Nursing Case Study: Stroke Assessment, Management, and Comparison

This nursing case study focuses on Mr. Sam Kwon, a 74-year-old man presenting with stroke symptoms. The assignment begins by outlining the incidence and prevalence of ischemic stroke in Australia and compares it to the USA, citing statistical data and trends. The study then delves into the assessment findings, including neurological, sensory, and motor assessments, analyzing the patient's vital signs, and diagnostic results such as CT scans and BGL. The discussion emphasizes the rationale behind the observed assessment data. Finally, the assignment explores nursing and interprofessional care and management strategies for stroke patients, emphasizing evidence-based practices to prevent complications. This includes fall prevention, DVT prophylaxis, edema management, promotion of self-care, and monitoring vital signs, with a focus on adequate nutrition and aspiration precautions. The study highlights the importance of comprehensive understanding and management of stroke to improve patient outcomes.

Running Head: NURSING CASE STUDY 1
Nursing Case Study
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NURSING CASE STUDY 2
Nursing case study
Introduction
Stroke is a condition in which the brain cells die suddenly due to lack of oxygen. It is
caused by blockage of blood flow to the brain either by ruptured arteries or blood clot (D’Souza,
Butcher, & Buck, 2018). In the case study, Mr. Kwom is suffering from stroke. The common
signs and symptoms of stroke include sudden weakness or numbness of the face, arm or leg .It
mostly happen on one side of the body. Other signs and symptoms include difficulty in speaking
and confusion. Globally, stroke is the second leading cause of death (Feigin, Norrving, &
Mensah, 2017). The purpose of this assignment is to describe the prevalence and incidence of
CVA in Australia and USA, assessment and management of the condition.
A comparison of the Incidence and prevalence of ischemic CVA between Australia
and the United States of America
According to data from the Australian Bureau of Statistics in 2015,394,000 Australians
experienced stroke at some given moment in their lives (Australia Bureau of Statistics, 2018).
Out of these, 199,000 were males while 195, were females. The estimated prevalence of stroke
as at 2016 was 1.7% (Lynch, Mackintosh, Luker, & Hillier, 2018). In 2015 alone, 36,700 cases
of stroke were reported in Australia translating to approximately 100 cases each day. In 2015,
more than 56,000 new and current cases of stroke were recorded in Australia (Newbury et al.,
2016). It is estimated that by 2050, more than 1million people in Australia will be suffering from
the condition (Kilkenny, Churilov, & Cadilhac, 2017). The indigenous Australians are 1.4 times
more likely to be hospitalized and die from stroke as compared to the non-indigenous Australians
(Leyden et al., 2013). The trends are quite significant.

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In the United States of America, stroke is the third leading cause of death. It is estimated
that more than 140,000 people die from the condition annually (Joffres et al., 2013).
Furthermore, more than 795,000 people suffer from stroke. Out of the 795,000,600,000 are new
attacks while the remaining 185,000 are recurrent attacks (Koton et al., 2014). Three quarters of
the cases normally occur in individuals above 65 years. The death rates from stroke are higher
among the African-Americans as compared to the whites. Averagely, a new case of stroke in the
country happens after each 40 seconds. In 2006, stroke accounted for a single death out of 17
deaths in the country (Koton et al., 2019). The risk of ischemic stroke is double among smokers
as compared to the non-smokers. Atrial fibrillation also increases the risk of stroke in USA by
fivefold. The incidence and prevalence of stroke in USA is slightly lower than that of Australia
("Internet stroke center," n.d.). This is due to intense campaigns and policies in USA whose
target is to lower blood pressure and reduce smoking. The rate of smoking in Australia is still
high due to the presence of indigenous Australians and this contributes to the high rates of the
condition.
Assessment of findings for the case
Nursing assessment is used to note current and future patient care needs. It is a systematic
process with five essential steps. For a patient with potential stroke, the assessment process
sequentially follow each other from A-G. During the process of assessment, both subjective and
objective data are obtained. Example of subjective data include numbness, headache, and pain,
nausea, and dizziness, difficulty in swallowing and decreased sensation (Brown and Edwards,
2015). Objective data on the other hand include hemiparesis, aphasia and facial droop,
hemiplegia, ataxia, vomiting, increased secretions, incontinence and dysphagia. From the case
study, the A-G assessment was conducted and most of the data was abnormal. To start with, the

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airway was patent and unobstructed while breathing was spontaneous. While assessing for
breathing, supplemental oxygen was provided at 21/min while the respiration rate was 24.The
saturation for oxygen on the other hand was 96%. According to studies the normal respiration
rate for an adult is between 12 to 20 breaths per minute. However in this case, the respiration rate
was 24 which is quite abnormal and diagnostic of stroke. Neurological assessment was
conducted by the use of CT scan which revealed a probable left cerebrovascular accident.
Sensory assessment on the other hand was conducted by asking some questions which the patient
would only answer by nodding his head. Motor assessment was described by the family
members who did not establish the insult since he was found late last night.
During stroke, low amount of oxygen reach the brain due to reduced blood flow. The
patient therefore has to breathe faster so as to make up for the low levels of oxygen reaching the
brain and this is why the patient in this case had a high respiration rate of 24. This is also the
rationale why supplemental oxygen was provided at 21/min. The circulation pulse was 98 while
the blood pressure was 140/105.This is high blood pressure since the normal blood pressure is
140/80 (Bullock, Hales and Manias, 2018). The high blood pressure in this case is as a result of
the body to try and repair the cerebral perfusion to the ischemic tissue. The patient is also unable
to speak and only responds to close ended questions. Furthermore, he could not see the left. This
is due to the fact that stroke affects one side of the brain yet it is the opposite direction of the
brain that controls the body. In this case, stroke attacked the right side and the patient could
therefore not see the left.
Crystalloid fluids were also provided due to heart failure. Ischemic stroke is characterized
by a clot (Wang, Lin, Huang, Chen, & Hsieh, 2017). This reduce blood flow and the brain tissue
and heart begins to die gradually leading to heart failure. This is the rationale for providing

