Nursing Case Study: Exploring Psychological Impact of Stroke Illness

This case study presents an analysis of Grant Baker, a 60-year-old Torres Strait Islander, who suffered a stroke. The study details his pre- and post-hospitalization conditions, including risk factors like smoking, lack of exercise, and family history. It explores the behavioral and psychological responses to the stroke, such as post-stroke depression, physical impairment affecting activities of daily living, catastrophic reactions, emotional problems, and denial of his condition. The study also discusses the importance of addressing these psychological factors in patient management, suggesting interventions like Cognitive Behavioral Therapy (CBT) and supportive social networks. It highlights the need for healthcare providers to pay attention to emotional problems and implement comprehensive treatment approaches, including medication and non-medication practices, to improve patient outcomes. The case study concludes by emphasizing the role of rehabilitation, social interaction, and educational materials in helping patients accept their condition and manage their limitations.

Running head: STROKE ILLNESS 1
Stroke Illness
Student’s Name
Professor’s Name
Institution Affiliation
Date

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Case Presentation
Stroke is a condition that occurs when flow of blood is occluded in a part of brain. The
disruption of oxygenated blood causes a damage to the cells of brain hence causing disabling
influence on an individual. Grant Baker being of older age and from Torres Strait Islander
Descent was more prone to stroke. Tracing the family history of Baker his grandfather was from
Fiji where stroke is a common occurrence. The main cause of Baker’s stroke may be due to
stress from the death of his mother and father, divorce and having no child. His long smoking
habit, lack of exercise, overweight and being not active since he had retired increased the
chances of stroke to occur (Feigin et al, 2016).
Before hospitalization Grant had presented possible signs of stroke like
hypercholesterolemia, hypertension and transient ischemic attack about six weeks ago. Grant had
been presented to Broome hospital after he had suffered from cerebrovascular accident at sleep
which confirmed the presence of stroke. At Perth hospital, Grant portrayed symptoms of stroke
like increased hypertension, increased heart beat rate, increased respiratory rate, decreased
muscle tone and hyperreflexia. At hospitalization, Baker was diagnosed of stroke and the results
confirmed that he suffered from stroke. Later after hospitalization he displayed signs of stroke
like feeling exhausted at night, complaining of being overwhelmed from friends and families
visits and due to this he becomes restless and agitated, teary when speaking, incapacity to rest
during the day, denial of his conditions, depression and continuous quarrels with health care
providers (IST-3 Collaborative Group, 2015).
Behavioral and psychological responses

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The physical damage of the brain that is as a result of stroke causes many behavior and
psychological responses. It is because parts of brains controls how our body functions. Examples
of behavioral and psychological effects of stroke as presented in the case scenario include;
Post stroke depression. Post stroke depression is a common incidence for a person
suffering from stroke. The common symptoms of post stroke depression include; lack of
interests, disturbed appetite, disturbed sleep, reduced energy, feeling guilt, thoughts of suicide or
death and psychomotor retardation or agitation (Micaela Silva et al, 2016). Prior conditions like
excessive alcohol intake and divorce increases the likelihood of post stroke depression occurring.
Depression is also associated with cognitive distortions. Therefore, a person who believes he will
not get better or feels his conditions are uncontrollable is at high chances of experiencing
depression. Grant chances of experiencing depression is increased by divorce and excessive
alcohol intake. He portrayed symptoms and signs of post stroke depression like eating problems,
inadequate sleep, and thoughts of death since he believed he will not get better.
Physical impairment. Stroke affects a person ability to carry out normal activities of daily
living (ADLs), the patient experience difficulties when conducting daily activities. Difficulties in
carrying out ADLs may be as a result of poor coordination, influence of paralysis and lack of
awareness. As presented in the case scenario Baker is unable to carry out activities like dressing
himself, cooking and writing (Nicholson et al, 2014).
Catastrophic reactions and Emotional problems. Stroke causes pseudobulbar affect and
catastrophic reactions. Patients portray emotional glitches like sudden anger, aggression or
crying, sudden anxiety, and uncontrollable laughing. Catastrophic reactions are the emotional
reactions a patients present when unable to carry out a task resulting from neurologic deficits.
The conditions mainly arises due to disturbing thoughts concerning the stroke and the feelings of

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hopelessness and helplessness. The emotional glitches causes overwhelming which causes
moodiness. Studies show that most people who suffer from stroke are more likely to experience
emotional hitches because stroke affects brains which controls our emotions. Grant has portrayed
emotional problems as he feels overwhelmed by the continuous visits from friends and families.
Also, Grant emotional problems is portrayed when he had an outburst with a staff due to feeling
of restlessness and agitation (Crowe, Coen, Kidd, Hevey, Cooney & Harbison, 2016).
Denial of condition. Many of the people who suffer from stroke do not accept their
conditions and are not willing to take any action to address their condition. The patients may not
be willing to accept their conditions because they fear being rejected by friends and family
members or lack of adequate awareness of their conditions. Brain injury that is as a result of
stroke can influence patient’s ability to appreciate and understand their certain mental issue
(stroke) and its effects (Morris, MacGillivray & Mcfarlane, 2014). As in the case study, Baker
denied his physical limits, and he is not ready to take therapy. Also, even though Baker had
paresis, he attempted to have a shower and repeatedly got outside the bed at the hospital in the
absence of a nurse assistance and refuses to attend physiotherapy for reorientation and
reassurance.
Management plan
Health care providers should ensure that they pay attention to patient’s behaviors that
occur after stroke like catastrophic reactions and overt or denial sadness. It is because these
behaviors are more likely to cause depression. Health care providers should also examine risk
factors that may cause mental illness, for example, negative thoughts, the harshness of disability,
isolation, and psychiatric history. In the case scenario, the healthcare providers did not pay

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attentions to emotional problems of Grant, and this might be the main cause of post stroke
depression in Grant (Jamison, Sutton, Mant & De Simoni, 2017).
When a healthcare providers encounters a patient like Grant treatment approaches that
can be effective include; practices that straight adjust the patient physiology like medication and
approaches mechanisms that address the patients behaviors, coping methods and thoughts.
Medications that can be effective for Grant include stimulants, tricyclic, antidepressants
(Crayton, Fahey, Ashworth, Besser, Weinman & Wright, 2017). Therapeutic approaches like
Cognitive Behavioral Therapy (CBT) could be useful in addressing post stroke behavioral and
psychosocial problems. CBT assist a patient to get access to effective coping approaches and
constructive ways of thinking hence helping in recovery process and acts as portion of treatment
even after medications have been employed (O'Carroll, Chambers, Dennis, Sudlow & Johnston,
2014). If CBT was administered to Grant, it could have helped him to change ineffective
behaviors and thoughts hence affecting his mood and alleviating depression. Non-medication
practices should be considered first before medication. Also, a health care provider should help a
patient to get appropriate supportive social network to assist in facilitating coping with stroke
and in alleviating depression (Bennett, Luker, English & Hillier, 2016).
Reading materials associated with stroke were not provided to Grant. Reading materials
related to stroke would have assisted Grant to feel that he can manage his stroke condition and
decrease his denial (Cahill, Carey, Lannin, Turville & O'Connor, 2017).
Encouraging Grant to undertake rehabilitation and social interaction would have assisted
him to accept his condition. Asking him to spend time with his old friends and continually
partaking the rehabilitation process would have assisted Grant to manage frustration hence
accepting his illness and limitations (Lindsay, Furie, Davis, Donnan & Norrving, 2014)

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