident did not affect the medulla. Mr. Kwon’s respiratory rate
is within the normal range of 12- 25 per minute. Mr. Kwon’s blood pressure is above the
normal ranges of 120/80mmHg- 139/89mmHg. The increase in blood pressure is attributed to
his history of hypertension and Type 2 Diabetes Mellitus. Hypertension and cognitive heart
failure increase the risks of developing high blood pressure in elderly patients. The saturation

of oxygen in Kwon’s red blood cells is normal, at 96% because the minimum value is 95%.
Despite his prolonged smoking and problem of congestive heart failure, the concentration of
oxygen in Mr. Kwon's blood is normal.
The Development of Inter-professional management and Care Plan for Mr. Kwon
Patients under acute care in hospitals require critical care from qualified and
registered nurses. Inter-professional management and care plan involve the participation of
all healthcare officers in the facility to promote patient care and health promotion. Mr.
Kwon's condition requires critical care from qualified and experienced registered nurses. The
management and care plan is pivotal in promoting patient experience in the healthcare facility
based on the expected outcomes. Fundamental ethical and legal components help in ensuring
patient-centered care and effective implementation of strategies used in health promotion.
According to nursing and medical standards, healthcare does not tolerate errors about ethics
(Bodenheimer & Pham, 2010). Ethical considerations and legal implications are pivotal in
developing appropriate and effective healthcare plan.
Ethical Values and Legal Implications in the Care Plan
Ethical considerations and legal implications are essential in promoting patient
experience based on the expected outcomes (Batras, Duff & Smith, 2016). The registered
nurses are obligated to ensure ethical values and legal implications to promote healthcare
delivery to Mr. Kwon and ensure effective recovery from his acute conditions. First, respect
Mr. Kwon’s dignity and ensure his privacy in the healthcare facility. The information from
Mr. Kwon's assessment should not be revealed to other people without his consent.
Respecting Mr. Kwon's dignity involves the ability to inform him of the proposed nursing
interventions and medications to be used in his treatment and care practices. Secondly,
maintain patient confidentiality by providing quality and patient-centered services in the

healthcare setting. Neglecting Mr. Kwon's needs leads to the breaching of patient
confidentiality in the facility; therefore, interfering with patient experience.
The third ethical and legal consideration is embracing cultural diversity in all nursing
practices. According to the practice standards established by the Nursing and Midwifery
Board of Australia (NMBA), all nurses are obligated to respect the diversity of all patient to
promote patient outcomes (Baum & Fisher, 2014). The ability to embrace diversity in the
facility depends on the personalities and experiences of the healthcare professions. Interaction
and collaboration between all healthcare professionals are important in ensuring that the
diversity of patients are taken into consideration. Mr. Kwon's is required to be cared for by
experienced professionals to promote his recovery from the critical condition. The healthcare
facility is required to create a diverse workforce; therefore, ensuring effective care services
provided to Mr. Kwon. The main legal implication is demonstrating appropriate practice
standards for promoting quality care and ethical conduct in the healthcare facility (Black et
al., 2010). All healthcare professionals are obligated to provide quality care through team-
based patient care.
Also, ensure integrity and honesty with Mr. Kwon’s family and other team members.
According to Evidence-Based Practice, honesty is the main ethical consideration that
improves patient experience in the healthcare setting. The inter-professional team members
are required to avoid disrespectful communication within the premises of their workplace
(Cleary, Hunt, Horsfall & Deacon, 2012). Lastly, professional competence is another
important legal implication and ethical consideration in all healthcare practices. Mr. Kwon's
condition requires a high level of professional competence to promote his recovery.
Person-Centred Care

The person-centred care is important for promoting patient experience and overall
healthcare outcomes in the facility (Cooper, Orrell & Bowden, 2010). This type of care is
recommended for use in the patient under critical conditions. Patient-centred care is also
important for caring Mr. Known in the case study because it also involves the incorporation
of ethical consideration in the healthcare setup. Patient-centred care involves various
components like the quality of healthcare services, patient safety interventions, and free
access to care services, integration/coordination of care, quality patient-nurse relationship,
and patient orientation. According to nursing research and Evidence-Based Practice, person-
centred care ensures that patient needs are taken into consideration. According to the
provisions of the person-centred care, the nurses are required to consider the opinions
provided Mr. Kwon’s family members about the type of services and nursing interventions to
be used for promoting his recovery from the medical condition.
Also, the person-centred care to be included in the plan should have an appropriate
conceptual that creates a clear connection between primary care and the joint principles for
nursing practice. Mr. Kwon is under critical conditions that require acute care from all
healthcare professionals. Person-centred care ensures superb access to health care services in
the facility. The second attribute of person-centred care the utilization of the available
information about healthcare practices and interventions for patients under acute care.
Publicly accessed information is used because due to their factuality and evidence developed
on their efficacies. The third attribute of person-centred care is the engagement of patients in
the implementation of care approaches. For example, asking Mr. Kwon simple questions
promotes quality care because the conversations are intended to improve his ability to speak
and promote recovery. Involving family members is also essential in Kwon's case because he
cannot speak to healthcare professionals. The last component attributed to the success of
person-centred care is patient feedback mechanism in the healthcare setting. Asking simple

