Charles Gibsons Case and the Role of a Nurse Educator in the Education of the Nursing Staff

Introduction The nurse educators play a crucial role in the development of new nursing staff. Apart from teaching theory, nurse educators must prepare the students to work in the clinical setting, think critically, and use the modern means of communication to obtain evidence-based data. In addition, nurse educators need to encourage passion and desire to work in the learners.Advertising We will write a custom assessment sample on Charles Gibson’s Case and the Role of a Nurse Educator in the Education of the Nursing Staff specifically for you for only $16.05 $11/page Learn More To teach the students properly, a nurse educator needs to have an in-depth knowledge of the pathophysiologic mechanisms of diseases (to explain to the students how a disease harms the organism), the associated physical assessments (to teach them how to identify/diagnose diseases), and the pharmacologic implications for care (so the students may prescribe the appropriate drug s). In this paper, we will study the case of Charles Gibson, an imaginary patient who has suffered from an ischemic stroke, and offer recommendations concerning the prescription of medications to him. We will also take a closer look at the role of the nurse educator in the students’ professional development. Charles Gibson’s Case Mr. Gibson was diagnosed with an ischemic stroke when he arrived at the hospital. He was treated with the tissue plasmogen activator. Recently, he was moved from the emergency department to the rehabilitation unit. According to the post-stroke MRI, the patient had no worsening ischemia, and had reperfusion in the affected area of the brain. The patient can consume nectar-thick foods; it is planned to move him to soft diet if swallow evaluation results are good enough. He also has difficulty speaking; the problems appear to have motor origins. Mr. Gibson identifies words when he is shown pictures with items for everyday use. His current physica l assessments are within the normal: the heart rate is 82 with normal sinus rhythm; the blood pressure is 130/80; the respiratory rate is 18, regular (the normal RR for people of Mr. Gibson’s age is 12-28 (Rodrà ­guez-Molinero, Narvaiza, Ruiz, Gà ¡lvez-Barrà ³n, 2013)); the oxygen saturation is 96% on 2 L/min; the body temperature is 98.6 F. On the whole, the patient’s condition seems to be favorable. He is apparently recuperating from his ischemic stroke.Advertising Looking for assessment on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More There are a number of factors that have predisposed the patient to the ischemic stroke. First, the patient had hypertension before the stroke (and refused to take medications for it); the vessels that are constantly tense can lead to a lack of blood supply, which increases the chance of an ischemic stroke. Second, diabetes is also a risk factor (Hewitt, Guerra, del Carmen Fernà ¡ndez-Moreno, Sierra, 2012); high sugar in blood damages many organs, including the vessels: the tunica intima loses its smoothness, which increases the risk of blood clotting. Third, smoking is also a factor that greatly increases the likelihood of a stroke; among the most known mechanisms are hypercoagulability (thrombophilia) and atherosclerosis (fibrofatty plaques inside the vessels) (Edjoc, Reid, Sharma, Fang, 2013). Fourth, the patient had the habit of eating all kinds of food, including junk food; apart from being a factor that increases the risk of stroke directly, it also exacerbates the patient’s diabetes. Fifth, the patient is overweight (weight: 250 lbs, height: 6 feet), which also stimulates the formation of plaques in the arteries, thus increasing the likelihood of thrombi, and, consequently, a stroke. To identify the specified pathophysiological problems that led to the stroke, it is essential to gather information about the patient’s habits, a s well as to obtain some clinical data. To know about the patient’s hypertension, it is necessary to monitor his blood pressure regularly for a period of time – to identify the persistently high BP. To find diabetes, it is important to control the level of sugar in the blood; the blood for the tests must be taken on an empty stomach, because the levels of sugar in blood increase after an intake of food. The rest of the named factors that increase the risk of a stroke are more apparent (because they are related to the lifestyle, such as eating junk food or smoking cigarettes, or because they are rather obvious, such as being overweight). To identify the pathophysiological problems caused by the ischemic stroke (the lack of blood supply to the brain), it is possible to look at the consequences of the stroke. The LoC (level of consciousness) test can