Case Study Analysis: Comprehensive Care Plan for Stroke Patient

This case study analyzes the case of a patient who suffered a stroke, focusing on ischemic stroke. The analysis begins with an introduction to strokes, including the causes, prevalence, and associated symptoms. It details the diagnostic process, emphasizing the importance of CT scans and neurological assessments to determine the extent of the brain damage. The study outlines the patient's symptoms, including high blood pressure, smoking history, and diabetes, and justifies the likelihood of an ischemic stroke. A significant portion of the analysis is devoted to the interventions required, highlighting the need for a multidisciplinary approach involving rehabilitation nurses, physical therapists, occupational therapists, speech therapists, and psychologists. The importance of patient education, particularly regarding glucose level management, is also emphasized. The conclusion reiterates the importance of thorough assessment and a collaborative care approach to improve the patient's quality of life and facilitate recovery.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the student:
Name of the university:
Author note:

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CASE STUDY ANALYSIS
Introduction:
Cerebrovascular accidents or stroke is mainly seen to occur when the artery supplying
blood to the brain is blocked or are ruptured and thereby begins to bleed. The former condition is
called the ischemic stroke or the later one is called the hemorrhagic stroke. These might result in
the gradual dying of the brain that not only leads to sudden impairment of the ranges of actions.
Stroke is often associated with the causing of paralysis on the different parts of the body that are
usually controlled with the area of the brain where the stroke had affected (Campbell et al.,
2015). Different types of speech problem and other symptoms are also seen to occur such as
vision, swallowing and even thinking. Researchers are of the opinion that stroke is preventable
because most of its risk factors are mainly modifiable like that of the high pressure, abdominal
overweight and obesity, physical inactivity as well as tobacco smoking (Arch et al., 2016). The
assignment is mainly based on the case study of a patient who had been affected by the stroke.
Proper assessment and care plan would be developed for him in order to ensure best quality life.
Prevalence of stroke in the nation:
In the year 2012, 2% of the people of the nation of Australia had been seen to have faced
a stroke at some point of their lives which gives an estimation of about 377000 people. Most of
the affected individuals for about 71% were aged over 65 while the prevalence of stroke had
more or less remains the same over the last 15 years. Data shows that in the year 2013 to 2014,
about 37000 hospitalizations had taken place with the diagnosis of acute stroke and about 28000
patients who took rehabilitation services. The stroke hospitalization rates were seen to be more
common among the males than the female that was about 1.3 times higher (Powers et al., 2015).
United Kingdom also shows similar rates of cardiovascular accidents stating more than 10000

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strokes occurring every year with around one stroke occurring in every five minutes. This had
been the fourth single leading cause of death in the UK. The average age for the occurrence of
stroke in males in UK is 74 and that is about 76 in that of the females. Over 40000 people have
been seen to have died from stroke in the year 2015and the situation is seen to be similarly grave
in both the nation.
Diagnosis and the assessment:
The CT scan should be one of the first tests that need to be done in order to undertake
stroke evaluation. This test is mainly seen to be helpful in the determining of the different arenas
of abnormalities in the brain. This should be extremely helpful in the determining the areas,
which have insufficient blood, flow as in case of ischemic stroke or also helps to show if there is
any rupture of blood vessels as in case of hemorrhage (Rizos et al., 2015). These had been
conducted for the patient which showed the proves of left cerebrovascular accident, with
increased density in the left middle and cerebral artery and possible early signs of edema.
Neurological assessment needs to be done in order to find out the needs and requirements
of the patients and accordingly would help the professionals to develop the care plan for the
patient help in him to come back to normal flow of life. The initial evaluation of the neurological
assessment is mainly based on comprehensive procedures that cover many critical arenas. These
would mainly include analyzing the level of consciousness. These would cover the domains of
being alert, drowsy, and stuporous or coma. The patient was found to be conscious but was not
being able to answer as his communication capability had impaired (Saber et al., 2017). After
evaluating the level of consciousness, the professionals should analyze the orientation phase
seeing whether the patient is able to give correct answer to places like hospitals and city and the

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CASE STUDY ANALYSIS
time like month or year. The patient was not being able to answer but was nodding head to
answer close-ended questions that helped to know whether the patient was oriented or not. The
speech of the patient also needs to be assessed. The patient would be asked questions that should
be both expressive and receptive in order to consider that the patient was normal. The patient
might be asked about different questions regarding objects, what they are used for and others.
The patient must also obey and answer different questions like closing of the eyes, pointing to
ceiling and others to find out whether he is receptive or not. All these would help in
understanding his neurological condition and the care that he would be requiring. Glasgow
comma scale is also a helpful tool that might be helpful in this situation (Powers et al., 2018).
Moreover, the assessment of the pupil size, equality as well as shape both before and after the
exposure of the light should be included in the neurological assessment of the patient.
Researchers are of the opinion that unequal as well as dilated pupils helps in providing warning
signs of the different increasing of the intracranial pressures. The patient is suspected to have
homonymous hemianopia and this test would help in finalizing on it.
The healthcare professionals should also be conducting a bedside neuro-assessment. This
would help in the evaluation of the sensory functions and at that time, the patient needs to be
cooperative as well as oriented. The face, arm, and leg of the patient should be assessed where
the professionals should be providing instructions to the patients should follow. The
professionals should note down the performance of the patients accordingly. In case of the
comatose patients, painful or other noxious stimulus needs to be provided towards the central
part of the body (Berkhemer et al., 2015). This might include trapezius muscle squeezing, or
application of supra-orbital pressure. Then the motor response should be noted. Here, in the

