Managing Stroke: Prioritization of Health Issues and the Nurse's Role

This report focuses on the complex health issues arising from an acute ischaemic stroke in a 65-year-old patient with pre-existing conditions like hyperlipidaemia, hypertension, and type 2 diabetes. The report identifies and prioritizes three potential health issues: potential for aphasia, potential for seizure, and impaired physical mobility, with aphasia given the highest priority due to its impact on communication and quality of life. The rationale behind each prioritization is discussed, highlighting the risks and complications associated with each condition. Furthermore, the report emphasizes the crucial role of nurses in managing these health issues through interdisciplinary collaboration, specific communication strategies for aphasia, seizure risk minimization, and interventions to improve physical mobility and prevent complications. The report concludes by underscoring the importance of comprehensive nursing care, medication management, and mental health support for stroke patients.

Complex health issues

Table of Contents
INTRODUCTION...........................................................................................................................3
Identification of health issues..........................................................................................................3
Prioritisation of health issues and rationale.....................................................................................4
Nurse’s Role.....................................................................................................................................5
REFERENCES................................................................................................................................7

INTRODUCTION
Complex health issues includes those illness which result in progressive deterioration in
health condition over time and often requires care from several specialist which include
emotional, social, mental health interventions (Runnels et.al., (2022)). Generally the person with
two or more chronic condition have complex health issue in which condition due to one health
issue hinder the conditions of other issue. The complex chronic condition generally include
cancers, heart diseases, chronic respiratory diseases, diabetes. This report is about Robyn Stewart
who is 65 year old lady and she suddenly collapsed at home and taken to hospital in ambulance.
After analysing the medical history it has been found that she has a medical history of
hyperlipidaemia, hypertension, and type 2 diabetes. While examining in emergency department
she had a right side facial droop, dysarthria, right sided limb weakness and incomprehensible
sound. Based on CT brain angiography she was diagnosed by territory acute ischaemic stroke in
Left middle cerebral artery (MCA). This report is going to discuss about three different health
problems on the basis of priority level, the rationales and the role of nurses while taking care of
Robyn.
Identification of health issues
With the diagnosis of left middle cerebral artery territory acute ischaemic stroke, several
health problem may hinder the treatment procedure for Robyn (Bettencourt & Ferro (2020)).
Three potential health issues are:-
 Impaired physical mobility
A physical state that affects their body motion ranges and restricted the independence of motility
are termed as Impaired Physical mobility. The stroke leads to permanent disability and
complication in movement. According to the presented case scenario the lady has a weaknesses
in right side limb and not adequate muscle strength. This all reflects that she is physically
impaired and this stroke will impact on the quality of her life (Zhang & et.al., (2020)).
 Potential for Aphasia
It is a disorder which will affect the communication ability. This will affect the ability of speech
along with the ability to write and understand languages. As per the case scenario the lady has
face droop, weakness, dysarthria and incomprehensible sounds. Similarly, her evaluation shows
that her cranial nerves (VII, IX, AND XII) are damaged which are accountable for sensational

and motorial working of facial expression, ability of smell, taste and also the ability to
communicate puts her at risk of having, this deficits will lead to mild or severe aphasia (Kumar
& Roy, J. (2018)).
 Potential for seizure
It is a sudden and uncontrollable electric dis-balance in the brain. It changes the behaviour,
movement and consciousness level. A stoke can affect the brain which result in disturbance of
electrical activity which leads to seizure. As the lady is fallen suddenly and loss of
consciousness, It reflects a potential of seizure (Shen (2021)).
Prioritisation of health issues and rationale
Potential for Aphasia should be on the top of the priority list. It is common and can be
analysed within the first few hour after experiencing acute ischaemic stoke. As per the case
scenario the lady has face droop, weakness, dysarthria and incomprehensible sounds. Similarly,
her evaluation shows that her cranial nerves (VII, IX, AND XII) are damaged which are
accountable for sensational and motorial working of facial expression, ability of smell, taste, and
ability to communicate. As the lady is unable to perform the motor functioning, the patient is not
able to consume the essentials which leads to poor quality of life, prolong the stay in hospital and
exist as a burden for care giver. The patient with Aphasia is not able to communicate properly
this will increases the confusion between the patient and the care giver. As the aphasia
progressed, it can lead to memory loss. The patient suffering from aphasia are not able to speak
or complete a sentence, they speak unrecognizable word, they get confused with what they read,
they are not able to understand the sentences thus they face difficulties in understanding the
people's conversation. This will enhance the frustration level in both the care giver and the
patient. This will hinder the satisfaction level of the patient (Tan & et.al., (2022)).
The chances of seizure is increased after the stoke in elderly patients. Thus this could be
prioritised at second position. According to the Petra Ehling, The lack of oxygen and glucose are
reasoned to be key intermediator for the neuron degeneration. The ischaemic stroke occur due to
an disruption of blood supply within the proportionate area of brain, initiating the ischaemic
cascade. The reduction of oxygen or glucose in brain tissue bring forth a series of irrelevant
events that result in neuron degeneration. This could lead to permanent disability and this ionic
asymmetry leads to permanent cell death. An alteration in intracellular calcium ions and sodium
ion with a resulting lower threshold for depolarisation, glutamate excitotoxicity, hypoxia,

