An 85-year-old man had a CVA 2 days ago, which resulted in left-sided hemiparesis.
1. An 85-year-old man had a CVA 2 days ago, which resulted in left-sided hemiparesis. The client is on the medical-surgical floor where he requires substantial assistance with personal care. His vital signs are not stable so he is being closely monitored by nursing staff. The nurse assesses the client frequently, including vital signs, selected physical assessment, and questions to the client to collect subjective data. (Expected Learning Outcomes 5 and 8)
a. Why does the nurse assess and re-assess?
2. The elderly man who had a CVA is having difficulty voiding on his own so an indwelling catheter is inserted. The man is quite confused. He wants to get out of bed and go home, because he believes his wife needs him. He is placed on fall precautions, meaning that staff are aware that he is more likely to engage in a behavior that will result in a fall. The man’s daughter is present and is eager to be helpful. (Expected Learning Outcomes 4 and 5)
a. How can the daughter help keep her father safe?
b. What tasks can be delegated to the nursing assistant to assist in preventing falls?