University Nursing Care Plan: Mrs. Waxman's Neurological Report

This report provides a detailed nursing care plan for Mrs. Waxman, a 31-year-old patient who sustained a head injury and is also dealing with gestational diabetes mellitus. The report begins with an admission summary, followed by a comprehensive analysis of her nursing care needs within the neurological ward. These needs include managing elevated blood glucose levels, addressing a low GCS score indicating reduced consciousness, and managing wound healing in her lower right leg. The plan also addresses the implications of gestational diabetes mellitus, its potential relation to her weight gain, and its impact on her condition. Finally, the report outlines the long-term physical, emotional, cognitive, behavioral, and family dynamic outcomes associated with her head injury, providing a holistic view of her care requirements and potential challenges. The report emphasizes the importance of proper nursing interventions and medical treatment for effective patient management.

Running head: NURSING CARE PLAN
Nursing Care Plan
Name of the Student
Name of the University
Author Note

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Table of Contents
Introduction................................................................................................................................2
Part One......................................................................................................................................3
Admission Summary..............................................................................................................3
Part Two.....................................................................................................................................4
Nursing Care Needs...............................................................................................................4
Part Three.................................................................................................................................10
Gestational Diabetes Mellitus..............................................................................................10
Part Four...................................................................................................................................12
Long Term Outcomes in Relation to Head Injury...............................................................12
Physical............................................................................................................................12
Emotional.........................................................................................................................12
Cognitive..........................................................................................................................12
Behavioural......................................................................................................................13
Family Dynamics.............................................................................................................13
Conclusion................................................................................................................................14
References................................................................................................................................15

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Introduction
Head injury is complex injury with a wide spectrum of disabilities and symptoms. The
impact of head injury on person and his or family is devastating (Hou et al., 2012). Mrs
Waxman is a 31 year working lady who has recently encountered a traumatic head, neck and
leg injury. The following reprt provides a clear insight about the admission summary of Mrs
Waxman followed by a detailing analysis of the nursing care needs of Mrs Waxman while
her stay in the neurological ward. The report also sheds light on the consequences of
gestational diabetes mellitus and its relation with Mrs Waxman gain in weight, who is also a
mother of three young children. Finally he report sums up with the long-term outcomes of
brain injury in context of Mrs Waxman.

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Part One
Admission Summary
Mrs Mary Waxman is 31 years old women. She is an orthodox Jew and works as
computer system analyst, managing the Australian branch. She has slipped from the top of
the escalator. This accidental fall has resulted in major head injury along with damage of the
soft tissues around her neck. She has also encountered grazes and lacerations over her arms
and legs along with a deep wound in her lower right leg. Following her fatal injuries, she was
admitted to Intensive Care Unit. After 48 hours, she was shifted to the neurological ward. She
was unconscious and was having intravenous line along with nasogastric tube and urinary
catheter in an in situ condition.

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Part Two
Nursing Care Needs
1. Elevated Level of Glucose
Mrs. Waxman is diagnosed with elevated level of glucose with 25mmole/L. [Normal blood
glucose level should be less than 6.9 mmole/L in non-fasting condition (Karlsson et al.,
2013)].
Nursing Diagnosis
1. Deficient Fluid Volume: This is majorly associated with imbalance in body weight,
either gain or sudden loss in weight (Bray & Popkin, 2014). In case of Mrs Waxman,
it is gain in weight, over 20 kilos in the past 12 months. It is also associated with
imbalance in urine output (>30mls/hour)
2. Imbalance in the level of nutrition: Doctors has recommended for the insertion of
Naso Gastric Tube for the introduction of equilibrium level of nutrition and this
shows that Mrs Waxman is suffering from deficiency in nutritional level which is
common is such clinical condition and also a sign of diabetes (Testa, Genovese &
Ceriello, 2014).
Expected Outcome
Proper monitoring of the body weight and nutritional intake and this will aid in the
secretion and synthesis of insulin the blood along with glucose metabolism.
Nursing Intervention Rationale
Proper reference to dietician for obtaining an Individualised diet plan depends on the body

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individualised diet instructions weight, BMR, body type, activity level and
specific clinical outcomes (Evert et al., 2014). In
case of Mrs Waxman, her physical activity is zero
at the present clinical scenario and thus her diet
plan must be regulated accordingly.
Periodic monitoring of the blood glucose level Periodic monitoring of the blood glucose level
(BGL) is important for a patient suffering from
high level of blood glucose; it gives an insight of
the current scenario and helps in adjusting the
insulin intake accordingly (American Diabetes
Association, 2014). In case of Mrs Waxman,
doctors has instructed for BGL monitoring after
every 6 hours for the next 24 hours in the
neurological ward.
Administration of Insulin Subcutaneous administration of insulin helps in
the reduction of the insulin level in blood as it
promotes insulin absorption into the cells
(American Diabetes Association, 2014).
Evaluation method
The evaluation method will be based on the BGL and how the patient is responding to
the nutritional intake and insulin.
2. Low GCS (Glasgow Coma Scale) Score

