Nursing Management of Acute Ischemic Stroke: A Case Study Report

This report presents a detailed analysis of a stroke case scenario involving a 65-year-old patient, Deborah Anderson, admitted with acute ischemic stroke, hypertension, and Type II Diabetes Mellitus. The report identifies and prioritizes three key patient health issues, including acute ischemic stroke, Type II Diabetes Mellitus, and Hyperlipidaemia. The prioritization is supported by current literature and rationales are provided for the ranking of each health issue. The report outlines the nurse's role in addressing these priority health issues through assessment, coordination of care, and provision of care, relating the discussion to nursing and healthcare regulatory frameworks and health department policies, such as RN Standards for Practice and National Safety and Quality Health Service (NSQHS) standards. The report emphasizes the importance of immediate medication and treatment for acute ischemic stroke, along with the management of diabetes and hyperlipidaemia to improve patient outcomes. The report also highlights the need for comprehensive nursing interventions, including patient positioning, communication support, and medication management, to ensure the patient's wellbeing. This report provides a comprehensive overview of nursing care in the context of a stroke case, emphasizing the importance of evidence-based practice and adherence to healthcare standards.

Stroke case scenario

Table of Contents
TASK...............................................................................................................................................1
Identify a total of three patient health issues from ONE of the case scenarios that nurses can
address within their scope of practice. You may include ‘risk for’ or ‘potential for’ health
issues.......................................................................................................................................1
Rank the three patient health issues that were selected in part 1 in order of priority. Provide a
rationale for the order of the rankings. The rationale must be supported with current literature.
................................................................................................................................................2
Outline the nurse’s role in addressing the top three priority patient health issues using
assessment, coordination of care and provision of care. Relate the discussion to nursing and
healthcare regulatory frameworks and health department policies e.g. RN Standards for
Practice, NSW health policy, National Safety and Quality Health Service (NSQHS) standards
etc...........................................................................................................................................4
REFERENCES................................................................................................................................7

TASK
Identify a total of three patient health issues from ONE of the case scenarios that nurses can
address within their scope of practice. You may include ‘risk for’ or ‘potential for’ health
issues.
Considering the given case of Deborah Anderson, it has been identified that she has admitted in
the emergency department due to acute ischaemic stroke. It is observed that patient has fallen off
and not able to hold the cup of tea with having slurred speech. However, her husband took her to
the hospital where nursing staff has been admitted her in emergency department due to severe
condition. It includes that patient has been suffered from some of other health problems as they
have medical history of Hyperlipidaemia, Hypertension and Type II Diabetes Mellitus which
should be considered while treating the problem of stroke (Schlick and Peyras, 2019). The
selected patient has three health issues such as acute ischaemic stroke, hypertension and Type II
Diabetes Mellitus which are required to be considered to treat the problem of stroke for making
individual stable by their health. Meanwhile, the acute ischaemic stroke refers to a condition of
sudden loss of blood circulation to an area that result in a corresponding loss of neurologic
function (Jurado and et. al., 2020). The acute ischaemic stroke is caused due to thrombotic or
embolic occlusion of a cerebral artery as well as is more common than haemorrhagic stroke. It
includes to criterion of treating the ischemic stroke by making accurate decision of medication to
make the patient wellbeing.
In addition to this, it is observed that Deborah Anderson has other health problem including
hypertension and Type II Diabetes Mellitus which are required to be considered by care
professionals to establish care plan. It is necessary to manage the condition of hypertension and
Type II Diabetes Mellitus by providing effective medications which helps to recover the
condition of acute ischaemic stroke for welfare of patient. Meanwhile, it is observed that proper
treatment or medication of Diabetes type II must be focussed because ignorance of diabetes is
responsible for reducing the ability of body to recovery fast from the condition of acute
ischaemic stroke (Dalen and Alpert, 2016).
It is necessary for care professionals to treat the previous health problems such as
Hyperlipidaemia, Hypertension and Type II Diabetes Mellitus. It will provide support to increase
the capability of human body to easily recover from acute ischaemic stroke otherwise negligence
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of these diseases may develop complications for an individual (Kim, Nogueira and Haussen,
2019). Moreover, it will facilitate to enhance the condition of patient and helps to avoid the
relevant complications in order to make the health condition stable completely.
Rank the three patient health issues that were selected in part 1 in order of priority. Provide a
rationale for the order of the rankings. The rationale must be supported with current
literature.
In context of given case scenario, the rank of three health issues can be set via their level of
complexity. It includes that Hyperlipidaemia is on rank 3, Hypertension has rank 4 and Type II
Diabetes Mellitus has rank 2 whereas acute ischaemic stroke has rank 1 which are required to be
considered for providing desired care practitioners (Gibson, 2019).
