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Case study 5 a case of cerebrovascular accident
Case study 5 a case of cerebrovascular accident
Clinical cases flashcards and management of stroke flashcards
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Medical Emergency Strokes. Generally, whenever we hear about someone who suffered from a stroke, the result is never good. Why is it that strokes are so dangerous and why is it so important for providers to recognize them as early as possible? What do we do when we suspect a patient is currently having an active CVA (cerebral vascular accident)? All of these are excellent questions that medical providers need to affluent in.
So, what is actually happening when a stroke occurs? A stroke occurs blood flow to the brain is either impeded or significantly reduced. When this happens, the brain cells are starved of the essential oxygen and nutrients they need and begin to die. There are three different kinds of strokes. They are ischemic, hemorrhagic,
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Like with anything else, it is imperative to ensure a patent airway, adequate ventilation, good oxygenation, and adequate circulation. However, stroke patients have an increased risk of losing the ability to protect their own airway and subsequently aspirate. You can help protect the patient from aspirating by simply placing them in the semi-fowlers position. Now if severe vomiting becomes a factor and the airway is compromised, intubation may need to be used to protect the patient from any further aspiration. If either the tidal volume or rate becomes inadequate, quickly assist their ventilations at a rate of 10-12 breaths per minute. If assistance is needed with ventilations, its good practice to have your BVM hooked up to oxygen too because unless your patient is intubated at this point, some of the room air you pump into them is going to go into the stomach, making for less adequate oxygenation. Along with the ABC component, you’re going to establish IV access and apply the cardiac monitor to see what the heart is doing (Mistovich, 2008). Treating the symptoms is all you’re going to be able to do. As it was mentioned before, the only way to treat the underlying problem is to get the patient to the hospital as quickly as you
Stroke occurs when the blood supply to the brain is blocked or condensed. Blood works to transport oxygen and other beneficial substances to the body’s cells and organs, as well as the brain. There are two main types of strokes that are known as Ischemic strokes and Hemorrhagic strokes. When the blood vessels that provides for the brain becomes congested, is it referred to as ischemic stroke, the most common stroke within adults. Blood clots, a cluster of blood that sticks together, are the cause of Ischemic strokes. Ischemic strokes also takes place when arteries become backed up with plague, leaving less blood to flow. Plague is cholesterol, calcium and fibrous and connective tissue that sticks to the walls of blood vessels. Ischemic strokes eternally damage the brain and cause a person's body to no longer function habitually.Some risk factors that may increase stroke are high cholesterol, diabetes, high blood pressure, and obesity. Some stroke factors are also due to old age or having a family that has a history of strokes. Men are more likely to have a stroke but the most st...
It goes without saying that everyone’s health is important and should be taken care carefully. Everyone has heard of strokes before but many people do not really know its meaning, types, and the number of individuals of that dies due to this issue. According to Centers for Disease Control and Prevention (2015), strokes kills an average of 130,000 people a year and it is one of the most common deaths that happen in the United States. An average of 800,000 of people die from cardiovascular disease and strokes and it is also a reason of long-term disability (Centers of Disease Control and Prevention, 2015). Strokes, which can also be called cerebrovascular accident or CVA happen when the blood supply to the brain is interrupted or the blood vessel going towards the brain burst. Then part of the brain dies or become seriously injured because the brain cells do not receive oxygen and they eventually die. People’s lifestyle may also impact seriously on their health and increase the possibility of having a stroke. Some of the risk that can severely increase the cause of stroke would be high blood pressure, heart disease, diabetes, cigarette smoking, as well as strokes that
Due to the lose in brain cells sometime facial nerve can become damage. Which is also a sign of a stroke. In stroke patient usually when ask to smile, only half of their facial muscle would be able to do so. While the other half remain drooped. The Circulatory system is affect as well. Remember in a Hemorrhagic stroke a ruptured blood vessel begins to bleed out into the brain. Once blood is secreted out side the blood vessel into the tissues, red blood cells will take away nutrient from the brain cells. In Ischemic, the blockage in the blood vessel does not allow the blood to circulated proper. As a result of lost blood supply brain cells will die in the area where it is not receiving nourishment. Traveling in our bloodstream is oxygen and glucose, which is constantly need for cells to preform they daily functions.
In cerebral vascular attacks, maintaining airway, breathing and circulation is the main focus (6). It essential to keep the airway open and clear of any objects. With the patient presenting hemiparesis, it is possible the patient may have blockage in the airway through the loss of ability to maintain the airway themselves, such as loss of muscle tone to tongue and loss of control to muscles in the airway (1,6). The patient presents with a Sp02 level of 99% which is normal, oxygenation and ventilation is not immediately required but respiratory rate, rhythm and Sp02 must continue to be monitored (1, 6). Curtis and Ramsden suggest that providing a patient with high Sp02 levels with supplememtary oxygen may cause hyperoxia, and therefore increase the cerebral injury severity (14), causing more harm to the patient (15). It is recommended that the patient is placed on a 45 degree angle in order to increase cerebral perfusion and decrease cerebral oedema, or build up of fluid (6). Antiemetics can be administered if the patient feels nauseous or is vomiting, or prophylactically to protect airway if patient shows an altered level of consciousness. Circulation needs to be monitored as the patient has presented with a high pulse rate and also a raised blood pressure
The most important elements of the guidelines are organized into two “bundles” of care (Angus, 2013). The first “bundle” is for within the first 3 hours sepsis is suspected. The first thing you would do is measure the lactate level. The second thing is obtaining blood cultures prior to administration of prescribed antibiotics. You administer broad spectrum antibiotics in patients with septic shock. The risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. The last thing you would do for the 3 hr “bundle” is fluid resuscitation: administer 30 mL/kg crystalloid for hypotension or lactate ≥ 4mmol/L (Subtle Signs of Sepsis, 2017). The second “bundle” is for within the first 6 hours sepsis is suspected. The nurse would do the same protocol for suspected sepsis within 3 hours and continue for more advanced treatment. The next thing you would do is administer vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP ≥ 65 mmHg. For persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥ 4 mmol/L (36 mg/dL), reassess volume status and tissue perfusion and document findings. After initial fluid resuscitation, repeat focused exam, including pulse, capillary refills, vital signs, cardiopulmonary assessment, and skin (Subtle Signs of Sepsis,
The bleeding of the brain also causes increased pressure on the brain and it presses against the skull. Symptoms of a hemorrhagic stroke vary upon the amount of blood tissues affected and the location of the bleeding. A transient ischemic attack only lasts for a few hours of the day or a day and it doesn't cause permanent brain damage like an ischemic stroke would. (TIA) transient ischemic attack is not considered to be a stroke, it is referred to as a warning signal before having a stroke. Ask yourself how does a stroke change a person's everyday life drastically? People who suffer from strokes have to live with a mental or physical disability that causes them to be limited.