be used not only to identify the severity of stroke; it includes a number of symptoms typical of a stroke, many of which ar e a loss of a certain function. Other tests may be used to identify the lost or damaged functions. Finally, a CT or MRI scan can be used to identify the area where the stroke occurred (ÃÅ"nlà ¼er et al., 2012); this information can be utilized to understand which functions are likely to have been impaired.Advertising We will write a custom assessment sample on Charles Gibson’s Case and the Role of a Nurse Educator in the Education of the Nursing Staff specifically for you for only $16.05 $11/page Learn More The only psychological problem mentioned in the description of Mr. Gibson’s case after he has been moved to the rehabilitation unit is that he â€Å"expresses remorse about not ‘being able to do what he did before’†; however, he stays motivated. Therefore, he apparently does not suffer from serious psychological disorders. However, such disorders still may be present. A psychologist’s examination might be us eful. The patient has suffered from an ischemic stroke. Pathophysiologically, it affects the function of blood circulation by creating an obstacle for the blood (an occluded vessel in the brain) and preventing it from reaching certain tissues in the brain. The brain tissues deprived of the blood supply stop performing their functions and start dying. The person may lose their ability to do different actions, and may achieve a disability; the types of abilities lost depend on which part of the brain has suffered from the ischemia. The disability may be permanent (and a stroke can also be lethal, of course); however, if the stroke was not too severe, and the blood supply was restored rapidly, the damage might not be so critical, and some of the living neurons may gradually adopt the function of the tissues that died, restoring the patient’s ability to perform certain actions, but this often may require additional training. Mr. Gibson has difficulty speaking, and the problem see ms to have motor origins. This means that he is capable of understanding words and formulating his thoughts using words in his mind, but he is unable to properly pronounce the words due to the damage to the parts of the brain that are responsible for moving speech muscles. It is possible that his ability to speak will be eventually restored, but a certain amount of time, and, quite possibly, special training (speech therapy) may be required. Psychologically, Mr. Gibson might start suffering from e.g. depression due to his inability to perform certain activities (especially if it turns out that he is incapable of performing everyday activities). However, as it was mentioned, currently the patient stays motivated. It is important to support him via e.g. occupational therapy, and, of course, various types of encouragement and motivation (Carey, 2011); the OT might also allow him to restore some of his lost abilities, if he has lost any. Pharmacologic Treatment Plan for Charles Gibson T he offered medications are as follows:Advertising Looking for assessment on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Metformin 1000 mg PO every 12 hours – an anti-diabetic drug that is often used for overweight people. We would recommend using this medication, but monitoring the levels of sugar in blood. The patient had bad dietary habits, and now his diet has completely changed; it is necessary to check whether the dose is adequate. The levels of sugar should be checked until the patient starts having a (relatively) stable diet (currently, it is being considered whether to move him from nectar-thick foods to soft diet). Enteric coated aspirin 81 mg PO every day – lowers the chances of blood clot formation. Use, but monitor the possibility of hemorrhagic stroke, for it may increase due to aspirin (Doutremepuich, Aguejouf, Desplat, Eizayaga, 2012). Also, ensure that the patient is not aspirin-resistant (Topà §uoglu, Arsava, Ay, 2011); if he is, the aspirin may be replaced by e.g. warfarin. Persantine (dipyridamole) 75 mg PO every day – also lowers the chance of blood clot f ormation. Administering it with aspirin means that if one of the medications is ineffective, the other will have an impact. However, perhaps it would be reasonable to start giving them gradually, not on the same day, to see whether they produce an effect. It also should be noted that if aspirin is ineffective, dipyridamole can be combined with warfarin. Losartan 75 mg PO every day – used for hypertension. The patient needs some hypertension medications, and Losartan is an appropriate choice. Amiodarone 200 mg PO every day – an anti-arrhythmic drug. The patient had atrial fibrillation when he arrived at hospital, but currently he has a normal sinus rhythm, and it