Stroke refers to a condition of medical emergency in which damage to the brain occurred that is
responsible for interrupting of its blood supply. It includes the condition developed because the
blood supply has been interrupted or reduced to brain and preventing brain tissue from getting
sufficient amount of oxygen as well as nutrients (Franco, 2018). In context of this project, it is
based on the case scenario of patient named Deborah Anderson having age of 65 years and
unable to lift teacup to her lips with her right hand during breakfast. She has slurred words and
off her chair to the right hand side due to which admitted in emergency department. This
assignment will focus on health problems from which given patient has been suffered and nurse
scope of practice to improve client condition. It will also include the arrangement of the health
problems on priority with rationale of respective rankings to provide appropriate care for patient
wellbeing. The role of nursing staff in order to treat relevant health problems of selected patient
by conspiring assessment, coordination or care and provision care is given here.
Meanwhile, it is necessary for care professionals to formulate more effective as well as efficient
care plan by making accurate decision making of treatment in respect of making patient
wellbeing (Mokin and et. al., 2017). It is required to provide immediate medication and treatment
for acute ischaemic stroke on priority for making health condition of given patient effectively.
However, it has been evaluated that effective treatment for other health problems should be
provided for managing the overall health condition of patient.
It is very important to continue the medication for addressing the condition of Type II Diabetes
as it is favourable to improve the recovery rate in terms of improving the condition of client.
Moreover, the acute ischaemic stroke is required to be treated on priority rather than other health
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problems because it is a severe condition and immediate care is must for making patient
condition stable. It is observed that negligence of this health problem may responsible for
developing the severe complications which can be difficult to be manage clinically in appropriate
way (Nasseri and et. al., 2020).
Priority 1: Acute ischaemic stroke has rank 1
 It includes to change the positions of patient within every 2 hours to improve her physical
mobility along with managing neutral position of them
 It is necessary to pad the chair seat with foam or water filled cushion and assist client to
shift weight at frequent intervals.
 It consist support client to produce simple sounds initially and provide alternative method
of communication like writing, pictures so that that can share about their problems to care
providers.
 It is required to treat the respect of injury of given patient and provide pain killer if
necessary to improve their condition.
Priority 2: Type II Diabetes Mellitus has rank 2
 It includes assessing feet for temperature pulses, colour and sensation and assessing
pattern of physical activity to provide appropriate therapy.
 It is necessary to monitor signs of hypoglycaemia and administer basal as well as prandial
insulin to improve patient condition.
 It is required to monitor urine albumin to serum creatinine for renal failure and instruct
patient to avoid heating pads and wear shoes always while walking.
 It is effective to use some of medications such as sulfonylureas, meglitinides, biguanides,
phenylalanine derivatives, alpha glucosidase inhibitors and incretin modifier.
 It is important to provide insulin as per direction of physician to manage the appropriate
levels of blood glucose.
Priority 3: Hyperlipidaemia is on rank 3
 It is necessary to reduce the body weight by using yoga or physical work out on daily
basis.
 It is required to consider the practice of regular walking in the early morning and in the
evening for better health condition.
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 It is necessary to prevent patient from any kind of substances abuse including alcohol,
smoke and drug abuse.
 It is required to reduce the total amount fat in food items eaten on daily basis with regular
meals.
 It is necessary to assist client to increase fruits, salad and fibre in their meals daily which
impact positively to treat the condition of hyperlipidaemia.
On the other hand, it is observed that first priority is acute ischaemic stroke problem which
should be treated on priority and then care professionals should focus on the condition of type II
diabetes in order to manage the health appropriately. It includes that diabetes can be considered
as severe health problem which is responsible for reducing the ability of human body to
overcome easily with health problem as it impact negatively to slowing the recovery rate of them
(Goyal and et. al., 2017). It is required to focus on proper treatment and medication related to
diabetes for managing the appropriate sugar levels on blood so that other health problems can be
recover as soon as possible. However, the other problem to be focussed is Hyperlipidaemia
which should be focussed to avoid relevant complications for patient which helps to gain
improved patient outcomes. It can be considered as a clinical condition in which there are high
levels of fat particles (lipids) in the blood that develop problem in easy flowing of blood to
different parts of body via blood vessels. Moreover, the final health problem is hypertension
which may impact negatively on recovery process of ischemic stroke them it should managed in
effective manner.
Outline the nurse’s role in addressing the top three priority patient health issues using
assessment, coordination of care and provision of care. Relate the discussion to nursing
and healthcare regulatory frameworks and health department policies e.g. RN Standards
for Practice, NSW health policy, National Safety and Quality Health Service (NSQHS)
standards etc.
Considering the top three health problem of Deborah Anderson, it has been identified that
nursing staff plays an important role in terms of managing the actual health problem for making
patient comfortable. It is necessary for nursing staff to follow regulatory frameworks and health
department policies as they are efficient to deliver appropriate care by avoiding risk as well as
clinical errors.
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Nursing role: It includes several roles of nurses including assessment of health condition,
diagnosis, and formulation of care plan, therapeutic relationship, treatment and other support to
client for improving their overall health condition. However, it includes the criterion of
considering several factors like effective assessment, coordination of care and provision of care
to provide accurate facilities for their wellbeing (Santos and et. al., 2019).
