Comparison of Stroke Prevention Strategies

The provided document appears to be an assignment related to stroke prevention and treatment strategies. It includes references to various studies and articles on the topic, such as the RE-SPECT ESUS trial, left atrial appendage closure, and endovascular thrombectomy. The assignment may involve comparing and analyzing different approaches to preventing and treating strokes, including oral anticoagulants, thrombin inhibitors, and conscious sedation vs general anesthesia for endovascular procedures.

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Nursing Care
Name of the student
University name
Author’s note

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Table of Contents
Introduction............................................................................................................................2
Section 1:................................................................................................................................2
Patient background.....................................................................................................................2
Reason for admission.................................................................................................................3
Diagnosis....................................................................................................................................3
Past medical history...................................................................................................................3
A-E assessment of the patient with expected findings typical of embolic stroke......................4
Section 2:................................................................................................................................5
Pharmacological treatment for embolic stroke..........................................................................5
Evidence based rationale for medication and nursing care........................................................5
Conclusion..............................................................................................................................7
References..............................................................................................................................8

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Introduction
The current assignment focuses on the nursing care practices for the management of
Embolic stroke. Embolic stroke could be referred to the condition when a blood clot which
forms elsewhere in the body travels to the brain via the blood stream. It blocks the adequate
supply of blood to the brain leading to ischemic stroke. This cuts off the required amount of
oxygen and nutrients from reaching the brain. Some of the factors which further increase the
chances of contraction of the disease are- being over 40 years of age, possessing autoimmune
disease such as diabetes, presence of heart disease (Holmes Jr et al., 2015). Cerebrovascular
accidents (CVA) are one of the biggest killers in Australia. It has been found that 80% of the
strokes could be prevented which in turn adds up to a sufficient amount of healthcare costs
(Mozaffarian et al., 2016). Therefore, effective nursing care could be designed for control and
management of the condition of the patient. The assignment discusses in detail the efficacy of
evidence based pharmacological intervention methods.
Section 1:
Patient background
In the current assignment we have focussed upon medication management and
nursing care for embolic CVA. For designing of an effective care management the patient
background needs to be taken into consideration (Hart et al., 2014). Here, the patient was a 58
year old man named John who had been brought and admitted to the hospital on grounds of
feeling numbness in his rights hands along with speech difficulty and light headedness. He
worked as a construction site engineer with Quality enterprises and solutions located in the
Osborne region of New South Wales. As reported by his family John had normally reported
to work for the day. However, he started feeling uncomfortable in the afternoon and was

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unable to work till he started feeling dizzy and had numbness in his right arms. Later he was
admitted the daffodils hospital on encountering blurred vision, slurred speech.
Reason for admission
John had been feeling dizzy at his place of work and had difficulty in breathing. He
later on developed slurred speech and blurred vision which made work difficult for him. His
fellow workers felt that he needed immediate medical intervention and got him admitted to
the hospital. John was immediately attended by a resident doctor. He reported that John
had poor pulse rating, high BP along with slow breathing. The patient also reported signs of
face muscle twitching along with slurred speech. Therefore, based upon these symptoms he
was shifted to the medical examination room.
Diagnosis
Based upon the range of a number of clinical symptoms such as slurred speed, blurred
vision, numbness in the right hands which gradually spread to the entire arm along with face
muscle twitching and dizziness, John was suspected of embolic stroke. The tool used in order
to access the condition of the patient was the FAST framework. Here, FAST stands for face,
arms, speech and time. Here, the patient exhibited constant face muscle twitching along with
difficulty in raising both his arms straight. Therefore, the preliminary diagnosis was given
that the patient might be experiencing an embolic stroke. Therefore, the patient was
suggested a blood test a along with CT scan. The CT scan confirmed the presence of
ischemic stroke in the penumbra region of the brain.
Past medical history
The diagnosis of the past medical history of the patient plays a crucial role in the
designing of effective care treatment for the patient. Here, John had a past history of

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hypertension and high blood cholesterol. On further investigations, it was found that he had
previously fallen unconscious in his place of work an had to be given artificial oxygen.
Therefore, based upon the past history of hypertension the patient was put under emergency
care for embolic stroke symptoms management and prevention.
A-E assessment of the patient with expected findings typical of embolic stroke
An A-E assessment of the patient was conducted for analysing the physical condition
of the patient. Here, A refers to airway, B for breathing, C for circulation, D for disability and
E for exposure.
Attributes Effects
A- Airway The patient had difficulty in breathing stressing upon the need
for mechanical ventilation. Once the airway had been inserted
into the patient the see-saw movement of the chest stops in the
patient.
B- breathing The patient recorded SpO2 level of 84% which is
comparatively low whereas the normal SpO2 is expected to
remain somewhere between 94% to 99% .The falling of the
SpO2 level below 84% point towards the administration of
artificial oxygen support.
C-circulation The patient recorded high blood pressure along with difficulty
in breathing.
D-disability The patients had slurred speech and difficulty in talking. He
could only answer to the inquiries made by the doctor by
making eye gestures.
E- exposure The patient further recorded temperature around 38.2 degree

