Case Study on Cerebrovascular Accident

Running head: CASE STUDY
Cerebrovascular accident
Name of the Student
Name of the University
Author Note

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Introduction
Cerebrovascular accident (CVA), commonly referred to as stroke occurs when the
blood flow to specific parts of the brain are stopped due to presence of some blockage or
rupture of the major blood vessels. Some of the most common types of CVA include
haemorrhagic stroke and ischemic stroke. Commonly manifested symptoms of stroke
comprise of dizziness, loss in balance and coordination, speaking difficulty, paralysis and
numbness, and blurred vision. Haemorrhagic stroke occurs when there is a rupture of the
vessels (Kim, Baumgartner & Clements, 2013). Conversely, blockage leads to ischemia. Both
the types of CVA deprive the brain of their essential blood and oxygen, thereby leading to
death of the cells (Marieb & Hoehn, 2007). The case study focuses on Mr. Sam Kwon, aged
74 years, who has been admitted on account of aphasia, hemiparalysis on the right side and
facial drooping. The essay will elaborate on the prevalence and incidence of the physiological
abnormality in Australia and will further illustrate on the different steps of disease assessment
and implications to nursing.
Incidence and prevalence
Stroke can be defined as the onset of sudden neurological deficit due to vascular
abnormalities. This deficit usually lasts for more than 24 hours. This condition is largely
avoidable due to the range of risk factors that can be modified or avoided by people at an
increased risk of suffering from the condition. Approximately 377,000 individuals (171,000
females and 206,000 males) that form 2% of the entire Australia population were hospitalised
for stroke rehabilitation in 2013-14. Most of the patients were aged more than 65 years (71%)
(Aihw.gov.au, 2018). The average hospitalization length for acute care due to stroke was 8
days, and that for rehabilitation was 14 days. Stroke is recognised as the third leading reason
for death in Australia (Abs.gov.au, 2018). There were an estimated 10,869 stroke related
fatalities in 2015, which accounted for 6.8% of the total deaths (159,052). Males aged under

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85 years of age, show higher mortality rates due to stroke, when compared tofemales. On the
other hand, high death rates were observed among females,aged 85 and
more(Strokefoundation.org.au, 2018).The median age for death due to stroke in Australia is
86.6 years. While this data elaborates on the fact that most stroke related death incidents
occur among older adults, it also feature as the top leading reasons of death among persons
aged more than 45 years. Similar findings are also presented by epidemiological studies that
have confirmed CVA as the third leading contributor to death in the US. An estimated
140,000 individuals die due to CVA in the United States every year. Furthermore,
approximately 795,000 people suffer from stroke in the country of which 185,000 are
recurrent attacks (Stroke Center, 2018).
Disease assessment
Clinical assessments are a way of diagnosing and preparing a treatment plan for a
patient to gather relevant information regarding the current health status. Stroke scales are
considered as standardized assessment tools that help in identifying the underlying factors
and health abnormalities present in the patient. Sudden deterioration of brain function is one
of the primary features of an ischemic stroke (Marieb & Hoehn, 2007). An assessment of the
patient Mr. Kwon will be conducted with the use of different assessment scales that will
measure his level of consciousness, stroke related deficits, disability, mental status, motor
function and balance. Information pertaining to his medical history will also be gathered with
the aim of understanding about the potential risk factors and formulating a care plan
(Harrison, McArthur & Quinn, 2013). Physical assessment is most imperative in this case as
it will help in recording the vital signs of the patient. The physical examination will
encompass all organ systems, such as, the airways, breathing, circulation (ABC) and the vital
signs. This can be attributed to the fact that patients with reduced levels of consciousness are
at a risk of damage to the airways. Furthermore, assessing the vital signs can help in the

