Patient Teaching Plan for Stroke Prevention: Evidence-Based Intervention

This report discusses an evidence-based intervention for stroke prevention and a teaching plan for patients to effectively utilize the intervention to promote health and well-being. Sedentary lifestyle is a modifiable risk factor for stroke, and physical activity is often targeted to prevent stroke. The report identifies one evidence-based intervention to eliminate modifiable risk factors and develop a teaching plan for the patient. The report also discusses the implementation and evaluation of the teaching plan.

Running head: PATIENT TEACHING PLAN 1
RN Health Assessment
Marilyn Hall Lawrence
Chamberlain College of Nursing
NR305 Health Assessment
June 9, 2018

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Introduction
Lifestyles and dietary patterns play a role in the prevalence of many preventable diseases,
and identification of modifiable risk factors is important to promote behavioral change for people
at risk of diseases. Based on the review of health history of the client’s health history from the
milestone 1 assignment, the patient is at risk of stroke (preventable disease). This can be said
because the patient has a history of hypertension and high cholesterol, which are medical risk
factors for developing stroke. She is also taking aspirin and Clopidogrel medications to prevent
stroke. One modifiable risk factor associated with the risk of stroke in a patient is an inactive or
sedentary lifestyle. Physical activity is often targeted in a patient to prevent stroke and premature
death (Arboix, 2015). The main purpose of the report is to identify one evidence-based
intervention to eliminate the modifiable risk factors and develop a teaching plan for the patient to
effectively utilize the intervention to promote health and well-being.
Preventable Disease Overview
Stroke is a medical condition associated with sudden onset of weakness, paralysis,
disturbed speech and aphasia caused the sudden interruption of blood flow to the brain area. This
lack of blood flow to the brain mainly results because of blockage or narrowing of the arteries
(Caplan, 2016). Some common symptoms include speech difficulty, paralysis, gait disturbance
and blurred vision and the symptoms may vary individually based on the region of the brain
which is affected. Smoking, high blood pressure, high cholesterol, and a diagnosis of diabetes
also increases the risk of stroke. The presence of high cholesterol, hypertension and uncontrolled
diabetes in the adult participant also helps to identify that the adult participant is at risk of stroke.
Arboix (2015) explains that hypertension is the leading risk factor for cerebrovascular disease.
Hence, controlling hypertension is necessary for prevention of stroke.

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The diagnosis of stroke can be done by physical examination, blood test, CT scan, MRI
or echocardiogram. A CT scan and MRI can help to get a detailed view of the brain and identify
damage to the brain tissue caused by ischemic stroke and brain hemorrhage. In addition, blood
tests can help to detect levels of blood sugars and blood clotting time to diagnose strokes (Urden,
Stacy & Lough, 2017). Physical assessment to identify patients with stroke also includes getting
the patient’s medical history, stroke’s cause and assessment of the degree of neurological deficit
in the patient (Jarvis, 2016). Physical examination is essential to rule out differential diagnosis
and identify the prognosis or complication in the patient (McGee, 2016).
Evidence-Based Intervention
The adult participant is at risk of developing stroke because of the presence of several
modifiable risk factors such as hypertension and diabetes. In patients with diabetes and
hypertension, sedentary lifestyle is one factor that increases the risk of high blood pressure and
cardiovascular disease. Lack of physical activity levels influence the mortality and morbidity
related to chronic diseases (Ezeugwu, Garga & Manns, 2017). According to Saunders, Mead,
Fitzsimons, Kelly, van Wijck, Verschuren & English, (2018) interventions to increase physical
activity are the most common recommendation for stroke rehabilitation and secondary
prevention. The study by Boysen et al. (2009) describes one evidence- based intervention to
promote physical activity in patients at risk of stroke. It used behavioral approach to motivate
stroke survivors to increase their physical activity levels. The main rationale for choosing this
intervention was that it looked to address the barrier to participation in physical activity
programmes and foster motivation in patient to promote behavioral change. The advantage of
behavioral intervention is that tailored intervention can be developed to eliminate barriers and