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Mrs Waxman, on the admission to the neurological ward from intensive care unitwas
unconscious and was not responding to the painful stimuli. The GCS score 10. However, the
pupils are intact and reacting upon exposure to light.
GCS scale is based on 15 point scale that is required for estimating and simultaneously
categorising the possible outcomes on the brain injury.
(Source: Ramirez, Rom & Persidsky, 2013)
Nursing Diagnosis
Risk of injury responsible for the decreased level of consciousness: In case of Mrs
Waxman, the injury which has attributed to unconsciousness is head injury (Wilkinsonet al.,
2016).

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Disturbed Sensory Perception in response to severe Neurological Impairment:
Neurological impairment is a chance in case of Mrs Waxman as she has encountered severe
brain injury followed by injury in the soft tissues of the lying over the neck (Wilkinsonet al.,
2016).
Her Glass Glow Coma Scale Reported 10, which means, her GCS score is moderate.
This moderated GCS is attributed to lack of consciousness (LOC) for 30 to 24 hours along
with Post Traumatic Amnesia for 1 to 7 days. In case of Mrs Waxman PTA is 48 hours (till
now).
(Source: Ramirez, Rom & Persidsky, 2013)
Expected Outcome
Proper Nursing care will help Mrs Waxman to score 15 in GCS.
Nursing Intervention Rationale Evaluation

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Protecting the patient from
encountering any further
accidental injuries while stay in
the hospital
Unconscious patient lies at an
increased risk of encountering
physical injuries and hence
protection must be given in order
to avoid the chances of accidents
(Kandeel & Attia, 2013)
Installation of padded side
rails in both sides of the
hospital bed will prevent the
chance of unwanted fall
(Kandeel & Attia, 2013)
Proper maintenance of the fluid
as well as the nutrient balance
Unconscious patient in the
majority of time is physically
unfit for the oral intake of food.
Mrs Waxman has injuries to the
soft tissues of the neck and thus
she need proper fluid support in
order to maintain her fluid
balance (Hannon, Finucane,
Sherlock, Agha & Thompson,
2012)
Insertion of Nasogastric
Tube in order to maintain
the nutrient balance along
with regular blood test for
the detection of the macro
and micro nutrient level
along with total protein
count (Hannon et al., 2012)
Prevention of urinary retention Lack of urine excretion from the
body will lead to the increase in
the level of toxic urea inside the
body which ultimately increases
the concentration of ammonia.
Proper clearance of urine is must
for the eradication of toxic
materials from the body fluid
(Weiner, Mitch & Sands, 2015)
Measuring hourly urine
output along with regulating
proper urine intake (Weiner
et al., 2015)

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3. Problem in wound healing in lower right leg
Mrs Waxman is facing difficulty in wound in her lower right leg with purulent discharge.
Nursing Diagnosis Expected Outcome
Proper access of the site of impaired tissue
integrity
Redness and swelling of the area, along with pain
and burning indication these are the signs of
inflammation and hypersensitivity reaction
(Carpenito-Moyet, 2006)
Assess any physiological change in the body like
increase in body temperature
Fever is regarded as an systemic manifestation
inflammation and also an indication for infection
(Carpenito-Moyet, 2006)
Nursing Intervention Rationale
Proper monitoring of the site of injury for
accessing tissue injury
Proper yet systematic intervention aids in early
identification of the impending problems
(Carpenito-Moyet, 2006)
Maintenance of sterile dressing technique Sterile dressing technique helps in the reduction
of chances of infection (Carpenito-Moyet, 2006)

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Part Three
Gestational Diabetes Mellitus
Pregnancy may results in the development of insulin resistance that predispose
women to acquire diabetes mellitus. Gestational Diabetes Mellitus (GDM) is manifested
when the pancreatic function of a pregnant woman fails to overcome the diabetogenic
environment, common during pregnancy (Coustan, 2013). GDM can also defined as a
condition related with glucose intolerance and its susceptibility increases if the excepting
mother is previously suffering from Type 2 Diabetes Mellitus. During pregnancy, alteration
of growth hormone, lactogen secretion from the human placenta negatively affects the
process of glucose metabolism and on the other hand, promotes lipolysis, increases insulin
secretion and decreases glucose uptake. All these physiological factors disrupt the normal
balance of insulin modulation, giving rise to GDM (Coustan, 2013). During pregnancy, there
also occurs a large change in the hormonal activity, mostly estrogen and progesterone and
this sudden change in the hormonal secretion disrupts the equilibrium between glucose and
insulin secretion, further increasing the chances of developing GDM. The risk factors which
are associated with GDM are polycystic ovary, obesity and pregnancy related hypertension
(Coustan, 2013).
Pathology in Relation to Patient
The chances of GDM increase with the prevalence of Type 2 Diabetes Mellitus
(Erem, Kuzu, Deger & Can, 2015). Long working hours of Mrs Waxman accompanied with
active corporate socialization may have promoted her susceptibility towards development of
Type 2 Diabetes Mellitus. This Type 2 Diabetes has further promoted the susceptibility of
GDM. Since, Mrs Waxman is survived by three young children, the rate of susceptibility can

