William King Case Analysis

Critically examine one issue of the care of the Adult in the Summative learning “Trigger” Case Study

The trigger case scenario introduces us to William King and His family, who is brought to the hospital after suffering a stroke and is being cared for in the Acute Care Unit.  William is being observed by the nurse and the multidisciplinary team who assess his condition.   According to the physiotherapist, William is not able to walk well but is able to sit upright. There is a weakness in his right arm, leg, and facial droop. He does not stop to knock over things in his locker, which is also indicated by abrasions in his right arm. From the nurse’s report, William has not had bowel action and experiences urinary incontinence. Also, using the Dysphagia screening tool for nurses, it was reported that William was able to drip sips of water from a glass. He, however, did it slowly and looked so tired. In regard to meals, William has only been able to eat small portions showing a problem with appetite. He has difficulty paying attention and speaks slurry and has aphasia where he, at times, uses wrong words and just gives up and only nods (Perry, Hamilton, Williams, & Dhami, 2008).  There was some difficulty in understanding William and whether his nods meant to agree or disagree. He, however, communicates on decision directions.  The nurse, however, adds that William's emotional status is distressful, he lives with his daughter and is divorced by his wife, and he is very emotional. There is a sense of hopelessness in William, which can be assessed from his physical and non-verbal communication (Kröber, 2016). As much as William is told, he will be in an acute stroke unit; his son still asks to see someone.

William Shows signs that indicate he is having a mental health issue, which is related to the emotional impact of having a stroke. I will thus explore the emotional impacts of having a stroke, mental health challenges, the immediate problems, and needs, and will also look at the role of the multidisciplinary team and nurses in the mental health assessment for his current needs.

A stroke is a medical condition that occurs when the blood supply to the part of the human brain is reduced or interrupted, thus depriving the brain tissue with much-needed nutrients and oxygen; when this happens, the brain cells will be dying within minutes. After a stroke, not only the aspects of the brain will be affected, but the individual’s social interactions as well, this will, however, depend on the part of the brain that was damaged.  The recency of the Stroke is also another issue that will vary with memory or thinking.  In most cases like that of William, most will have difficulties in remembering their day to day activities or people’s names and faces (Carod-Artal, 2010).  Some, like in the case of William, will find it difficult to coordinate instructions, which calls for them to begin re-learning new techniques or use other assisting devices. Others will take time to solve simple problems; they will have a difficult time reasoning and will need additional guidance.  

All the above will contribute to a lot of emotional changes since the Stroke has impacted the brain, and the brain is responsible for controlling and processing human behavior. William is experiencing a feeling of confusion, forgetfulness, and irritability due to his difficulty in using his legs and arms.  Emotional liability will also entail the loss of control over emotional expressions like crying or laughter (Carod-Artal, 2010). With the physical changes in the brain, this destroys or interferes with the way he would normally control his emotions. In most cases, when a person suffers a stroke, they will depict mixed emotions; at times, one may see them crying or laughing uncontrollably for no reason, and they may not be able to control it. This is even more depressing when family and friends misinterpret these mixed emotions and attempt to console or scold them in this regard.  It is important for the care system to understand that it is a result of the Stroke that they undergo these emotional challenges.  

The emotional impact will also depict itself when the patient experiences reduced motivation due to physical impairment that does not allow them to perform simple tasks without aid.  The issues are as a direct result of the brain changes. With the mild problems of motivation, the patient will appear to be apathetic as he adequately carries normal tasks (Carod-Artal, 2010). In very severe cases, they will not be able to do any task, and family or people around them may seem disinterested in them, which leads to a state of depression, among other mental health challenges.

Evidence-Based practice shows that incidences of Stroke will often increase sharply as the individual continues to age, after the age of 55 and above, the Emotional impacts will continue to worsen, where he will have several episodes of anxiety, worthlessness, and depression with the increase with the doubling of the stroke incidence.  According to recent studies both in Europe and the united states,  about 70% of patients with Stroke that are older than 65 years and those that are at the median age all fell at the age of 73 (Atalu, 2019). The increased challenges in life expectancy and the advancement in medical management has seen most of the elderly individuals surviving the situation.  

However, when looking at the physical and the psychological aspects that are as a result of the Stroke, continue to become devastating, most patients like Mr. King will begin to experience serious mental health challenges leading to post-stroke depression. This is one of the most unresolved issues when it comes to the recovery of the individual in that situation, calling for the rehabilitation of these patients.  As a matter of fact, post-stroke depression is usually thought to be among the common neuropsychiatric challenges of Stroke. In any, the emotional impacts are going to depict itself directly or indirectly to more other forms of impairments of the daily activities that call for a much more careful institutionalization and services of the patient suffering from Stroke (Atalu, 2019).  

