Walkthrough Q4: Health Promotion and Maintenance – NCLEX-PN®

00:01 The nurse is caring for a client diagnosed with a stroke involving the right side of the brain.

00:06 Which intervention is included in the plan of care? Select all that apply.

00:13 Okay. We've talked about how important the stem is and that matters in every type of question.

00:18 Now, some of you might say, "I'm just feeling a little wild today. I don't want to start with number one.

00:23 I want to start somewhere in the middle or somewhere at the end." You do it. Whatever it takes to keep you engaged in the questions, I fully support it.

00:32 But here's what I'm going to ask you to be very careful to do. Use your write on, wipe off board strategy.

00:39 So, write down one, two, three, four, five, and you can work through them in any order that works for you.

00:45 If you're selecting it, circle the number. If you're eliminating it, cross through it and you can do it in any order that you want, okay? So, you do you.

00:56 Whatever it takes to keep you engaged because, wow, taking a test is intense but please make sure you consistently use your write on, wipe off board to your advantage.

01:08 Okay. Let's go back to the question after that public service announcement.

01:11 The nurse is caring for a client diagnosed with what? Stroke, involving the right side of the brain.

01:18 Which interventions is included in the plan of care? Okay. That would mean I'm looking for the things that are - you deal with someone who has a right-sided brain stroke.

01:30 So, if it's something for a left-sided brain stroke, I'm not going to use that, right? These are very specific in the question telling me right side of the brain.

01:41 One strategy you could use is read through each one of those five options and see.

01:46 Is there anything that seems to be left-sided stroke from what you remember? So, go ahead and try that and then, I'll talk you through it.

02:02 Okay. Welcome back. Hey, pausing the video and practicing by yourself is the best thing you can do.

02:09 And then, we come back and we walk through it together.

02:11 Now, did you see anything that seemed to just be a left-sided stroke? If you picked it up, there are two options that are just left-sided stroke.

02:23 So, I'll show you what those are as we walk through them in order.

02:27 But remember, do what works best for you as long as you're keeping track on your write on, wipe off board, and you're good to go.

02:36 As long as you're intentionally telling your brain, "I have to choose in or out and say why." That's the key. In or out, yes or no, and say why because that's what quiets those crazy voices in your head that tell you, you got this question wrong.

02:52 So, back up to the stem just one more time because I've talked a little bit in between there.

02:56 What you have is which intervention is scheduled in the plan of care for who? A client who's had a stroke involving the right side of the brain.

03:06 And I know you might make fun of me but even if I was taking the test, I'd be like, "Right side of the brain." That's just what I would do. So, number one, is it appropriate for a right-sided stroke to have small quick tasks to complete? Is that something that would benefit the client? Oh, right-sided.

03:25 Yes, because right-sided strokes, they really struggle with attention span and they have a hard time keeping things in order.

03:34 So, short tasks are going to be better for them that they don't have multiple directions that they are supposed to follow.

03:40 So, short tasks that they can see are completed, that's going to be the best for their brain because they also might have impaired judgement and difficulty around the concept of time.

03:50 So, you don't want to ask them to do something that's over a long period of time with multiple steps.

03:55 So, for a right-sided stroke, that is going to be your best option to do short tasks.

04:04 So, on my write on, wipe off board, I have circled number one because I know that small quick tasks are best for right-sided stroke.

04:13 Display clocks and calendars to help keep on schedule. Is that good for a right-sided stroke? Oh, yes. These are visual aids to assist with their memory in helping them keep up with the schedule.

04:27 We've even gone from my mom putting a clock that says whether it's morning, afternoon, or night.

04:33 It's got the date and it's got the time in big numbers because that helps her with her memory.

04:40 So, yes. Number two, I know from personal experience, that's a good idea.

04:45 So, we selected by circling number one, circling number two on our worksheet, on our write on, wipe off board.

04:51 Now, we're going to number three. Speak in direct sentences and allow time for responses.

04:58 Okay. That might seem like just being polite to you but keep in mind, left-sided stroke can often be speech impairment, so, it makes them hard for them to express themselves which I think would be horrifying if you were the person.

05:15 So, they have things like aphasia. I mean, they can't really communicate clearly.

05:21 Show performance, they can't understand things well. Now, this doesn't mean they're not bright people.

05:26 It just means their brain has a hard time processing it because they've had a stroke.

05:32 Now, that's why clients with a left-sided stroke, they're the ones most likely to have these challenges, speech impairment, aphasia, have problems processing.

05:43 So, that's why they would benefit from direct statements that allow them time to process, comprehend what you're saying, and then, respond using gestures, drawings, and writings is also very helpful.

06:00 Think of it like this. Have you ever tried to talk to somebody in another language? Like it's not your primary language? You'll notice when you're communicating with someone who speaks a different language, if you will slow down politely, don't make it over the top but give them small pauses, let them - let them have time to process, give them a few words, give them time to catch up and then, give them some more words and give them time to catch up.

06:27 Same thing with somebody who's had a left-sided stroke. Just give them time and for the love of Pete, do not look irritated.

06:36 They are doing the very best they can, working as hard as they can to process but their brain is just working differently now after the injury.

06:45 Okay. That was kind of a long explanation. I know but sometimes, I just really get on my soap box because people treat stroke patients sometimes not as kindly as they could.

06:54 So, number three, I know the topic of the question was, what should be appropriate for a right-sided stroke? But the symptoms in number three are a left-sided stroke, so, I am going to cross-off number three.

07:07 Now, number four, remember, what I'm looking for is symptoms of a right-sided stroke that we're trying to help them with.

07:13 Number four says use non-verbal cues and gestures to communicate.

07:18 Aha. Remember what we said? That's again, a continuation of left-sided stroke using non-verbal cues can be very helpful as long as you use them appropriately to help them process what you're asking them. So, number four is a left-sided stroke.

07:34 I'm going to cross it off. Number five, keep a bed alarm on at all times.

07:40 Now, I'm looking for right-sided stroke appropriate.

07:44 What's the connection between keeping a bed alarm on at all times and a right-sided stroke? Hey, safety's a concern with either, right, left, it doesn't matter.

07:55 But those with a right brain stroke are also impulsive. So, they'll do things like they'll jump out of bed.

08:00 And especially if they're elderly, they may have that orthostatic hypotension that puts them at an increased risk for falls.

08:07 They also might not have solid judgement. They might overestimate what they're capable of doing.

08:13 They kind of underplay their problems and their challenges and overplay what they can do.

08:18 So, they may be unsafe. They may be at increased risk for falls.

08:23 So, a right-sided stroke, is it appropriate to put a bed alarm on at all times? It is. If the patient's in bed because particularly, we know right-sided strokes, they may need help getting out of the bed.

08:38 So, you want to make sure that someone's there to assist them.

08:41 Also, at night, even if they're fine during the day, sometimes, that can be a real challenge at night time where they're even more disoriented. So, let's go back.

08:50 We're looking for, how can we help somebody with a right-sided stroke? Number one, is that correct? Yes, because memory's a real problem. They can't keep track of time.

09:00 Number two, is that correct for a right-sided stroke? Yup. It helps orient them, clocks and calendars.

09:07 Number three, speak in direct sentences and allow them time to respond? Oh, that's a left-sided stroke, so, I'm going to eliminate that one because the topic of the question is right-sided stroke.

09:18 Use non-verbal cues and gestures to communicate? Left-sided stroke.

09:24 Questions asking me for right-sided stroke, number four's eliminated.

09:28 Number five, keep a bed alarm on at all times? Right-sided.

09:33 So, I've selected one, two, and five. I'm confident in that. I'm picking that answer and moving on.