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crystalloid fluids in the case study. Stroke generally alters the normal functioning of the muscles
since it destroys the nerves in the brain (Brown and Edwards, 2015). This in return leads to
muscle weakness down on one side, a condition known as hemiparesis. Spasticity also affects the
weakened muscles mostly in arms and hands. This is the reason why the patient could not
swallow. The BGL in the case study was 9.4mmol/L. This is higher than the recommended level
(Goyal et al., 2015). This could be the risk factor for stroke since it causes a buildup of plaque in
blood vessels. The patient also had facial drooping and this is caused by damage of the nerves
that control muscles in the face. This nerves are also in the brain.
Nursing and inter-professional care and Management for the case
Stroke is associated with different complications such as aspirations, falls, malnutrition,
contractions and subsequent stroke. The aim of the nursing and inter-professional care
management of stroke is to prevent such complications. There are different evidence based
management of stroke (Thompson, 2015). There is the need to prevent the risk of falls. Studies
note that patients who experience stroke are likely to fall and get injured. The health care
professionals should therefore ensure that they provide non-skid socks, place the bed in a low
locked position just to ensure that the patient does not fall off. Prevention of contractions is also
necessary. Different studies link stroke to paralysis of the extremities and can easily become
contracted. The nurse should therefore ensure that the patient is supported by pillows and their
hands rolled in a towel and other adaptive devices just to ensure that they do not contract. DVT
prophylaxis should be initiated as early as possible. This can either be mechanical or chemical
(Miller, 2017). This pharmacological management prevents the risk for subsequent strokes since
the patient won’t be as mobile as they are at the baseline. Patients who suffer from stroke are
also at risk of edema and it is essential that nurses and inter-professionals collaborate to prevent

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edema. This can be achieved through elevation of limbs. Other methods include ambulation, use
of compression stockings and complete emptying of the bladder. Patients with underlying heart
conditions such as atrial fibrillation that decrease cardiac output experience difficulties in
clearing fluids especially when in bed and the nurses should therefore ensure that such patients
are placed in a comfortable position just to prevent accumulation of fluids within the body.
Promoting self-care is another important management of stroke. Patients suffering from
stroke will have low ability to take good care of themselves as a result of the new deficits. The
healthcare professionals should therefore ensure that they assist the patient develop confidence
and participate in taking care of themselves. It is also important that they provide adaptive
devices and alternate strategies for ADLs. Stroke also leads to neurological damage and nurses
should ensure that they promote cerebral tissue perfusion (Miller, 2017). However, this nursing
intervention normally differ depending on the type, location and other factors of the stroke.
Monitoring of vital signs such as Blood pressure is also necessary. Monitoring of the blood
pressure is necessary in managing Intracranial Pressure so that there is appropriate cerebral
perfusion pressure. Adequate nutrition is also necessary since it facilitates the healing process. If
the patient is therefore cleared to eat, the nurses should encourage the patient to eat as much as
possible. Aspiration is common among patients suffering from stroke. This is due to impaired
swallowing. It is therefore necessary to keep HOB at 45 degrees during oral intake (Thompson,
2015). The patient should also be kept in an upright position after a meal. Suction should be
available as well as assessment of both lung sounds and body temperature. Before an Oral intake,
it is necessary to consult speech therapy for swallow evaluation. This is due to a likelihood of
dysphagia and aspirations. Brain injuries lead to impaired swallowing. The nurse should
therefore conduct a bedside swallow evaluation.

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Conclusion
Stroke is one of the leading causes of death globally. It is therefore necessary that nurses
or rather all health professionals understand the assessment and management of the condition to
prevent further effects or mortality brought about by the complications of the condition such as
aspirations or recurrent strokes.
References
Australia Bureau of Statistics. (2018). Australia's Health 2018. Retrieved from
https://www.aihw.gov.au/getmedia/56bb591f-6c56-4397-b928-8de6872e2cdd/aihw-
aus-221-chapter-3-7.pdf.aspx
Bullock, S., Hales, M. and Manias, E., (2018). Principles of Pathophysiology +
Fundamentals of Pharmacology. Pearson Australia.
Brown, D. and Edwards, H., (2015). Lewis's Medical-Surgical Nursing: Assessment and
Management of Clinical Problems (4th Ed.). Elsevier.
D’Souza, A., Butcher, K. S., & Buck, B. H. (2018). The Multiple Causes of Stroke in Atrial
Fibrillation: Thinking Broadly. Canadian Journal of Cardiology, 34(11), 1503-1511.
doi:10.1016/j.cjca.2018.08.036
Feigin, V. L., Norrving, B., & Mensah, G. A. (2017). Global Burden of Stroke. Circulation
Research, 120(3), 439-448. doi:10.1161/circresaha.116.308413
Goyal, M., Demchuk, A. M., Menon, B. K., Eesa, M., Rempel, J. L., Thornton, J., …
Hill, M. D. (2015). Randomized Assessment of Rapid Endovascular Treatment of
Ischemic Stroke. New England Journal of Medicine, 372(11), 1019-1030.
doi:10.1056/nejmoa1414905

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Joffres, M., Falaschetti, E., Gillespie, C., Robitaille, C., Loustalot, F., Poulter, N., …
Campbell, N. (2013). Hypertension prevalence, awareness, treatment and control in
national surveys from England, the USA and Canada, and correlation with stroke and
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(2016). Stroke Epidemiology in an Australian Rural Cohort (SEARCH).
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