Patient Care With Stroke Assesment

Running head: PATIENT CARE WITH STROKE
Introduction to the assessment and management of acute and longterm physical and
mental health condition
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PATIENT CARE WITH STROKE1
Stroke, conventionally associated with a life-long disability or death, is now perceived
as treatable with growing interventions in the traditional models of care. Evidence suggests
that better prevention measures in the primary stage result in highly effective outcomes. This
paper is based on the case of Joan, a 65 years old individual who experienced a stroke. This
paper discusses the various dimensions of her stroke which include an overview of stroke and
its pathophysiology, risk factors, assessment strategies, immediate treatment response, the
role of a multidisciplinary team and finally, suggests recommendations to keep Joan’s
symptoms under control.
A stroke may be characterized as the sudden loss of the cells in the brain because of a
deficiency of oxygen in that particular region of the brain, mainly caused by the disruption of
an artery or a block in the flow of blood to the brain. Classically, it may be defined as a
neurological attack associated with the central nervous system (CNS) due to vascular reasons
such as cerebral infarction, subarachnoid haemorrhage (SAH) and intracerebral haemorrhage
(ICH) (Mendelow et al. 2015). Stroke is regarded as one of the most widespread causes of
disability and, in extreme cases, mortality in the United Kingdom. Approximately 32,000
deaths per year due to strokes are recorded in the UK. Of these, 59% of strokes occur in the
people of the older age group (Gov.UK, 2020).
Two main types of strokes, which include ischemic stroke and hemorrhagic stroke,
are identified. Ischemic stroke is a transient brain attack in which the blood circulation to a
specific part of the brain stops, which results in neurological dysfunction. It is the most
common type of stroke, constituting 80% of all strokes. The pathology of this type of stroke
has evolved considerably over the last three decades, with early studies on animal samples
followed by a transition to human bodies. Most of this research focuses on proximal
occlusion in the middle cerebral artery (MCA). As the flow of blood is interrupted to the
basal ganglia, cortex, as well as white matter, leads to the emergence of hypoperfusion. Parts
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PATIENT CARE WITH STROKE2
with the highest levels of hypoperfusion represents the ischemic core and may result in
severe, irreversible damages (Jickling et al. 2010). The remaining tissue within
hypoperfusion demonstrates the disablement of the regular blood flow mechanisms.
Pathophysiologically, it is classified into two compartments, called the penumbra and
oligaemia. In the penumbra, the cerebral blood flow (CBF) is preserved while the oxygen
extraction factor (OEF) is raised. The cerebral blood volume (CBV) remains normal or might
be elevated. The penumbral tissues are the chief therapeutic targets. On the other hand, in the
oligaemia, hypoperfusion levels are comparatively milder than penumbra. The level of
oxygen consumption is standard while the levels of CBV and OEF are raised. The risk of
infarction, in this case, is less (Khoshnam et al. 2017).
On the other hand, a hemorrhagic stroke involves bleeding or haemorrhage in the
brain, which intervenes with the normal functioning of the brain. It accounts for
approximately 20% of the total brain strokes. The haemorrhage may occur either in the brain,
which is called intracerebral haemorrhage or in the region between the skull and the brain,
known as the subarachnoid haemorrhage. In an intracerebral haemorrhage, a broken blood
vessel inside the brain causes the bleeding or different types of strokes may ultimately lead to
bleeding within the brain. Sometimes, this bleeding causes accumulation of blood which
flows into space in between the brain and the skull and ultimately fuses with the
cerebrospinal fluid. This causes an intense headache as the fusion builds pressure on the
brain. Within a few days, the infection spreads to the neighbouring arteries causing a spasm,
which destroys the neural tissues (Brainin and Heiss 2019).
There are a variety of risk factors responsible for the occurrence of a brain stroke.
Most of these factors are based on gender, age and family history and are uncontrollable. Age
is a vital determinant, as many other diseases are present in older adults (Zuhaid et al. 2014).
Atrial fibrillation, the most common disease among the older generation, is a significant risk
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PATIENT CARE WITH STROKE3
for stroke. However, the lifestyle also influences the onset of a stroke to some extent.
Cigarette smoking, excessive alcohol consumption, obesity, physical inactivity, diabetes and
high blood pressure are some of the lifestyle-based factors that stimulate strokes.
Among these factors, hypertension or increased blood pressure in the arteries is a
significant risk for stroke. Hypertension thickens the walls of the arteries which makes the
lumens narrow. An extremely small lumen resists the flow of blood and results in ischemic
stroke. Another means of blockage of the arteries is by the accumulation of debris while the
circulation of blood in patients with atherosclerosis. The collected debris blocks the path of
the blood and, again, result in ischemic stroke (Lackland and Weber 2015). The risk of stroke
by hypertension can be minimized for Joan by modifying her lifestyle. These changes include
maintaining a healthy diet, regular physical activities, limit the intake of alcohol, take
medicines that control hypertension, such as antihypertensive drugs, most importantly quit
smoking.
Smoking is major factor that increases the risk of stroke by four times. Cigarettes
contain nicotine and carbon monoxide, which cause atherosclerosis, ultimately narrowing the
arteries. Also, smoking cigarettes make the blood thicker than usual and stimulate the
secretion of highly sticky platelets and other clotting factors. The smoke also constricts the
walls of the arteries preventing the flow of blood (Nordahl et al. 2014). Chain smokers like
Joan, need a proper strategy to quit smoking and lower the risk of strokes, especially the ones
with multiple diseases or family history with a severe disorder, like the case of Joan.
The most accepted approach for immediate clinical assessment of critical patients,
such as Joan, is the ABCDE method. ABCDE stands for airway, breathing, circulation,
disability and exposure. This method does not require any medical equipment or device for
assessment and is clinically used in emergencies such as emergency wards, intensive care
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