Cerebrovascular accidents (CVA) are caused by hypertension mainly and in turn it causes many complications making handling the CVA patients particularly difficult. In this article, I will cover my reflective account on the patient and justify the actions that I took.
The Patient and the Events that Occurred
Mr. Nelson, a 66 year old male, had been suffering from hypertension for six years. He is married with two children and his wife is in geriatrics ward suffering from diabetes mellitus. The symptoms of the disease had been noted two weeks prior when he had had expressive aphasia. He had had sudden onset of headaches two days before. On arrival at the hospital, Mr. Nelson lost motor co-ordination or sensation on the right side of the trunk and limbs. These features indicated a CVA. Diagnostic tests had been done including a Carotid ultrasound, an echocardiogram, Electroencephalogram, CT scan of the head, and blood works for clotting disorders.
On my placement, I was supposed to ensure that the patient is adequately attended to so I entered the room to see how he was doing. The patient seemed distressed and angry. I introduced myself. The patient had difficulty in speaking. The patient complained of being neglected and being confined in the same place for a long time.
Before I could talk more to the patient, I measured his blood pressure. Measuring blood pressure in patients with CVA is essential and should be the first thing to be done. The patient was being managed for blood pressure and on this day it was slightly raised (190/115 mmHg). I gave the patient Labetolol IV 20mg over 2 minutes so that I could lower his blood pressure in preparation for tPA administration. (Allen, Ruggiero & Troutman, n.d.).
Since the patent could not speak clearly, I called the nurse that had been attending to him, Allison and together we went through his history to find out if he had had any recent surgery in the previous 14 days, any history of ICH, seizures, history of active internal bleeding, thrombocytopenia heparin administration in 48 hour or lumbar puncture. These factors are contraindicated in tissue plasminogen activator (tPA) administration as they could lead to serious bleeding. (Allen, et al. n.d.). We confirmed that they were all negative. Knowing the patients specific and early recognition of change is important in patient care. It is important to know the pattern of the changes and relevant history of a patient to provide good care that is timely and more effective. (Pipe, Buchda, Hansen & Martyn, 2005).
Having reduced his blood pressure and ensuring that the patient had no contraindications to tPA administration, I confirmed that the patient had signed the consent to be administered with the drug. I then did the necessary calculations to find the correct dosage according t the patient’s weight, double checked for the correct dose. (Allen, et al. n.d.).
I used Carper’s ways of knowing when I was attending to the patient. In the actions that I have mentioned, I used the empirical knowledge where I observed directly or indirectly to practice evidence based nursing practice by using parameters and measures that have been scientifically proven to work. It is also the Knowledge that has standards that can be replicated by various observers. I used the ethics knowledge when I was making the various decisions in his management. I made the decisions that were morally right and valuable to support the patient. I also made sure that the patient had signed the consent before administering tPA. (McKenna, Cutliffe & McKenna, 19 99).
While attending to the patient, I was also discussing some issues with him. I told him that I understand what he was going through since my father had the same problem when I was young. My father had died 6 moths later after he was diagnosed with CVA. I told him I know the pain that there is to be sick to the patient and the people around him. He then asked me if he was also going to die but I told him that the disease is not serious as it looks like. I told him that I have also seen many patients as I am studying who overcame the disease and went to further their professions and join their families. By doing this, I used personal knowledge to deal with the patient. Personal knowledge involves treating the patients in a subjective manner where the nurses become aware of themselves which constitutes using their own past experiences and good relations to those around them. (McKenna et al. 1999).
Though I was talking to the patient, he was frightened, angry and I could note that he was crying since nobody had come to visit him. I asked him who he really wanted to visit him and I offered to call him, and also explained that his wife was sick so she could not manage. From these observations, I could note that the situation had not been handled well and that may be more was required.
The patient was transferred to the male geriatrics ward because of his distress. This was in an effort to reduce the boredom that the patient had for staying in one place for long. Patients can be transferred when necessary to improve their health conditions by providing psychological support. The patient could also be transferred to the ward where necessary instruments were to help in management. (Phan, n.d.).
Feelings about the Patient
Looking at the distressed patient, who definitely has more to say but can’t due to aphasia, could not move one part of his body and whose CNS was in great danger, I was really merciful despite my training, and the fact that it reminded me of my father made me sad. But I tried all I could to be empathetic so that I could offer quality care. The nurse Allison who had been attending to this patient must have been merciful to since when she was going she told me to take good care of him and to be careful and I could see from her face that she was sad too. The patient’s wife too must have been distressed and angry since she was also sick and could not be there to support her husband.
Areas Enhanced by the Reflection on the Patient
Reflection of the patient has enhanced my use of Carper’s ways of knowing to understand the patient and hence provide more quality care. It has taught me more about CVA, its complications and causes and the proper course of action in its management and that of related conditions.
I need further development in practicing evidence based nursing especially in being up to date with the new findings in research. I also need to learn to understand the patient better so that even when he has communication problems so that I can handle similar situations better. I can do this by using the objectives that were set by the nursing evidence based practice conference which includes developing skills and knowledge in critically appraised topics, recognizing the knowledge gaps, searching and evaluating nursing and health science literature, using group discussions and I will develop a culture to self-perpetuate my self in seminars. (Pipe et al. 2005).
Evaluating the Development
I can evaluate the what I learn by being keen to see if I am handling the situations better, doing consultations, doing research and case studies to brush off any areas of incompetency.