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identification of approaching clinical deterioration and will also facilitate narrowing down the
process of differential diagnosis.
Most stroke patients have been found hypertensive in baseline measures and the blood
pressure shows an elevation following a CVA. Temperature changes might act as indicators of
brain dysfunction and intracranial pressure (Bullock & Hales, 2012). A comprehensive
neurological assessment will involve determining the gross and fine motor skills, the sensory
function and the level of consciousness. The level of consciousness will be assessed wi8th
the use of a Glasgow Coma scale that has been established as a practical method that helps to
determine consciousness in response to external stimuli. This will involve assessing the
patient against the scale criteria, followed by giving the patient certain scores between 3 and
15 (Teasdale et al., 2014). Fine and gross motor skills will be evaluated with the Motor
Assessment Scale designed for stroke patients. Its utility is related to the valuation of
functional task performance, in place of isolated movement patterns. Mr. Kwon will be tested
for his tone, posture, symmetry, coordination, and gait. His sensory function evaluation will
comprise of assessing the hearing ability, taste, response to touch, smell and vision (Duffy et
al., 2013). The Fugl-Meyer is another alternative that can be used in this scenario. This scale
is widely used to measure presence and severity of motor impairment following a stroke
incident (See et al., 2013).
It will help in determining presence of symptoms that are related to lower and upper
extremity sensory and motor impairment. Furthermore, owing to the fact that the patient has
hemiplegia, the NIH Stroke Scale can also be used, with the aim of quantifying the severity
of his CVA (Saposnik et al., 2013). The patient will also be evaluated for determining the
adequacy of his cardiac output and the assessment will comprises of several techniques of
inspection/observation, palpation, and auscultation. Additionally, MRI has increasingly

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gained importance in the diagnosis of acute ischemic stroke and will produce a clear image of
the brain structures that might have been affected due to deprived blood supply and oxygen.
Nursing and interprofessional implications
Stroke management and care plan formulation is imperative to optimal health
outcomes of the patient. Stroke patient\s who require admission must be immediately
admitted to the stroke units that are staffed by a coordinated interdisciplinary team that is
essential for patient care. Early assessment of the patient will reduce the chance of mortality.
Emergency treatment for the patient will involve detection of the type of stroke that he has
suffered from. Following admission of the patient, clot-busting drugs must be administered
with 4.5 hours to improve his chances of survival. This will be facilitated by the
administration of tissue plasminogen activator (tPA) or alteplase, the gold standard for
ischemic CVA (Bullock & Manias, 2013). The care plan will include injecting tPA through
the vein into the arm that will restore the blood flow in the patient by dissolving all blood
clots or blockages that had resulted in the stroke (Powers et al., 2015). The use of tPA must
be followed by regular monitoring of the patient for bleeding. Management of intracranial
pressure also forms an essential aspect of stroke care plan. This will generally be conducted
by the administration of osmotic diuretics that will prevent reabsorption of sodium and water
by increasing blood osmolality (Jovanovic et al., 2014).
Furthermore, efforts will be taken to maintain the PaCO2 near 30-35 mm Hg. One
essential component of the care plan will be associated with appropriate therapeutic
positioning of the patient to promote his optimal recovery (Steiner et al., 2013). Five
positions in which the patient will be kept are lying on the affected or unaffected sides,
supine, and sitting up on chairs or the bed. The care plan will also comprise of maintaining a
flow sheet to assess the essential measures of the clinical status of Mr. Kwon such as,
changes in his levels of consciousness, presence of involuntary movement extremities, neck

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flaccidity, eye opening and pupil size, blood pressure, speech ability and bleeding (Lang et
al., 2013). Appropriate positioning will help in preventing contractures, reduce pressure and
eliminate chances of neuropathies.
Adduction of affected arm will also be prevented. Elevating the head of bed by 15-30
degrees, at low fowler’s position will increase the venous return (Kubota et al., 2015).
Furthermore, a trained clinician will also assist the patient with his activities of daily living to
maximise the outcomes and enhance the perceptual, sensorimotor and cognitive faculties
(Lee, 2013). A speech pathologist will be crucial in managing all forms of swallowing
deficits (if any), while the patient is kept on a monitored diet and fluid intake. Additionally,
efforts will also be taken to prevent breakdown of the skin that can occur due to inability of
the affected person to move extremities, or incontinence (Brown et al., 2015). Facilitating
communication with the patient and his family members is another essential approach that
will help in coping with the condition. A speech pathologist will help in including an aphasia
friendly environment in the setting (Flynn et al., 2013). The care plan will also include
regular administration of medications for T2D and a constant monitoring on the nutrition and
hydration status.
Conclusion
To conclude, nursing professional are vital to the interdisciplinary team for stroke
care that will assess the admitted patient in the emergency setting. There need to be a rapid
assessment of the patient to facilitate easy diagnosis and nursing interventions. Proper
monitoring and reporting in relation to the essential aspects of stroke assessment such as,
vital signs, motor control, sensory perception and neurological status are imperative for the
prevention and elimination of CVA associated complications. Thus it can be concluded that
working in collaboration with the other members of the interdisciplinary team will help in
maximising the amount of nursing interventions.

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