Question

Patient Profile

E.J. is a 57-yr-old white woman who was is referred to the neurosurgery service for management of her temporal-parietal glioblastoma. She was diagnosed after presenting with persistent headaches, a seizure in her HCP's office, and left side upper visual field loss and neglect. Her MRI/MRA demonstrated a temporal-parietal glioblastoma that extends into the occipital lobes. She is scheduled for surgery to debulk the tumor. E.J. lives alone and holds a management position. She is concerned about her ability to return to work after her surgery.

E.J. returns from surgery to the neurosurgery unit drowsy but following commands. During the night E.J. is noted to have a pronator drift of the left arm, her pupils are equal and respond to light, but she has also developed left-sided weakness of both arm and leg and difficulty with answering questions.

Medications: dexamethasone 4 mg q6hr, famotidine, metoclopramide, ondansetron (Zofran), codeine, and levetiracetam (Keppra) since her admitting seizure.

Subjective Data

• Left arm and leg are weak and feel numb
• She is trying to answer questions but looks confused and cannot follow commands.

Objective Data

• BP 150/90 mm Hg
• right gaze preference
• Left homonymous hemianopsia
• Left arm weakness (3/5) greater than leg weakness (4/5)
• Decreased sensation on both left arm and leg
• Has speech but not clear. Difficulty with word finding and following commands
• A diagnostic CT scan demonstrates a hemorrhagic stroke into the site of the tumor bed, and temporal-parietal and anterior occipital areas extending into the thalamus.

What are the priority nursing interventions and decisions that have to be made regarding safety and self-care related to the left neglect and visual field cut?

Based on the assessment data provided, what are the priority nursing diagnoses?

How can you work together with the interprofessional team to develop and implement strategies to improve communication for E.J.?

Answer 1

#. The priority nursing interventions and decisions that have to be made regarding safety and self-care related to the left neglect and visual field cut are :-

- Don't keep any article on the left side of the patient

- Dont leave the patient alone

- Keep all objects to the right

- Make efforts from the right side than putting stress on left

- Keep the side rails up always

- Proper provision of light

- Emergency call bell to the right side of the patient

#. The interprofessional team includes speech therapist , physiotherapist , nurse , physician ,and dietician . All these health workers have to make strategies with the goal to improve the communication of the patient. Each one have their own specific purpose and by the collage of every function the patient would be able to communicate . Some of the strategies :-

- Use of lipsing

- Use of images and photos of near ones to accerlate the patient to speak

- Physiotherapy of the mouth and jaw muscles

- Speech therapy