is uncertain whether this condition will relapse again. On the other hand, atrial fibrillation, if it was persistent, may have damaged the tissues of the heart, making a relapse more likely (Kowey, Mohmand-Borkowski, Burke, 2011, pp. 33-39), which is especially dangerous after a stroke, because strokes also of ten relapse (Ostwald, Godwin, Ye, Cron, 2013). So perhaps it is justified to give him Amiodarone, especially when the dose is not high – 200 mg daily. We could also recommend using: d-amphetamine, 10 mg once every four days for 10 sessions, in conjunction with physical therapy. It is stated that some experiments have shown positive results in patients with motor impairments and aphasia after a stroke (Stein, Harvey, Winstein, Zorowitz, Wittenberg, 2015, ch. 12). This treatment may be offered to Mr. Gibson as experimental. Nurse Educator’s Role in Developing Students The nurse educator plays an important role in developing student’s professionalism. Apart from advancing their knowledge by providing theoretic information, the nurse educator has to develop the student’s practical skills of caring for the patients, and develop their abilities so they may use them effectively in the clinical setting. In other words, the nurse educator has to link the medi cal and nursing theory with the clinical practice, develop the learners’ natural abilities, and boost their passion for caring for patients. Critical thinking in nursing comprises the use of logic and intellect in combination with the analysis of the data from the current research to provide patients with the care and medical assistance of the highest quality. The nurse has to be clear and precise in their judgments to eliminate possible mistakes or irrelevant information when caring for their patients. To develop critical thinking, clinical judgment, and innovative communication in their students, nurse educators may use two following strategies: 1. Give the students tasks which require self-reliant research and analysis. For instance, it is possible to give the students case studies with imaginary patients who have diseases that the learners have not studied before (but, clearly, they must have enough background knowledge to figure it out). The students will learn to act in a situation when they have to gather information about a disease unknown to them (using the innovative means of communication, for instance, by searching medical databases), combine it with their current knowledge (develop critical thinking), and prescribe the treatment for the patient (use clinical judgment). 2. Another option is to create a â€Å"role game† where a nurse has to deal with a patient (who has a disease that requires the nurse to look for new data to treat it properly), as well as with other individuals involved in the process of treating and caring: relatives, multiple physicians, other nurses. This situation contains the benefits of the previous approach, developing the critical thinking, clinical judgment, and innovative communications skills in the same way, but it also adds additional practice of clinical judgment, for the nurse has to take into account the wishes, attitudes, and opinions of the other parties. To realize this method in practice, it is pos sible to use the virtual reality. Conclusion To sum up, we have studied the case of Charles Gibson, evaluated his physical assessments, described the pathophysiological mechanisms of his disease, and provided pharmacological options for his treatment. We have also explained the role of a nurse educator in the nurse teaching process. It is important to stress that understanding patients on an in-depth levels helps the nurse educator develop their students’ skills by e.g. showing how important the information and attitudes of the patients are for their treatment. References Carey, L. M. (Ed.). (2011). Stroke rehabilitation: Insights from neuroscience and imaging. New York, NY: Oxford University Press. Doutremepuich, C., Aguejouf, O., Desplat, V., Eizayaga, F. X. (2012). Paradoxical effect of aspirin. Thrombosis, 2012, 1-4. doi:10.1155/2012/676237 Edjoc, R. K., Reid, R. D., Sharma, M., Fang, J. (2013). The prognostic effect of cigarette smoking on stroke severity, disability, l ength of stay in hospital, and mortality in a cohort with cerebrovascular disease. Journal of Stroke and Cerebrovascular Diseases, 22(8), e446-e454. Web. Hewitt, J., Guerra, L. C., del Carmen Fernà ¡ndez-Moreno, M., Sierra, C. (2012). Diabetes and stroke prevention: A review. Stroke Research and Treatment, 2012(12), 1-6. doi:10.1155/2012/673187 Kowey, P., Mohmand-Borkowski, A., Burke, J. (2011). Clinical management of atrial fibrillation (1st ed.). West Islip, NY: Professional Communications. Ostwald, S. K., Godwin, K. M., Ye, F., Cron, S. G. (2013). Serious