Nursing Assignment | Top Universities

L.M. is a 57-yr-old white woman who was 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. L.M.. lives alone and holds a management position. She is concerned about her ability to return to work after her surgery.

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L.M. returns from surgery to the neurosurgery unit drowsy but following commands. During the night L.M.. 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 to Answer:

  1. How does L.M.’s diagnosis (glioblastoma) put her at risk for a stroke?
  2. Priority Decisions: What are the priority decisions that need to be made regarding safety and self-care related to the left neglect and visual field cut?
  3. Patient-Centered Care: What factors should you assess for related to rehabilitation for L.M.?
  4. Priority Decisions: What are the priority nursing interventions for L.M.?
  5. Priority Decisions: Based on the assessment data provided, what are the priority nursing diagnoses and are there any collaborative problems?
  6. Teamwork and Collaboration: What nursing interventions for J.K. can the RN delegate to unlicensed assistive personnel ((UAP)?
  7. Teamwork and Collaboration: How can you work together with the interprofessional team to develop and implement strategies to improve communication for L.M..?
  8. Safety: How can you ensure safety forL.M. in light of her homonymous hemianopsia and left-sided neglect?
  9. Patient-Centered Care: How can you address L.M..’s concerns about her finances and self-care?
  10. Patient-Centered Care:L.M.’s family wants to know if her tumor surgery caused her hemorrhagic stroke and if so, what they should watch out for at home.. Get  Nursing Assignments  Help Today

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