metabolic dysfunction, hypo-perfusion and hyper-perfusion injury have all been claimed as
supposed neuron functional cause. This all can lead to seizure. Brain get damaged after the stoke
and the injury in the brain forms the scar tissue which ultimately affect the electrical
conductivity in brain which can lead to seizure. Due to ischemia of brain tissue after stroke,
excess amount of glutamate is released and there is over activation of post- synaptic glutamate
receptor which will lead to enhance excitability in neuron and a state of irritation in the brain.
This make the brain susceptible to seizure (Han (2020)).
Physical fitness is highly hindered by the stroke. In Robyn case the impaired physical
mobility is prioritized at third position. By prioritizing this the risk of falling is prevented and the
Robyn independency can be increased. When the patient is not able to perform the daily activity
and spend the maximum time on bed puts stroke patient at risk of having falls, skin break down,
reduced blood flow, urinary retention, depression, stiffness, anxiety, muscular atrophy,
constipation, and several other co morbidities. This health condition will act as a barrier in the
Robyn's care ad hinder the recovery procedures. Furthermore, several studies have suggested that
patient those have physical limitation can face severe health issues like hyperlipidaemia, T2DM,
and hypertension. Robyn have a symptoms of peripheral oedema which has impacted the muscle
movement. This should not be ignored in Robyn’s care as it may get induced with some other
severe complications such as pulmonary embolism, Deep Vein Thrombosis (DVT), decreased
cardiac and respiratory vital capacity (Bunschoten &et.al., (2022)).
Nurse’s Role
Nurses are at frontline in delivery the care for the Stroke patient. They play a crucial role
in identifying and managing the Aphasia in stroke patient. Nurses should make a goal and
engage with collaborative approach with inter-disciplinary team in the management of aphasia to
support needs and irritability or frustration due to aphasia. Different inter-disciplinary team
involves Speech Pathologist, Physiotherapist, Occupational Therapists, Dieticians, Respiratory
Physicians, and Gastroenterologists. while communicating with the patient who have aphasia
problem the nurses should present a single thought or idea at a time. For example a question
which can be answered in either Yes or No. when possible provide them choices but not too
many choices at once. The visual cues will also help them well. Nurses should breakdown the
instruction into small steps so that they can easily understand it. The Nurses should more time to
understand the instruction and change the activity when the patient is becoming frustrated. The

nurses should encourage the patient to use the other ways for communicating such as pointing,
writing, drawing and hand gestures. Robin is already referred for speech pathologist (Wong &
et.al., (2020)).
In order to minimise the risk of seizure the nurses should understand the factor that are
contributing top the possibility of trauma and will ready with the action which should be taken
while seizure. The nurses should maintain the treatment plan to control or eliminate the seizure
attack and also understand the disorder or other stimuli which have potential to increase the
seizure. The nurses should promote the airways by maintaining lying position, turning head to
side during attack. The post-stroke patient are bed bounded for various days so nurses should
reposition her every two to four hours which helps blood flow and minimize risk of pressure
injury. Nurses should do falls risk assessment and refer Robyn to the physiotherapist to help
identify the appropriate mobility status of her after stroke (Sandberg & et.al., (2021)).
In order to minimize the risk of immobility, the patient to mobilized by their own. sitting
up, proper ambulation, dangling, and transfer to chair should be implemented for the patient
according to the circumstances. This will encourage the patient to perform the daily activity. The
nurses should encourage the patient to perform light exercise this will support the cardiac health
also. Nurses should engage a team to identify the mental status of the patient. The patient must
be referred to counselling service as they might be feeling emotionally distressed. The nurses
should conduct assessment and maintain documentation which inform the other team member
about the patient condition. Nurses should be aware about the indication, uses and side effects of
medication and should follow eight patient’s medication rights as per their scope of practice
(Youngerman & et.al., (2020)).

REFERENCES
Books and Journals
Bettencourt, S., & Ferro, J. M. (2020). Acute ischemic stroke treatment in infective endocarditis:
systematic review. Journal of Stroke and Cerebrovascular Diseases, 29(4), 104598.
Bunschoten, J. W &et.al., (2022). Sudden death and cardiac arrythmia with lamotrigine: a rapid
systematic review. Neurology, 98(17), e1748-e1760.
Han, I. W. (2020). Behavioral and Psychological Symptoms in Vascular Cognitive Impairment.
In Stroke Revisited: Vascular Cognitive Impairment (pp. 43-59). Springer, Singapore.
Kumar, N., & Roy, J. (2018). CLASSIFICATION OF ISCHEMIC STROKE. The Protocol
Book for Intensive Care, 454.
Runnels, P et.al., (2022). A Longitudinal, Relationship-Based Model for Managing Complex
Chronic Disease in the Medicaid Population. Population Health Management, 25(4),
535-541.
Sandberg, C. W & et.al., (2021). Counseling in aphasia: Information and strategies for speech-
language pathologists. American journal of speech-language pathology, 30(6), 2337-
2349.
Shen, W. C. (2021). Medical Imaging of Ischemic Stoke. In Diagnostic Neuroradiology (pp.
135-192). Springer, Singapore.
Tan, C & et.al., (2022). Effect of Continuous Nursing Model Based on WeChat Public Health
Education on Self-Management Level and Treatment Compliance of Stroke Patients.
Iranian Journal of Public Health, 51(5), 1040.
Wong, S. P & et.al., (2020). Planning for a safe discharge: more than a capacity evaluation.
Journal of the American Geriatrics Society, 68(4), 859-866.
Youngerman, B. E & et.al., (2020). Patterns of seizure prophylaxis after oncologic neurosurgery.
Journal of Neuro-Oncology, 146(1), 171-180.
Zhang, Y & et.al., (2020). Prevalence and risk factors governing the loss of muscle function in
elderly sarcopenia patients: a longitudinal study in China with 4 years of follow-up. The
journal of nutrition, health & aging, 24(5), 518-524.