Question

Patient Profile

J.K. 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. J.K. lives alone and holds a management position. She is concerned about her ability to return to work after her surgery.

J.K. returns from surgery to the neurosurgery unit drowsy but following commands. During the night J.K. 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.

Questions:

#1. 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?

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

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

Answer 1

There are a quite a few interventions to do with your patient experiencing unilateral neglect.

1.) Encouraging use of affected side. If they have enough movement in their affected hand to pick up and drop a wash cloth, consider making this an activity.

2.ANCHORING

Instruct the patient to scan to the affected side by providing visual cues like a bright post. It note or colored tape and train the patient to sacan using the mental imagery light house strategy looking all the way to the anchor and back. Sit at this patient affected side at all the time as well as this can help to cue the individual to look more towards their affected side.

3.VISUAL SCANING

In corporate visual sacaning activities like letter cancellation, work sheets or word finds, and even consider adding in vibration to the affected side during rest breaks to provide more sensory inputs.

5. EYE PATCH /PARTIAL VISUAL OCCLUSION

The technique uses standard eyeglasses that have half of both lenses taped or blacked out on the same side of each lens .This aids in training the person look through the side of the lens being ignored.

2). Nursing diagnosis may be part of nursing process and is a clinical judgement about individual, family or community experiences ,responses, to actual or potential health problems life process. The nursing diagnostic process is unique among others. Nursing diagnosis intergrates patient involvement when possible throught the process. Prioritization is done by the patient most important needs. Keep in mind that The care plan is a problem solving process so each nursing diagnosis is actually patient problem.

The hierarchy from most important as follows

1.physiological needs

2.safety and security needs

3.love and belonging needs self esteem needs

4.self actualization

3).can improve J. K health

* communicating clearly

* providing sufficient information

* notifying the appropriate health care provider about the patient condition including any changes in that condition

* Being polite and respectful

* Responding to other health care professionals.

Team members need to learn how to work together cooperatively. It is critical important for team members to share relevant information they possess concerning. The health care situation with all of the different members of their team. Even when team members are able to share their specialised knowledge effectively.