Assessment | Management of stroke

Management of stroke
Pathophysiology and
symptomatology
• The patient is 76 year old women who had experienced
stroke in 12 months ago.
• During stroke, the artery gets blocked either due to
bursting or leaking which leads to sudden interruption of
the flow of blood that is flowing to the particular area of
brain (Mendelow et al., 2015).
• The symptom which is observed in the case of patient due
to the heart stroke includes:
• Hemiplegia: One part of the body is affected which is
caused due to stroke as the corticospinal tracts of one
hemisphere of the brain is affected.
• Trouble while walking that is observed in case of Belle.
• Trouble with understanding and speaking ad also seems to
be confused.
• Headache along with dizziness (Mendelow et al., 2015).
Assessment of the patient
To provide proper care to the patient it is important
for the nurses to gather all the subjective and
objective data to formulate a proper care plan.
Subjective data: It is the type of data that provides
information about the symptoms of the disease
which is observed in case of patient (Sajjad et
al.,2015). The subjective data identified in case of
belle includes:
1. Confusion
2. Aggressive
3. Trouble while walking
4. Disoriented
5. Unsteady
6. Dizziness
7. Numbness
Objective data: It is the type of the data which is
observed after proper assessment of the patient
(Nijsse et al., 2017). It includes:
8. Hemiplegia
9. Facial droop
10. Vomiting
11. Paralysis
12. Aphasia
13. Ataxia
Diagnostics tests
• Physical examination: The signs and symptoms are assessed
• CT scan: Detailed imaging of the brain is done to evaluate
the effect of stroke.
• Blood tests: To identify blood clots in the artery
• MRI: To detect the any damage in the tissue of the brain
(Sposato et al., 2015).
Potential complications and
cues
The condition of stroke is associated with
different health complications that must be
addressed and known to the patient for better
health outcome. The two major health
complication identified in this study are
(Caplan, 2016):
• Psychological complication- the
symptoms exhibiting psychological
complication are confusion, emotionalism,
anxiety and depression. Since, Belle had
lost her husband she was in a state of
confusion and depression that could further
result in serious psychological
complication.
• Infection- The common infection
associated with stroke are pneumonia,
aspiration and urinary tract infection (UTI).
Belle was exhibiting the condition of
indwelling catheters and immobility that
might result in the issue of infection.
Education/Self-management strategies
The patient suffering from stroke often experience diverse health
complications and due to inadequate self-care and management
strategies, they also fail to manage their health. Hence, the
healthcare professionals must adapt education and self-
management strategies that will focus on educating Belle
regarding the self-management techniques and motivate her to
participate in different community or social activities that will
enhance her health. Since, Belle was old she was not really aware
of the new techniques and strategies this will improve her
knowledge regarding self-management strategies (Fryer et al.,
2016).
Nursing Intervention
The persistent condition of stoke leads to some severe health
complications that must be managed and prevented by the
healthcare professionals and nurses. The effective nursing
intervention as proposed by North American Nursing Diagnosis
Association (NANDA), exhibits three priority nursing
intervention and management of stroke that includes (Middleton
et al., 2017):
• Cognitive behavioural therapy- This therapy is considered
as the major intervention for managing the patient with stroke
with adverse life events. Since, Belle was very aggressive and
agitated, it was very crucial that the nurse manage her well-
being and provide different therapy session that will help her
to prevent the occurrence of stroke.
• Physical therapy intervention- Physical therapy intervention
is used for enhancing the mobility of the patient and motivate
them to perform the daily activities of life. The intervention
will focus on Belle’s movement as she was suffering from
hemiplegia and faced extreme difficultly to walk or mobilize.
• Patient-centred care and education- The last nursing
intervention will be to increase the knowledge and awareness
of Belle regarding her health issue. The nurse will educate
Belle regarding pathogenesis or risk factors and instruct her
with the activities that she must perform to enhance her
outcome.
Role of Nurse in delivering
collaborative care
Nurses have a very significant role in providing effective
are and support to the patient suffering from stroke. The
nurse will take assistance form physiotherapist who will
aim to improve the mobility of Belle. The Cognitive
therapist will also help the nurse to improve the mental
health condition of the patient by managing and educating
the patient with different self-care management strategies
(Davidson & Everett, 2015). The nurse will also assure the
patient is consuming the prescribed medicines on time that
will improve her health outcome.
References
Ahtisham, Y., & Jacoline, S. (2015). Integrating Nursing Theory and
Process into Practice; Virginia's Henderson Need Theory. International
Journal of Caring Sciences, 8(2).
Caplan, L. R. (Ed.). (2016). Caplan's stroke. Cambridge University
Press.
Davidson, P., & Everett, B. (2015). Managing approaches to nursing
care delivery. Transitions in nursing: preparing for professional
practice. Chatswood, New South Wales, Australia: Elsevier Health
Sciences, 125-142.
Fryer, C. E., Luker, J. A., McDonnell, M. N., & Hillier, S. L. (2016). Self
management programmes for quality of life in people with stroke.
Cochrane Database of Systematic Reviews, (8).
Mendelow, A. D., Lo, E. H., Sacco, R. L., FAAN, M. M. F., & Wong, L. K.
(2015). Stroke: pathophysiology, diagnosis, and management. Elsevier
Health Sciences.
Middleton, S., Coughlan, K., Mnatzaganian, G., Low Choy, N., Dale, S.,
Jammali-Blasi, A., ... & McElduff, P. (2017). Mortality reduction for
fever, hyperglycemia, and swallowing nurse-initiated stroke
intervention: QASC Trial (Quality in Acute Stroke Care) follow-up.
Stroke, 48(5), 1331-1336.
Nijsse, B., van Heugten, C. M., van Mierlo, M. L., Post, M. W., de Kort,
P. L., & Visser-Meily, J. M. (2017). Psychological factors are associated
with subjective cognitive complaints 2 months post-stroke.
Neuropsychological rehabilitation, 27(1), 99-115.
Sajjad, A., Mirza, S. S., Portegies, M. L., Bos, M. J., Hofman, A.,
Koudstaal, P. J., ... & Ikram, M. A. (2015). Subjective memory
complaints and the risk of stroke. Stroke, 46(1), 170-175.
Sposato, L. A., Cipriano, L. E., Saposnik, G., Vargas, E. R., Riccio, P. M.,
& Hachinski, V. (2015). Diagnosis of atrial fibrillation after stroke and
transient ischaemic attack: a systematic review and meta-analysis.
The Lancet Neurology, 14(4), 377-387.
Erikson theory
• According to the Ahtisham & Jacoline (2015), Erikson’s
developmental theory includes 8 development stage which
helps the person to gain the sense of identity.
• It is a psychological development process from the childhood
to the adulthood.
• All the stage of the psychological development, experiences
certain psychological crisis which pose a negative impact on
the health of the patient.
• In this case, belle lost her husband, who used to take care of
her. Death of her husband might be the reason behind her
aggressive nature.