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be assumed to be more. The chances of development of GDM, may be responsible behind her
weight gain (20 kg in the past 12 months) and now increase in the blood glucose level (25
mmole/L) (Erem et al., 2015). [Normal blood glucose level should be less than 6.9 mmole/L
in non-fasting condition (Karlsson et al., 2013)].

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Part Four
Long Term Outcomes in Relation to Head Injury
Physical
Brain function of Mrs Waxman can be temporarily impaired the condition is
commonly known as concussion (Hou et al., 2012). In long term outcomes, head injury can
lead to headaches, dizziness, depression, fatigue irritability along with memory problems.
Complex long term problems include change in personality, change in the dimension of
relationship and difficulty in leading an independent life (Ponsford et al., 2014).
Emotional
Brain injury can change the psychological balance of a person. In case of Mrs
Waxman, the long term outcomes include mood swings, difficulty in controlling emotions. In
some extreme cases, traumatic brain injury may result in sudden episodes of crying or
laughter, without any significant reasons. Emotional expression may at times fail to match
with the situation, like crying during a funny situation or vice versa (Washington et al.,
2012).
Cognitive
The cognitive outcome after traumatic brain injury may include difficulty in attention
or issues with maintaining sound concentration. Problems associated with speech, language,
learning and memory (Washington et al., 2012). Mrs Waxman may also face problem on
carrying out long conversation with people. This may inversely affect her carrier as active
socialization is an important aspect for her corporate life.

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Behavioural
The behavioural problems will be somewhat related with the cognitive problems like
mood swings (Washington et al., 2012). Moreover, due to her physical injury in leg, Mrs
Waxman may need to spend a couple of months in a complete bed rest condition. This
sedentary life will affect Mrs Waxman negatively giving rise to depression and this
depression will lead to irritability, or helplessness.
Family Dynamics
Change in family dynamic may occur as due to brain injury, Mrs Waxman may fail to
connect emotionally with her children and husband (Washington et al., 2012)..

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Conclusion
Thus from the above discussion, it can be concluded that, the aftermath and the
sufferings of head injury are wide stretch. Proper nursing intervention along with effective
medical treatment is the only way out to treat this problem.

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References
American Diabetes Association. (2014). Diagnosis and classification of diabetes
mellitus. Diabetes care, 37(Supplement 1), S81-S90. https://doi.org/10.2337/dc14-
S081
American Diabetes Association. (2014). Standards of medical care in diabetes—
2014. Diabetes care, 37(Supplement 1), S14-S80. https://doi.org/10.2337/dc14-S014
Bray, G. A., & Popkin, B. M. (2014). Dietary sugar and body weight: Have we reached a
crisis in the epidemic of obesity and diabetes?. Diabetes care, 37(4), 950-956.
https://doi.org/10.2337/dc13-2085
Carpenito-Moyet, L. J. (Ed.). (2006). Nursing diagnosis: Application to clinical practice.
Lippincott Williams & Wilkins.
Coustan, D. R. (2013). Gestational diabetes mellitus. Clinical chemistry, 59(9), 1310-1321.
doi: 10.1373/clinchem.2013.203331
Erem, C., Kuzu, U. B., Deger, O., & Can, G. (2015). Prevalence of gestational diabetes
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Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., ...
& Yancy, W. S. (2014). Nutrition therapy recommendations for the management of
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https://doi.org/10.2337/dc14-S120
Hannon, M. J., Finucane, F. M., Sherlock, M., Agha, A., & Thompson, C. J. (2012).
Disorders of water homeostasis in neurosurgical patients. The Journal of Clinical

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Hou, R., Moss-Morris, R., Peveler, R., Mogg, K., Bradley, B. P., & Belli, A. (2012). When a
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(2014). Longitudinal follow-up of patients with traumatic brain injury: outcome at
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Ramirez, S. H., Rom, S., & Persidsky, Y. (2013). U.S. Patent Application No. 14/406,400.
Testa, R., Genovese, S., & Ceriello, A. (2014). Nutritional imbalances linking cellular
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