adverse events experienced by survivors of stroke in the first year following discharge from inpatient rehabilitation. Rehabilitation Nursing, 38(2), 254-263. Web. Rodrà ­guez-Molinero, A., Narvaiza, L., Ruiz, J., Gà ¡lvez-Barrà ³n, C. (2013). Normal respiratory rate and peripheral blood oxygen saturation in the elderly population. Journal of the American Geriatrics Society, 61(12), 2238-2240. doi:10.1111/jgs.12580 Stein, J., Harvey, R. L., Winstein, C. J., Zorowitz, R. D., Wittenberg, G. (2015). Stroke recovery and rehabilitation (2nd ed.) [Google Books version]. Topà §uoglu, M. A., Arsava, E. M., Ay, H. (2011). Antiplatelet resistance in stroke. Expert Review of Neurotherapeutics, 11(2), 251-263. doi:10.1586/ern.10.203 ÃÅ"nlà ¼er, E. E., Yaka, E., Akhan, G., Limon, Ãâ€"., Kara, P. H., YavaÅŸi, Ãâ€".,†¦Kutluk, K. (2012). Ability of emergency physicians to detect early ischemic changes of acute ischemic stroke on cranial computed tomography. Medical Principles and Practice, 21(6), 534-537. Web. This assessment on Charles Gibson’s Case and the Role of a Nurse Educator in the Education of the Nursing Staff was written and submitted by user Parker Holder to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Characteristics of Blanch and Stanleys Relationships in The Streetcar Named Desire by Tennessee Williams

Characteristics of Blanch and Stanleys Relationships in The Streetcar Named Desire by Tennessee Williams A Streetcar Named Desire by Tennessee Williams is a classic of American theater. Thomas P. Adler said that â€Å"it was the finest play ever written for the American stage† (Kolin 1). Exactly this play determined the author’s themes, thoughts and ideals. Advertising We will write a custom essay sample on Characteristics of Blanch and Stanley’s Relationships in â€Å"The Streetcar Named Desire† by Tennessee Williams specifically for you for only $16.05 $11/page Learn More According to Harold Klerman, it is the only play that describes the personality, society and depicts realistically the reality of that time. The setting of the play took place in contemporary times. It is a story of a decline of a Southern lady Blanche DuBois. In this play, Williams disclose a wide range of themes. Among them are the themes of domestic violence, relationships of men and women, the fantasy and its confrontation with reality. One of the most import ant themes of the play turns around the relationships of the main characters, Blanche DuBois and Stanley Kowalski. These are two characters that are put in opposition. The climax of their opposition is the Stanley’s rape of Blanche. On one hand, this episode depicts a cruel attitude and immoral behavior, â€Å"Stanley is wrong and Blanche is right, the moralists agree† (Fleche 500). On the other hand, Blanche’s rape was inevitable (Fleche 500). And through the characterization of Blanche and Stanley’s relationship, I will argue that Blanche was raped. Blanche DuBois comes to New Orleans to her sister Stella married to rude and down-to-earth man Stanley Kowalski. Blanche and Stanley did not like each other from the very first second they met each other. Blanche saw Stanley beat his wife and behaved as an animal, â€Å"the primary example of physical abuse against Stella occurs in Scene Three, when drunk and angry, Stanley first tosses the radio out the w indow and then charges after his pregnant wife and strikes her† (Koprince 46). Stanley is showed as a brutish person without moral qualities. However, Blanche is also not â€Å"an angel†. Her previous life is not perfect and all the manners and tenderness is just a mask to hide her â€Å"dark† past and alcoholism. The only person who suspects her and wants to show her real face to everybody, â€Å"and yet it seems natural to read A Streetcar Named Desire as an allegorical journey toward Blanches apocalyptic destruction at the hands of her executioner, Stanley† (Fleche 504).Advertising Looking for essay on american literature? Let's see if we can help you! Get your first paper with 15% OFF Learn More As it has already been mentioned, these two characters are put in opposition, however we cannot say that this is an opposition of good and evil. Thus, Blanche appears as a young, beautiful, and unhappy woman who survived the suicide of her husband and wants to start all over again. For the first time, we see her elegant and tender. The first impression is absolutely positive. She is so light and smart, she knows French and music. However, we do not know much about her past and it is also suspiciously. We guess that she lies and Stanley helps us understand it. The author is sympathetic to his heroine. He does not idealize her, on the contrary, he is quite objective: he shows her live to whiskey and relations with men after her husband’s death. â€Å"Blanche