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provide the right support for addressing sedentary behavior (Morris, MacGillivray, & Mcfarlane,
2014). These interventions can be most effective for patients at risk of stroke.
The study by Boysen et al. (2009) was a randomized, controlled trial which aimed to
provide repeated encouragement and verbal instruction related to physical activity to the
intervention group. In contrast, the control group received only information related to need for
exercise without any specific instruction. The intervention group received in-depth instruction
during the training sessions with trial physiotherapist. The first session focused on developing
rapport with patients and evaluating their knowledge regarding risk of stroke. The aim of the first
session was to identify most suitable physical activity for participants. In the next phase, the
physical activity programme was individualized as per each patient’s resource, former activity
level and preferences. Participants were encouraged to engage in physical activity by using
fitness centers, walking, swimming and exercising in local center. Follow-up visits with
participants were done every three months and every six months to reinforce the behavior.
Telephone call was also used as a strategy to remind them about the physical activity arguments.
The evaluation of changes in physical activity before and after the intervention revealed an
improvement in walking ability; however no significant changes in physical activity. Hence, the
intervention needs to be modified by including one or two specific exercises that promote
behavioral change in patient.
Based on this discussion, it is necessary that a nurse set effective care priorities for the
client and identify a strategy that can increase the ease with which the adult participants can
perform physical activity. The short term goal for care of patients will be to change attitude and
behavior towards physical activity and to reduce hypertension and high cholesterol. The long

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term goal for patient will be to sustain positive behavioral change such as engagement in
physical activity to reduce risk of stroke.
Implementation: Teaching Plan
I plan to use the behavioral intervention to make the adult participants aware about the
benefits of different exercises on health outcomes and increasing the chances of survival.
However, based on initial session of interview with participants and identifying their capacity to
engage in physical activity, I plan to provide the patient with only one structured physical
activity plan to increase the effectiveness of the activity on health. As aerobic exercise has the
potential to reduce all cardiovascular risk factors, the plan is to include aerobic exercise in the
patient’s care plan to increase physical activity. Most stroke rehabilitation lacks training on
aerobic exercise (Billinger et al. 2015). However, inclusion of these in the rehabilitation process
can improve cardio--respiratory fitness and walking endurance. It is planned to provide all
information to patient related to frequency, intensity and timing of the exercise as per individual
assessment. Low intensity exercise will be provided to patient with no motor impairment, and
high intensity will be provided to those who can sustain exercise for long duration.
Evaluation
To evaluate the effectiveness of the teaching plan, follow up with participants will be
done regarding adherence with the exercise session. Furthermore, improvement in physical
activity level will be judged by number of hours spent in exercise and the barrier found during
the process. Other important criteria for the success of the teaching plan will be to assess
improvement in clinical indicators like hypertension and sugar levels.

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Summary
The report gave an insight into the process of managing and preventing disease like
stroke by addressing modifiable risk factors for the disease. Sedentary life style was regarded as
one of the common causes behind risk of stroke. As physical activity is lacking in many stroke
rehabilitation programs, the study utilized one evidence-based intervention related to behavioral
strategies in order to change patient attitudes towards physical activity and promote behavioral
changes in the patient.

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References
Arboix, A. (2015). Cardiovascular risk factors for acute stroke: Risk profiles in the different
subtypes of ischemic stroke. World Journal of Clinical Cases: WJCC, 3(5), 418.
Billinger, S. A., Boyne, P., Coughenour, E., Dunning, K., & Mattlage, A. (2015). Does Aerobic
Exercise and the FITT Principle Fit into Stroke Recovery? Current Neurology and
Neuroscience Reports, 15(2), 519. http://doi.org/10.1007/s11910-014-0519-8
Boysen, G., Krarup, L. H., Zeng, X., Oskedra, A., Kõrv, J., Andersen, G., ... & Winkel, P.
(2009). ExStroke Pilot Trial of the effect of repeated instructions to improve physical
activity after ischaemic stroke: a multinational randomised controlled clinical
trial. BMJ, 339, b2810.
Caplan, L. R. (Ed.). (2016). Caplan's stroke. Cambridge University Press.
Ezeugwu, V. E., Garga, N., & Manns, P. J. (2017). Reducing sedentary behaviour after stroke:
perspectives of ambulatory individuals with stroke. Disability and rehabilitation, 39(25),
2551-2558.
Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO:
Saunders/Elsevier.
McGee, S., 2016. Evidence-Based Physical Diagnosis E-Book. Elsevier Health Sciences.
Morris, J. H., MacGillivray, S., & Mcfarlane, S. (2014). Interventions to promote long-term
participation in physical activity after stroke: a systematic review of the
literature. Archives of physical medicine and rehabilitation, 95(5), 956-967.

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Saunders, D.H., Mead, G.E., Fitzsimons C., Kelly P., van Wijck F., Verschuren O., & English
C. 2018. Interventions for reducing sedentary behaviour in people with stroke
(Protocol). Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.:
CD012996.
Urden, L.D., Stacy, K.M. & Lough, M.E., (2017). Critical Care Nursing-E-Book: Diagnosis and
Management. Elsevier Health Sciences.