For William King, being 85 years and above emotional aspects will be much more  challenging  and  the deterioration of his cognitive function and the increased complications of his medical condition means that it is going to highly influence  the speedy recovery of his current situation  including the level of residual function during the rehabilitation moments (Kröber, 2016).  Other issues that he is bound to experience will include high costs of healthcare in regard to most of the main problems that are related to the elderly stroke patients, which looks at ways one can identify and manage post-traumatic stress disorder. 

It is thus good to assess his mental health capacity to determine whether he is likely to develop most stroke depression and take on the major steps. According to the mental health Act, there are five steps as defined in the following diagram:

According to the first principle, during acute care, it should not be assumed that Mr. King is not able to make his own decisions based on the fact that he has recently suffered a stroke or that he is depicting emotional challenges.  In the second principle, it is important for the multidisciplinary team to ensure that every effort is made to encourage and support Mr. King in decision making regarding his treatment and care plans.  In the event that Mr. King is unable to do so himself, it is still required that he is involved to the highest level he can in making decisions about his health (Umccoventry, 2019).  The third principles emphasize the second principle by insisting that the patient should be allowed to make decisions even when they are a time though to be eccentric; this is because every individual has their value, beliefs, and choices, which may be unique to others.  It is important that Mr. King is not treated as not being mentally capable of doing so. As a part of the principle, the fourth states that anything is done for or on behalf of Mr. King in the event that he is not able to decide should be done in his best interest (Umccoventry, 2019).  The last principle adds that when anything is done to or for Mr. King in the event that he is incapacitated to do so, it should also not interfere with his fundamental rights and freedoms.  

The Mental capacity Act is important in making action plans and should also consider other aspects like the high cost of treatment, reduction of the social abilities, and the increase in vascular-related events, which, if not monitored and controlled, could eventually mean death for Mr. William.  One of the major challenges however posted by someone like Mr. William are the mechanisms he can use to identify and be in a position to manage emotional aspects of depression, this is even more common among elderly groups like William than young people under 55 years (Kröber, 2016) (Theofanidis, 2016). It is important, thus, to understand from the healthcare specialists observations the symptoms, diagnosis, and management of mental issues that are related to Emotional aspects. 

Also, the emotional impacts can be approached from the interviewer-administered self-completed case of depression, or the nurse can also make use of the screening instrument, which is also used in the study of mental problems caused by Stroke. Among them are the nine-item patient health questionnaire, the hospital anxiety and depression scale, the center of epidemiological studies depression scale the beck depression inventory, or the Montgomery-amber depression scale.  During this approach, the nurse will look at the level of PSD from a scale of 5 to 67%. There is, however, a lot of variations when it comes to different study settings since the Post Stroke Depression will look at different methods that can be used in the diagnosis. In general, when it comes to the prevalence of major depression, it is possible that with the right therapy, this can reduce with time.  

The role of the multidisciplinary team and nurses in the mental health assessment

As discussed above, Stroke impacts the brain, which controls human behavior and emotions; the patient will experience forgetfulness, irritability, confusion, and carelessness. All these lead to anger, anxiety, and depression.   The mental capacity assessment will thus look at the emotional impact of Stroke to Mr. King and whether this is likely to develop in to Post Stroke Depression; This is a mental condition where the stroke patient finds it difficult to control their emotions or might respond to clinical question with inappropriate emotions in certain areas, it is evident that this put him to depression and anxiety. Even though from the initial ones, one might conclude that Williams's condition is related to mental illness, it is important to look at various reported demographics that are characterized by age and sex that are often associated with the post-stress disorder. Also, there has never been any consistent relationship between the stroke hemisphere and the pathological subtype or the lesion location in addition to the issue of depression (Theofanidis, 2016). A good history of depression before the individual was diagnosed with Stroke may also be related to the Post Stroke Depression, including other factors like the inability for William to recognize people or remember events which might also have to do with the fact that he was falling into depression.

 In respect to the literature review, the most common factor to be found in Williams will entail the severity of the Stroke, late or early physical disability (Theofanidis, 2016). When looking at the use of the Montgomery Asberg Depression scale score as it had been correlated with the neurological improvement or impairments, it looks like the patient who had acute depressive symptoms were also related to the physical dysfunction in regards to the chronic stage which also includes the additional psychosocial component of PSD.