who has never spoken an honest word in her life is allowed, indeed encouraged, to present her life to the audience as a vocational decision†¦Ã¢â‚¬  (Toles 119). The â€Å"impurity† of Blanche’s past suggests the final of the play and it is a quite logical completion of the story. The truth cannot be hide and everybody should pay for his/her actions. Blanche planned to marry Mitchell, but sooner or later, he would find out about her â€Å"sins†, â€Å"she cannot escape the status of victim, on many fronts, nor avert the plans which have led to her committal† (Toles 117). She could not expect other attitude to herself, especially in that social layer with it principles and relations between men and women. Thus, the character of Blanche can be interpreted as positive and negative at the same time, on the one hand â€Å"she has been enshrined as a hallowed representative of the Old South, a secular saint. On the other, negatively, she has been branded a nymphomaniac, a liar, an infectious source of destructive feminine desire† (Kolin 3). With this â€Å"image† of a liar and nymphomaniac Stanley fought. Stanley appears as a person with animal nature. He drinks bear all the time, â€Å"copulates, play games, smashes light bulbs, paws through Blanche’s wardrobe, throws plates on the floor, even commits rape† (Cardullo 29). Stanley is a representative of a dark reality. He embodies the â€Å"prototypical batterer†. According to Susan Koprince, he has all signs of such person. â€Å"He is hypermasculine, believes in mail’s superiority and has dual personality† (50). Those traits make him hate Blanche. Advertising We will write a custom essay sample on Characteristics of Blanch and Stanley’s Relationships in â€Å"The Streetcar Named Desire† by Tennessee Williams specifically for you for only $16.05 $11/page Learn More First of all, he hates her aristocratic past and he is outraged by her attempts to fool him showing that she is better than he and his friends. This is contradictory to his image of a woman. It makes him look for â€Å"dark spots† in her past and he finds them. Stanley does everything to ruin life of this woman. It seems to be cruel and basely. However, he is the only person who supported the truth and â€Å"justice† and reality. Stanley is a dark version of the s alesman, selling the idealistic Blanche a harsh reality on the specious grounds that it is somehow good for her and willing to use force, if necessary, to make the sale.† (Cardullo 30). The result of the confrontation of Stanley and Blanch was the rape. However, it cannot be considered as a cruel violation. Neither the context, nor the scene manifests it. In her article, Anna Fleche says, â€Å"she is the erring woman who gets what she asks for (her realistic antecedents are clear)† (507). This is the way other men treated her, this is what she expected, this is how a logical flow of things should be like. All the situation and Blanche herself â€Å"suggests† rape to Stanley. If other men did it, why he cannot? Moreover, she does not resist but sinks on her knees and remains â€Å"inert†, â€Å"She is not only silent but crumpled, immobile, while he takes over control and agency† (Fleche 508 ). Thus, the scene of the rape denies any emotions, it is a conflict that arises between two characters. In addition. With this action Stanley returned Blanche to reality. As George Toles mentions, â€Å"Stanleys casually violent gesture recalls the rape and, less malevolently, repeats the realists inalterable lesson: those who live entirely in dreams will perish† (130). Thus, Blanche and Stanley are two characters put in opposition. Neither of them is perfect. Blanche lives with her dream and she constantly lies to hide a cruel reality and her real past. Stanley is a representative of this cruel reality which opens Blanche’s eyes through the violent action. However, both, with context, main characters’ traits of character and actions, especially in the scene of a rape, the author coverts the meaning of the rape. Now, it is not just the act of violence, but the conflict that shows who is who in the play.Advertising Looking for essay on american literature? Let's see if we can help you! Get your first paper with 15% OFF Learn More Cardullo, Robert James. â€Å"Selling in American Drama.† Helen Dwight Reid Educational Foundation. (2007): 29-33. Fleche, Anne. â€Å"The Space of Madness and Desire: Tennessee Williams and Streetcar.† Modern Drama. Vol. 38. Issue 4. (1995): 498-509. Kolin, Phillip. Williams. A streetcar named Desire. New York: Cambridge University Press, 2000. Print. Koprince, Susan. â€Å"Domestic violence in A Streetcar Named Desire.† Southern Studies. Vol 7. Issue 2. (1996): 43-55. Toles, George. â€Å"Blanche Dubois and the kindness of endings†. Raritan. Vol 14. Issue 4. (1995): 115-144.