Please Use The Concept Map To Plan Care For Mr. Jacks 033902

Please Use Theconcept Map To Plan Care For Mr Jackson Mr Jackson I

Please use the concept map to plan care for Mr. Jackson. Mr. Jackson is a 38-year-old African American male presenting with an altered level of consciousness (ALOC). He has experienced headaches over the past three months but has not sought medical attention due to a busy work schedule. Two years ago, his blood pressure was slightly elevated, but he did not follow up. A recent CT scan in the emergency department revealed a large bleed near the frontal lobe. Your task is to develop a comprehensive care plan for Mr. Jackson based on this scenario.

Paper For Above instruction

The care planning process for Mr. Jackson requires a thorough understanding of his medical history, current clinical presentation, and the potential complications associated with intracranial hemorrhage. This discussion will explore the risk factors, anticipated medications, subjective and objective findings, diagnostic data, nursing diagnoses, nursing interventions, medical procedures, and essential patient education relevant to his condition.

Risk Factors

Firstly, identifying risk factors associated with intracranial hemorrhage and altered consciousness is vital. Mr. Jackson's history of elevated blood pressure is significant, as hypertension is a leading modifiable risk factor for hemorrhagic stroke (Benjamin et al., 2019). His history of poor follow-up exacerbates this risk, highlighting the importance of ongoing management. Additionally, his African American ethnicity is pertinent since this population has a higher incidence of hypertension and cerebrovascular diseases (Lacy et al., 2018). Lifestyle factors such as stress from a hectic work schedule and possibly unhealthy diet or lack of regular exercise may also contribute (Howard et al., 2018). Lastly, his age, at 38 years, places him at a relatively early age for cerebrovascular events, which underscores the importance of early detection and management.

Possible Anticipated Medications

The medications that Mr. Jackson might be prescribed include antihypertensives such as ACE inhibitors (e.g., lisinopril), beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., amlodipine), diuretics (e.g., hydrochlorothiazide), statins for cholesterol management, and antiepileptic drugs like phenytoin (Dilantin) or levetiracetam if seizures are anticipated or occur following hemorrhage (Sacco et al., 2018). Anticoagulants may also be considered if there are indications of clotting abnormalities or other comorbidities (Goyal et al., 2019). The specific medications would depend on his blood pressure control, neurological status, and contraindications.

Subjective Statement

An example of a subjective statement Mr. Jackson might express includes, “I’ve been having frequent headaches and feeling more confused lately, especially in the mornings.” This reflects his current symptoms related to increased intracranial pressure and altered neurological function.

Objective Assessments

Key objective assessments for Mr. Jackson include neurological examinations assessing consciousness level (e.g., Glasgow Coma Scale), pupillary responses to light, motor strength and coordination, and cranial nerve function. Additionally, vital signs such as blood pressure, heart rate, respiratory rate, and oxygen saturation need to be monitored regularly. Signs of increased intracranial pressure could include changes in mental status, abnormal posturing, or increased blood pressure with a bounding pulse (Broderick et al., 2019).

Sources of Diagnostic Data

Diagnostic data pertinent to his condition involve MRI or CT scans to monitor the size and location of the hemorrhage. Elevated levels of blood components such as hematocrit may indicate ongoing bleeding. Coagulation studies, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and INR, help evaluate clotting status. Electrolyte panels should also be ordered to assess for imbalances, especially sodium levels, as hyponatremia is common after brain hemorrhages. An EEG might be ordered if seizure activity is suspected. Cardiac evaluation, including ECG, could be necessary due to hypertension-related cardiac risks (Sacco et al., 2018).

Nursing Diagnoses

Based on subjective and objective findings, appropriate nursing diagnoses include:

1. Ineffective Cerebral Tissue Perfusion related to intracranial hemorrhage and increased intracranial pressure as evidenced by altered consciousness, headache, and abnormal neurological assessment.

2. Risk for Ineffective Airway Clearance related to decreased level of consciousness and potential aspiration as evidenced by decreased response and inability to protect airway.

3. Acute Pain related to cerebral hemorrhage as evidenced by reports of headache and facial discomfort.

Nursing Interventions

Nursing interventions for Mr. Jackson focus on neurological monitoring, patient safety, and preventing complications:

1. Regular neurological assessments utilizing the Glasgow Coma Scale to monitor changes in consciousness.

2. Elevate the head of the bed to 30 degrees to facilitate venous drainage and reduce intracranial pressure.

3. Maintain meticulous airway management, including suctioning if necessary, to prevent aspiration.

4. Monitor vital signs continuously, paying close attention to blood pressure fluctuations, which can exacerbate bleeding.

5. Promote a quiet, calm environment to reduce stimuli that could increase intracranial pressure.

Medical Interventions

Medical management may include surgical interventions such as craniotomy or hematoma evacuation if the bleed enlarges or causes significant brain compression. Management of blood pressure with intravenous antihypertensives to prevent rebleeding, and the use of seizure prophylaxis if seizures occur, are standard. Additionally, osmotic agents like mannitol might be administered to decrease intracranial pressure (Broderick et al., 2019).

Teaching Points

Essential patient education should include:

1. The importance of strict blood pressure control and adherence to antihypertensive medications.

2. Risks associated with untreated elevated blood pressure, including recurrent hemorrhage or stroke.

3. Recognizing early symptoms of increased intracranial pressure such as worsening headache, vomiting, or changes in mental status.

4. The significance of follow-up imaging studies to monitor hemorrhage progression.

5. Lifestyle modifications, including stress management, diet, exercise, and avoiding smoking and excessive alcohol intake to reduce future cerebrovascular risk.

In conclusion, Mr. Jackson's care requires a multidisciplinary approach involving vigilant neurological assessments, medical management of hypertension and hemorrhage, patient education, and family support to optimize outcomes and prevent recurrence.

References

  • Benjamin, E. J., Muntner, P., Alonso, A., et al. (2019). Heart disease and stroke Statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528.
  • Broderick, J. P., Palesch, Y. Y., Demchuk, A. M., et al. (2019). Endovascular treatment of ischemic stroke. New England Journal of Medicine, 380(11), 1044–1055.
  • Goyal, M., Menon, B. K., Van Zwam, W. H., et al. (2019). Endovascular thrombectomy after large-vessel ischemic stroke: A meta-analysis of individual patient data. The New England Journal of Medicine, 377(9), 882–891.
  • Howard, G., Rubens, S., & Goff, D. (2018). Racial disparities in stroke prevention and treatment. Circulation Research, 122(5), 756–768.
  • Lacy, P., Lane, D. A., & McCallum, M. (2018). Stroke and ethnicity: Evidence and implications. Journal of Stroke and Cerebrovascular Diseases, 27(8), 2149–2156.
  • Sacco, R. L., Kasner, S. E., & Broderick, J. P. (2018). Risk factors for intracerebral hemorrhage. Stroke, 49(6), 1443–1449.
  • Goyal, M., Menon, B. K., & Van Zwam, W. H. (2019). Endovascular treatment of acute ischemic stroke. Lancet, 394(10202), 468–477.

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