and open-ended questions to Mr. Kwon enables him to respond by nodding with his head;
therefore, improving his recovery process.
Strategies for Health Promotion
The strategies established for promoting health have been recommended by various
medical and nursing organizations in the world. World Health Organization has also provided
a list of appropriate strategies to be used in health promotion (Delaney, Van Haren & Lopez,
2015). The determination of the efficacies of the strategies depends on the organizational
culture, professional competence experience, and condition of the patient under care services
in the facility. The strategies for acute care cases are described in this inter-professional and
managed care plan. According to the reports of the World Health Organization, health
promotion is an important program intended to foster wellbeing and appropriate health for
patients (Kobau et al., 2011). In this case study, the health promotion program requires
participation in alerting Mr. Kwon and his family members on the appropriate ways of
ensuring a healthy living. The participation of all healthcare professionals in the
implementation of strategies for promoting health status is important in ensuring effective
performances of the adopted interventions.
World Health Organization has proposed various strategies for promoting the health
status of the patients under acute care and the community. Evidence-Based Practice from
many case studies and research activities provide insightful information on the efficacy of
strategies used in health promotion. First, establish appropriate personal skills in the
healthcare facility. Skills are important in ensuring the desired professional competence;
therefore, promoting patient safety and satisfaction (Yanek et al., 2016). The skills are also
important in promoting patient safety and satisfaction because it reduces the chances of
medical errors in the healthcare facility (Kemppainen, Tossavainen & Turunen, 2013).

Interdisciplinary participation in the care of Mr. Kwon. The second strategy to be adopted
managing the condition and ensuring effective care services delivered to Mr. Kwon is
creating a conducive environment in the healthcare setting. A recovery environment should
be created for Mr. Kwon to ensure positive outcomes and early discharge planning. Thirdly,
ensure effective community action within and beyond the premises of the healthcare facility.
The fourth strategy for promoting Mr. Kwon’s health in the case study is reorienting
the health services in the facility. The reorientation of the services in the healthcare facility is
intended to promote recovery and satisfaction before the actual discharge (Sørensen, 2012).
The services to be delivered to Mr. Kwon should promote mental recovery and provide
appropriate interventions for preventing lifestyle conditions like hypertension, type 2
diabetes, and congestive heart failure. Lastly, establish appropriate health policies that
regulate the performances of all interdisciplinary practices in the healthcare facility. the
health policies also provide approaches used in the adoption of healthy lifestyles; therefore,
reducing the risks of developing conditions like hypertension, type 2 diabetes, and congestive
heart failure (Havens, Vasey, Gittell & LIN, 2010).
Discharge Plan Form for Mr. Kwon
Section A:
Facility: the Queen Elizabeth II Family Centre
Name: Mr. Sam Kwon
MRN: 684421
Gender: Male
D.O. B: 1945
Address: 668-010, Curtin

Ward: 004
Diagnosis:
i. Increased in the density of the cerebral artery and the left middle cerebral hemisphere.
ii. Immediate signs of oedema.
iii. homonymous hemianopia
iv. Body temperature- 36.8 degree Celsius
v. The heart rate of 98 beats per minute
vi. The rate of respiration- 24 per minute
vii. Blood pressure- 140/105mmHg
viii. SpO2- 96%
ix. BGL- 9.4 mmol/L.
EDD on admission: 14 days after admission
Name: Director of Clinical Services
Signature: XX
Time/date: 30th August, 2019
Part B: Patient Discharge Criteria
Agreed Milestones Name Designation Contact
The patient is
deemed during
admission
Director of Clinical
Services
DCS [phone]
The signing of the
eligibility of the
patient
Lead Medical
Consultant
LMC [phone]

Completion of
medications and
scripts
Nurse Manager NM [phone]
Discussion of the
discharge plan with
the patient and
family members.
Allied Health Staff AHS [phone]
Responsible person
1. Director of Clinical Services
2. Lead Medical Consultant
3. Nurse Manager
4. Allied Health Staff
Part C: Patient Criteria
The observations documented for patient criteria- Yes Name Senior Medical Clinician
Signature: XX
Completion of patient discharge checklist- Yes Name: Senior Medical Clinician
Signature: XX
Confirmation of completion of the parts in the patient discharge checklist has been achieved:
Name: Senior Medical Clinician Designation: SMC
Signature: XX Date/time: 30th August, 2019
Justification of the Discharge Plan
The appropriate discharge plan should be justified based on the evidenced provided in
the literature materials (Murdaugh, Parsons & Pender, 2018). Before completing all sections

of the checklist in the discharge plan, the patient's medical history should and current health
status must be assessed to prevent readmission to the healthcare facility. For example,
according to the case study, the history of congestive heart failure, type 2 diabetes, and
hypertension should be assessed to ensure that Mr. Kwon’s recovery process is appropriate as
expected by Senior Medical Clinician and nursing staff. The discharge milestones to be
applied in the process comprises of activities to be undertaken during homestay care to
promote effective recovery (Munoz-Price et al., 2010). Also, the milestone for discharging
Mr. Kwon should include the consideration and assessment of his abilities to speak and stand
without any support.
Conclusion
In conclusion, acute care provided to the patient under critical conditions requires
interdisciplinary participation in the healthcare facility. According to nursing research and
Evidence-Based Practice, person-centred care ensures that patient needs are taken into
consideration. Nursing and medical interventions are important in this case because person-
centred care requires the nurses to consider the opinions provided Mr. Kwon’s family
members about the type of services to be used promoting his recovery from the medical
condition. Documentation of discharge milestones is important in promoting patient safety
and satisfaction

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