In regard to mental illness caused by the Stroke, the best intervention will be to conduct a mental capacity assessment to establish the level.  The post-stroke depression, cognitive impairments, and uncontrolled anxiety are very common, especially when the patient continues to stay in the acute care unit. It will be important for the occupational therapist together with the initial team to help Mr. King overcome the effects related to ACU psychosis will is usually triggered by sleeping disorder, stress, sensory problems, and immobilization. The best intervention from the side of the nurse will be to promote an optimal environment for Mr. King and reduce the amount of stress the patient is undergoing by incorporating care with the tasks that are familiar and self-oriented for the patient so he does not feel incapacitated or a burden (Perry, Hamilton, Williams, & Dhami, 2008). Evidence practice also suggests that the use of light massage care and soft music can be useful in minimizing the level of anxiety and fear or from the patient falling to depression. It is important for the nurses to also engage the patients in constructive conversation about their health and general aspects of life and current issue affecting them so they can feel they are involved in their care; it also gives them an opportunity to share their problems. Also, the nurse could implement the use of various pharmacological agents, which is common, especially as the patient goes to the rehabilitation process for Stroke to being able to treat the complications related to Stroke, among other unspecified medical issues (Atalu, 2019).  Post-stroke depression is often treated through the use of anti-depressants, of which an advanced nurse in practice can administer to the patient.

Other Immediate consequences of William King situation

Apart from the mental condition brought about by William King's condition, there are other physical aspects of care his family that also needs to be looked into while the patient is under care. For his children, for example, the condition has caused a lot of trauma to them, and the deficits are either temporary or can be resolved in an unexpected manner or be fully set or without the help of rehabilitation. If this is not looked in to, William King’s condition could be permanent. In the case report, it is evident that Mr. King suffered from Hemiplegia, which is the paralysis of one side of his body because of the brain damage on one side. In most evidence-based cases, it reveals that Hemiplegia will occur when the damage of the right side of the brain affects part or the whole left side of the body (Theofanidis, 2016).  The weaknesses experienced by Mr. King on one side of his face, the arm, and the leg could have also affected the entire part of the face or the body, and this is why he was difficult in speech.  It was also evident that due to the Stroke, he was not able to coordinate his body, including speech and non-verbal communication. This is why he was having a lot of difficulties communicating various activities like responding to questions from the doctors, making decisions, feeling or the fact that he had to walk through using aids as he had difficulties in the coordination and balance (Perry, Hamilton, Williams, & Dhami, 2008). 

Conclusion

In conclusion, the major aspects of care and intervention looked at the emotional impacts of Stroke and the possibility that it would eventually result in post-stroke depressions for Mr. King.  This means that the MDT and nurses are required to reach out to the patient’s functional levels and promote his independence as much as they can.  It is important that when Mr. King is still at the ACU, a safe environment is provided that allows them to perform various self-care activities like this that allows them to heal faster and move from their depressed form.  Other aspects like bed position, suitable mattress, among other aspects, need to be looked into to ensure that the patient grows to know how to do things for himself.

References

Atalu, A. (2019). Relation between Post Stroke Depression (PSD) and CT- Scan and MRI Findings and Estimation of Functional Degradation in Patients 2-7 Months after Stroke. Journal of Complementary Medicine & Alternative Healthcare, 9(3). doi:10.19080/jcmah.2019.09.555762

Carod-Artal, F. J. (2010). Post-stroke depression: can prediction help prevention? Future Neurology, 5(4), 569-580. doi:10.2217/fnl.10.27

Kröber, H. (2016). Mental illness versus mental disorder: Arguments and forensic implications. Oxford Medicine Online. doi:10.1093/med/9780198722373.003.0011

Perry, L., Hamilton, S., Williams, J., & Dhami, R. (2008). Nursing interventions for improving the nutritional status of stroke patients. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd005209.pub2

Perry, L., Hamilton, S., Williams, J., & Jones, S. (2012). Nursing Interventions for Improving Nutritional Status and Outcomes of Stroke Patients: Descriptive Reviews of Processes and Outcomes. Worldviews on Evidence-Based Nursing, 10(1), 17-40. doi:10.1111/j.1741-6787.2012.00255.x

Theofanidis, D. (2016). Nursing Interventions and Rehabilitation Activities for Stroke Patients. Journal of Nursing & Care, 05(03). doi:10.4172/2167-1168.1000e131

Umccoventry. (2019, November 5). 3. The Five Principles of the Mental Capacity Act. Retrieved November 6, 2019, from http://www.umccoventry.co.uk/the-five-principles-of-the-mental-capacity-act/