Brain aneurysms practically go unnoticed and tend to have few to no symptoms until the rare occasion when the aneurysm ruptures. The bursting aneurysm causes bleeding in the brain and then often leads to a stroke. This is exactly what happened to my great-aunt Judy who survived a brain aneurysm and stroke.
The World Health Organisation (2013) explains that an Ischaemic stroke occurs as a result of a blood vessel becoming blocked by a clot, reducing the supply of oxygen to the brain and, therefore, damaging tissue. The rationale for selecting Mary for this discussion is; the author wishes to expand her evidenced based knowledge of stroke since it is the principal cause of disability and the third leading cause of mortality within the Scottish population (Scottish Intercollegiate Guidelines Network (SIGN), 2008) and, therefore, a national priority. In response to this priority, the Scottish Government (2009) produced their ‘Better Heart Disease and Stroke Care Action Plan’. Additionally, they have introduced a HEAT target to ensure 90% of stroke patients get transferred to a specialised stroke unit on the day of admission to hospital (Scottish Government, 2012).
Stroke survivors or anyone with chronic illness and health providers remain hopeful and “realistic” by counting on each other. The patients while being realistic about the outcome of their disease, stay hopeful that each of their health care providers will give them the appropriate care and will make sure that they can live with their disease in the best way possible.
According to the American Stroke Association, someone dies every four minutes from a stroke (American Stroke Association, 2014). This can be devastating to the loved ones who survive the victim. Surviving a stroke requires a tremendous amount of therapy and will power to overcome the disabilities and challenges that arise after having a stroke.
The nature and extent of damage depends on the size and location of the affected blood vessels. b) Like all organs, the brain needs the oxygen and nutrients provided by blood to function properly. If the supply of blood is restricted or stopped, brain cells begin to die. This can lead to brain injury, disability, and possibly death. There are two main causes of strokes: ischaemic – where the blood supply is stopped due to a blood clot (this accounts for 85% of all cases) haemorrhagic – where a weakened blood vessel supplying the brain bursts.
Stroke is a commonly known disease that is often fatal. This cellular disease occurs when blood flow to the brain is interrupted by either a blood clot halting the progress of blood cells in an artery, called an Ischemic stroke, or a blood vessel in the brain bursting or leaking causing internal bleeding in the brain, called a hemorrhagic stroke. When this happens, brain cells are deprived of oxygen and nutrients because the blood cells carrying these essential things are stopped, causing them to die. When the cells in the brain die, sensation or movement in a limb might be cut off and may limit an organism’s abilities. A person with stroke is affected depending on where in the brain the stroke occurs. In other words, symptoms of a stroke
Stroke is a serious medical condition that affects people of all ages specifically older adults. People suffer from a stroke when there is decreased blood flow to the brain. Blood supply decreases due to a blockage or a rupture of a blood vessel which then leads to brain tissues dying. The two types of stroke are ischemic stroke and hemorrhagic stroke. An ischemic stroke is caused by a blood clot blocking the artery that brings oxygenated blood to the brain. On the other hand, a hemorrhagic stroke is when an artery in the brain leaks or ruptures (“About Stroke,” 2013). According to the Centers for Disease Control and Prevention (CDC), “Stroke is the fourth leading cause of death in the United States and is a major cause of adult disability” (“About Stroke,” 2013). Stroke causes a number of disabilities and also leads to decreased mobility in over half of the victims that are 65 and older. The CDC lists several risk factors of stroke such as heredity, age, gender and ethnicity as well as medical conditions such as high blood pressure, high cholesterol, diabetes and excessive weight gain that in...
I think about the difference that educating clinical staff about these needs could make for patients. It is obvious that a stroke patient is in a situational crisis and most likely will not be able to vocalize needs. I believe that continuing education should be taken more seriously and be of more practical use. I also would like to see the implementation of a peer to peer discussion forum where providers could learn from the experience of other providers. This practice is utilized for trauma patients and there is an established tumor board
In Conclusion, it is common for people to have strokes. Many think that it won’t happen to them, but it does. It is recommended to get checked regularly by their doctor just to be on top of their health. We do not always know what is going on inside of our body. This is why it is important to have our doctors give the confirmation that we are okay or if something is worse. It is always better to be a step ahead. It is also important that people know that they aren’t alone. There are so many resources and medical places that will be glad to help them get back to being healthy.