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centigrade which was slightly higher than the normal.
Preliminary diagnosis: The patient could be suffering from an embolic CVA.
Section 2:
Pharmacological treatment for embolic stroke
The pharmacological treatment for stroke could be divided into- stroke-specific
treatment and stroke prevention. As commented by Ruff et al. (2014), the treatment process
further varies depending upon the nature of the stroke whether it is ischemic or hemorrhagic.
Some of the pharmacotherapeutic options are tissue plasminogen activartor (tPA) and
antiplatelet agents. It was found that the ones receiving tPA were more likely to have minimal
or no disability after several months of treatment (DeBaun et al., 2014). Anti platelet agents
such as aspirin have been found to be effective for the treatment of acute ischemic stroke.
The aspirin therapy should begin within 24-48 hours of the acute ischemic stroke (Berkhemer
et al., 2015). The secondary treatment addresses the prevention of recurrences of the
symptoms of stroke by controlling some of the metabolic risk factors namely blood pressure
and lipids. The use of diuretics along with angiotensin –converting inhibitor enzyme has been
seen to be beneficial.
Evidence based rationale for medication and nursing care
The medication provided for the management of the conditions of embolic stroke
could be justified with the help of a number of supportive theories and arguments. Evidence
based approaches have proved that revasculiarization of the ischemic brain and arousing
sleep neurons can improve outcomes in patients with acute stroke (Campbell et al., 2015).
The two major drug classes used over here are thrombolytic and antiplatelet agents.

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Currently one of the approved drugs which are used is tissue plasmionogen activator (t-PA)
alteplase, which results in reperfusion by dissolving the thrombus (Saver et al., 2016). The
affectivity of the drug supplied depends on the effectiveness of delivery to the damaged
channel. As supported by Diener et al. (2015), if tPA is administered within three hours of
onset of stroke improved functional outcome is observed. As supported by Schönenberger et
al. (2016), administration of low molecular weight heparins have been further seen to lower
the risk of thrombocytopenia or osteoporosis in the patient.
tPA has been rated as the Gold standard for the treatment of ischemic cerebral
stroke. It works by dissolving blood clot and improving the flow of blood to the brain. As
reported by Doucet, Roncarolo, Tampieri & del Pilar Cortes (2016), patients who have got
tPA administration on time have been seen to recover better than the one who had not
received the drug therapy at the right time. The after treatment could be started with the right
doses of administration of anticoagulants. The anticoagulants have been seen to interfere with
the blood capacity to clot (Nikoubashman et al., 2017). Therefore, improving the supply of
blood to the brain and can be used an effective preventive measure. In this respect, the
chances of recurrence are most common in the patient within 90 days of suffering a first
stroke. Therefore, in order to control the rate of the fatalities it is necessary to put the patient
on anti-coagulants.
In this respect, employment of trained nursing professionals trained in the areas of
acute stroke management could be beneficial. Additionally, using frameworks such as Fast
can r help the nurse analyse the condition of the patient. As mentioned by Anderson, Saleemi
& Bialystok (2017), effective record keeping and documentation has also been seen to
enhance the process of drug delivery and monitoring in the patients. However, the nursing
professional should ensure that permission have been sought from the respective family
members of the patients before putting them through any aggressive care procedures.

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Conclusion
The current assignment focuses on the concept of nursing care provision and
management for embolic stroke. The patient has suffered an embolic stroke and had to be
provided immediate care provision and management. In this respect, effective caution needs
to be practised regarding the administration of the medications to the patient. For the
preliminary examination of the condition of the patient a FAST framework was followed.
Form the diagnosis it was ascertained that the patient could be having an embolic stroke.
Hence, the patient was put under further blood tests and CT scan, which confirmed the
presence of Embolic stroke in the patient. The assignment also discusses the effectiveness of
different medications. Some of these have been discussed with regards to the rate of success
in controlling the progression through the condition of embolic stroke. More emphasis had
been given to tPA administration which if provided within a particular time frame can reduce
the severity of the stroke.

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References
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cognitive aging in monolingual and bilingual older adults. Journal of
neurolinguistics, 43, 17-27.
Berkhemer, O. A., Fransen, P. S., Beumer, D., Van Den Berg, L. A., Lingsma, H. F., Yoo, A.
J., ... & van Walderveen, M. A. (2015). A randomized trial of intraarterial treatment
for acute ischemic stroke. New England Journal of Medicine, 372(1), 11-20.
Campbell, B. C., Mitchell, P. J., Kleinig, T. J., Dewey, H. M., Churilov, L., Yassi, N., ... &
Wu, T. Y. (2015). Endovascular therapy for ischemic stroke with perfusion-imaging
selection. New England Journal of Medicine, 372(11), 1009-1018.
DeBaun, M. R., Gordon, M., McKinstry, R. C., Noetzel, M. J., White, D. A., Sarnaik, S.
A., ... & Telfer, P. T. (2014). Controlled trial of transfusions for silent cerebral
infarcts in sickle cell anemia. New England Journal of Medicine, 371(8), 699-710.
Diener, H. C., Easton, J. D., Granger, C. B., Cronin, L., Duffy, C., Cotton, D., ... & Sacco, R.
L. (2015). Design of Randomized, double-blind, Evaluation in secondary Stroke
Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor
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Undetermined Source (RE-SPECT ESUS). International Journal of Stroke, 10(8),
1309-1312.
Doucet, C., Roncarolo, F., Tampieri, D., & del Pilar Cortes, M. (2016). Paradoxically
decreased mean transit time in patients presenting with acute stroke. Journal of
computer assisted tomography, 40(3), 409-412.

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Hart, R. G., Diener, H. C., Coutts, S. B., Easton, J. D., Granger, C. B., O'Donnell, M. J., ... &
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