Enhancing Care for a Patient with Hemiplegia and Hemiparesis: SMART Goals and Recommendations

QUESTION

Situation

The patient is 51-year-old male is admitted for CVA. The residents admitted diagnosed hemiplegia and hemiparesis following cerebral infarction affecting the left non-dominant side.  He was brought to the rehab facility after having a hospital visit due to a brain blood clot that occurred at a bar while drinking with friends. Patient stated he experienced his hand moving on its own, without him making an effort to move it. Patient lives alone. He has no family around. He is allergic to NSAIDs. The patient is full and his diet is regular thin texture liquid. Patient has no prior surgery. The patient has behavior issues, appears to be easily agitated, and difficult to communicate with related to his care. The doctor requested that the patient’s blood sugar be checked frequently.
Background

Hypertension, protein calorie malnutrition, vitamin B12 deficiency, body mass index (BMI) 44.9 adult, muscle weakness (generalized) and chronic kidney disease stage three.

The residence has no prior surgery.

Objective data

current vital sign temp 97.5 F, Pulse 98, R 18, BP 130/88, O2 saturation, 97%, blood glucose 124, patient starting level is at 8/10 on a scale of 0/10. Patient creatinine level is high 1.9 mg/dL. Glasgow coma score 15, no facial drooping, good skin turgor. tremor on the right hand. Impaired mobility, Patient uses a 2 front wheel walker and cane. Patient appears not well groomed, redness on his lower abdomen.

Subjective data

Patient states he is allergic to NSAIDs, lives alone, and stated once he gets discharged, a caregiver will  help take care of him. The patient also mentions from time to time he has a sudden headache, loses balance and has an occasional accident in his underwear (loose stool).

Recommendation ?

Expected patient outcomes/goals for the shift written as SMART goals?

Specific

Measurable

Achievable

Relevant

Time-bound

ANSWER

Enhancing Care for a Patient with Hemiplegia and Hemiparesis: SMART Goals and Recommendations

Situation

The patient, a 51-year-old male, is admitted for cerebral infarction affecting the left non-dominant side, resulting in hemiplegia and hemiparesis. The patient has a history of hypertension, protein calorie malnutrition, vitamin B12 deficiency, high BMI, muscle weakness, and chronic kidney disease stage three. The patient is allergic to NSAIDs, lives alone, and has behavior issues.

Background

The patient’s vital signs and objective data are within acceptable ranges, except for a high creatinine level of 1.9 mg/dL. The patient’s subjective data includes occasional headaches, balance issues, and incontinence.

Recommendation

Dietary Management: Given the patient’s protein calorie malnutrition and high BMI, collaborate with a registered dietitian to develop a balanced, low-calorie, high-nutrient diet plan to address both issues.

Hydration and Kidney Function: Ensure the patient’s adequate fluid intake to support kidney function. Monitor fluid balance and creatinine levels closely.

Medication Review: Collaborate with the healthcare team to review the patient’s current medications and manage his pain effectively without NSAIDs to prevent allergic reactions.

Fall Prevention: Develop a personalized fall prevention plan including mobility exercises, balance training, and education on using assistive devices to enhance independence and reduce the risk of falls.

Expected Patient Outcomes/Goals for the Shift: SMART Goals

Specific: By the end of the shift, the patient will be able to safely transfer from bed to chair using a 2-wheel walker and cane with minimal assistance.

Measurable: The patient will be observed successfully completing three consecutive bed-to-chair transfers using the walker and cane, while maintaining balance and minimizing risk.

Achievable: Given the patient’s current functional level, he has the potential to achieve safe transfers with proper assistance and practice.

Relevant: Improving the patient’s mobility and ability to transfer safely aligns with his overall rehabilitation goals and enhances his quality of life.

Time-bound: This goal will be achieved within the shift, allowing the patient to practice the skill and become more independent in his mobility.

Conclusion

By addressing the patient’s nutritional status, kidney function, pain management, and fall prevention, the healthcare team can work together to enhance the patient’s overall well-being and functional abilities. The SMART goals set for the shift provide a clear framework for the nursing interventions that will be implemented to achieve these desired outcomes.