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CASE STUDY ANALYSIS
patient in the case study, face, arm and leg motor tests should be done to understand the
performance and accordingly develop interventions.
The patient is believed to have suffered from ischemic disorder
Signs and symptoms of the patient Justification for ischemic or hemorrhagic stroke
The patient has high blood pressure These symptoms show that both stroke might occur
and cannot be the indicating factor.
The patient smokes higher number of cigarettes Strong causes both types of stroke and therefore,
this symptom cannot justify the stroke type.
Another symptoms is that he has ill managed high
blood glucose level
Researchers are of the opinion that people with
diabetes are four time more likely to develop
carotid artery which in turn increases chances of
ischemic stroke (Holliday et al., 2015).
The patient had the history of congestive heart
failure
Researchers have conducted studies that patients
who have congestive heart disorders are more
prone to develop ischemic strokes.
Interventions:
The patient suffering from stroke requires multidisciplinary treatment as the nursing
professionals themselves would not be able to provide specialized treatments that experts of
different backgrounds can provide. The rehabilitation nurses should be providing direct care to
the patient and would educate the patient and the families about the disabilities that the patient is
facing. They should be also helping the patient by medication administration, ensuring the daily

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CASE STUDY ANALYSIS
activities of lives of the patients and similar other care. They would be coordinating among all
the members to ensure smooth flow of communication and coordination among the multi-
disciplinary teamwork. The physical therapists should be evaluating as well as treating the
problems that the patient would face with moving, coordination as well as balancing (Sposato et
al., 2015). They would help the patient by providing training for their improvement of the
walking, getting out of the bed, sitting on a chair, moving around without losing of the balances.
The occupational therapist should be helping the patients to learn ways by which they can
conduct normal activities of life like that they used to do before stroke affected them. This would
be helping them in developing activities like eating, bathing, dressing, cooking, writing and
many others. The speech language therapist would be also working with the patient. The patient
is having aphasia and he would help the patient to get back his language skills and thereby
develop the ways to communicate. They would be also helping the patient in developing
swallowing techniques if the patient is identified with dysphasia or difficulty or impairment in
swallowing (Kleindorfer et al., 2015). The patient might also need the support of psychologist.
Traumas that stroke results might cause anxiety, depression, anger and disappointment in the
patient and in such conditions, psychologists would be helping the patient to develop better
quality life. Besides, the nurses should educate the patients about the ways by which glucose
levels need to be maintained and follow the teach-back process to ensure compliance (Kishore et
al., 2014).
Conclusion:
From the above discussion, it is seen that for patients who suffer ischemic strokes, it is
very important for the nursing professionals to undertake proper neurological, sensory as well as
motor assessment. Accordingly, nursing professionals need to work with multi-disciplinary

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system so that all the needs and requirements of the patients are met helping them to get back in
normal quality lives.

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References:
Arch, A. E., Weisman, D. C., Coca, S., Nystrom, K. V., Wira III, C. R., & Schindler, J. L.
(2016). Missed ischemic stroke diagnosis in the emergency department by emergency
medicine and neurology services. Stroke, 47(3), 668-673.
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.
Holliday, E. G., Traylor, M., Malik, R., Bevan, S., Falcone, G., Hopewell, J. C., ... &
Boncoraglio, G. B. (2015). Genetic overlap between diagnostic subtypes of ischemic
stroke. Stroke, 46(3), 615-619.
Kishore, A., Vail, A., Majid, A., Dawson, J., Lees, K. R., Tyrrell, P. J., & Smith, C. J. (2014).
Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a
systematic review and meta-analysis. Stroke, 45(2), 520-526.
Kleindorfer, D., Khoury, J., Alwell, K., Moomaw, C. J., Woo, D., Flaherty, M. L., ... & Kissela,
B. M. (2015). The impact of Magnetic Resonance Imaging (MRI) on ischemic stroke
detection and incidence: minimal impact within a population-based study. BMC
neurology, 15(1), 175.

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Powers, W. J., Derdeyn, C. P., Biller, J., Coffey, C. S., Hoh, B. L., Jauch, E. C., ... & Meschia, J.
F. (2015). 2015 AHA/ASA focused update of the 2013 guidelines for the early
management of patients with acute ischemic stroke regarding endovascular treatment: a
guideline for healthcare professionals from the American Heart Association/American
Stroke Association. Stroke, STR-0000000000000074.
Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker,
K., ... & Jauch, E. C. (2018). 2018 guidelines for the early management of patients with
acute ischemic stroke: a guideline for healthcare professionals from the American Heart
Association/American Stroke Association. Stroke, 49(3), e46-e99.
Rizos, T., Quilitzsch, A., Busse, O., Haeusler, K. G., Endres, M., Heuschmann, P., & Veltkamp,
R. (2015). Diagnostic work-up for detection of paroxysmal atrial fibrillation after acute
ischemic stroke: cross-sectional survey on German stroke units. Stroke, 46(6), 1693-
1695.
Saber, H., Yakoob, M. Y., Shi, P., Longstreth Jr, W. T., Lemaitre, R. N., Siscovick, D., ... &
Mozaffarian, D. (2017). Omega-3 fatty acids and incident ischemic stroke and its
atherothrombotic and cardioembolic subtypes in 3 US cohorts. Stroke, 48(10), 2678-
2685.
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.
Van Der Hoeven, E. J., Dankbaar, J. W., Algra, A., Vos, J. A., Niesten, J. M., Van Seeters, T., ...
& Velthuis, B. K. (2015). Additional diagnostic value of computed tomography perfusion

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for detection of acute ischemic stroke in the posterior circulation. Stroke, 46(4), 1113-
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