Nursing intervention: It includes the criterion of formulation clinical interventions in order to
treat the health problem for given patient. It is necessary to establish the care interventions for
every disease in order to treat them effectively. However, the nursing staff plays an important
role to carry out appropriate assessment of Deborah Anderson to evaluate the presence of health
issues with their level of complexity to formulate accurate decision making of treatment to make
them wellbeing.
Care plan: The nursing staff has an important role to formulate more effective as well as
efficient care plan via considering respective health problems of patient. It is necessary for nurse
to consider patient centred approach for making accurate clinical strategies and interventions to
apply them. Meanwhile, it is required to use evidence based practices which are favourable to
ensure effectiveness of care plan in order to make an individual wellbeing.
Nursing standards: Meanwhile, it involves the necessity of considering RN standards of
practice that are mentioned here. It includes to think critically & analyses nursing practice,
engages in therapeutic & professional relationships and maintains the capability for practice. It
consist to comprehensively conducts assessments, provide safe, appropriate & responsive quality
nursing practice and evaluates the outcomes to inform nursing practice (Crockett, Phillips and
Chiu, 2019).
Health policy: They nursing staff has an important role to follow the NSW health policy to
maintain the clinical documents and provide guidelines documents to staff so that they can
follow desired criterion and deliver accurate healthcare services for wellness of Deborah
Anderson. However, it is very important responsibility of care professionals to consider the
standards provided by NSQHS in terms of providing appropriate medication as well as treatment
to people for their wellness (García-Tornel and et. al., 2020). It includes number of quality
standards such as high prevalence adverse events, healthcare associated infections, medication
safety, comprehensive care, clinical communication, the prevention & management of pressure
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injuries, the prevention of falls and responding to clinical deterioration respectively (Ashton and
et. al., 2020).
Guidelines: The guidelines for nurse include care standards, quality standards ethics and legal
framework which must for followed by them while providing care to patient. It is necessary to
consider ethical principles like informed consent, beneficence, honesty, trustworthiness, justice
and confidentiality. However, these guidelines are beneficial to deliver accurate care and ensure
positive patient outcomes respectively.
From the above assignment, it has been concluded that stroke can be described gas severe health
condition which needs immediate treatment otherwise patient may acquire extremely
complicated health condition. It is necessary to conduct effective assessment to diagnose the
actual health problem and formulate effective acre plan for making an individual wellbeing.
However, it is very important for nursing staff to follow the regulatory frameworks and standards
of care which facilitate to reduce the chance of occurring clinical errors and facilitate effective
care for patient.
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REFERENCES
Books and journals
Franco, J., 2018. Imaging and Treatment of Strokes. Radiologic technology, 89(6), pp.549-568.
Schlick, S. and Peyras, V., 2019. Multi-professional care and treatment of strokes. Revue de
l'infirmiere, 68(248), pp.42-43.
Dalen, J.E. and Alpert, J.S., 2016. Cryptogenic strokes and patent foramen ovales: what's the
right treatment?. The American Journal of Medicine, 129(11), pp.1159-1162.
Mokin, M. and et. al., 2017. Endovascular treatment of middle cerebral artery M2 occlusion
strokes: clinical and procedural predictors of outcomes. Neurosurgery, 81(5), pp.795-802.
Goyal, N. and et. al., 2017. Admission systolic blood pressure and outcomes in large vessel
occlusion strokes treated with endovascular treatment. Journal of neurointerventional
surgery, 9(5), pp.451-454.
Santos, T. and et. al., 2019. NCCT and CTA-based imaging protocol for endovascular treatment
selection in late presenting or wake-up strokes. Journal of neurointerventional surgery, 11(2),
pp.200-203.
Crockett, M.T., Phillips, T.J. and Chiu, A.H.Y., 2019. Dual suction Headway27 microcatheter
thrombectomy for the treatment of distal intracranial arterial occlusion strokes: initial experience
with the micro-ADAPT technique. Journal of neurointerventional surgery, 11(7), pp.714-718.
García-Tornel, Á. and et. al., 2020. Sudden Recanalization: A Game-Changing Factor in
Endovascular Treatment of Large Vessel Occlusion Strokes. Stroke, 51(4), pp.1313-1316.
Nasseri, I. and et. al., 2020. Ischemic Strokes in Anticoagulated Patients: Treatment Failure or
Alternate Etiology?(734).
Kim, S.J., Nogueira, R.G. and Haussen, D.C., 2019. Current understanding and gaps in research
of carotid webs in ischemic strokes: a review. JAMA neurology, 76(3), pp.355-361.
Jurado, P.G. and et. al., 2020. Treatment of posterior circulation strokes by mechanical
thrombectomy with a stent-retriever: a retrospective observational study at a single
centre. Radiología (English Edition), 62(1), pp.51-58.
Gibson, M.I., 2019. Effective Strategies for Recognition and Treatment of In-Hospital Strokes.
Ashton, C. and et. al., 2020. Implementation of a prealert to improve in-hospital treatment of
anticoagulant-associated strokes: analysis of a prehospital pathway change in a large UK
centralised acute stroke system. BMJ Open Quality, 9(2), p.e000883.
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