Introduction
Stroke can cause severe disability and death. Timely diagnosis and appropriate treatment can significantly reduce the risks of impairment and mortality (Kimera et al. 2010).
Mr David King, a 71 year gentlemen was admitted to emergency at 8.45am with unconfirmed diagnosis of a Cerebral Vascular Accident (CVA). At 7.30am this morning, he was found in the shower by his wife Mary. She reported the right side of his body was flaccid, his face and mouth had drooped, he had difficulty communicating with slurred speech, couldn’t raise his arms and was incontinent of urine. This report describes the assessment processes, priority health problems, short term goals, outcomes, interventions, and discharge planning for Mr King.
Assessment Tools
Mr King requires a full neurological assessment which will include the monitoring of ABC, vital signs, oxygen saturation, and blood pressure. The monitoring of ABC will ensure the immediate safety of Mr King, as any deteriorations may indicate an underlying condition (Summers et al. 2009). Vital signs assessment will give baseline measurements to monitor his continuing stability.
Mr King requires a clinical health assessment. It is important to determine time of symptom onset and prior medical history including a history of diabetes, seizures, hypertension, atrial fibrillation, heart disease, past transient ischemic attack (TIA) or CVA, and any trauma related to Mr King’s current event. It will also determine Mr King’s current medication regime including anti-coagulant medication which may influence future treatment (Summers et al. 2009, table 8).
Health Problems (in order of priority)
1. Ineffective cerebral perfusion caused by unconfirmed CVA, evidenced by symptoms of right si...
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Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
Ischemic Stroke is caused due to a blood clot in an area of the brain, leading to loss of neural function if last for more than 24 hours. In the United States, ischemic stroke affects 2.7% of men and 2.5% of women of age range 18 years and older. In addition, it has reported that annually about 610,000 and 185,000 of new strokes and recurrent strokes cases occur in US1. Moreover, it has reported that patients who have suffered from a stroke have more chances of recurrent stroke, Myocardial infarction, and death from vascular causes2. One of the risk factor of ischemic stroke is formation of plaque in the blood vessels causing blood clot3. Several randomized trials have also reported that antiplatelet medications are efficient in preventing recurrences of stroke in patients who had an incident of ischemic stroke. Antiplatelet medications for preventing recurrences of stroke are aspirin, combination of aspirin and extended-release dipyridamole, and clopidogrel alone4. It ha...
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.
Treatment for strokes is called "acute care." What is an acute care? Acute care is when you make sure the condition is caused by a stroke and not some other medical condition, determining the type of stroke where it occurred and how serious the stroke is, prevention of another stroke from happening, or maybe rehabilitation.
Stroke not only affect the life of the patient but also their significant others, especially the caregiver. Caregiver is identified as the “hidden patient” (Andolstek et al, 1988). Families maintain the primary care responsibility for elderly with chronic illness and disability (Montgomery et al, 1985). The effects of caregiving span across physical health (Grafstrom et al, 1992; Kiecolt-Glasier et al, 1991), mental well-being (Cochrane et al, 1997) and social life (Luterman, D. ,2008; Bakas et al, 2006).
Mr. X is 84 years old. He was admitted to the hospital on January 4, 2014, due to hematuria in his urine and a suspected Transient Ischemic Attack (TIA). After the admission, he was sent for a CT scan, which confirmed Mr. X’s TIA in his right hemisphere. On January 5, 2014 Mr. X was transferred to CP1, an acute care stroke unit. His first TIA episode had been on August 28, 2012. His comorbidities include hypertension and type II diabetes. His activities are limited to bed rest as he has risk of falls; also he is on input-output with a Foley catheter. He has left side weakness and mild facial drooping on the left side. He is alert and oriented; however, he has trouble focusing on many people at one time. His care plan state...
759. Mr. Miller is likely presenting with an acute myocardial infarction. Based on his past medical history of hypertension, hyperlipidemia, obesity, and diabetes, along with his current symptoms of chest pain, shortness of breath, pale skin with beads of sweat on the forehead, as well as elevated lab 's Troponin, CK, and CK-MB, he is most likely presenting with an acute myocardial infarction.
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.
“Time is brain” is the repeated catch phrase when addressing the treatment and management of stroke (Saver, 2006). Access to prompt and appropriate medical care during the first few hours of stroke onset is critical to patient survival and outcomes. Recent changes in the guidelines for acute stroke care released by the American Heart Association (AHA) and the American Stroke Association (ASA) have improved patient access to treatment. Stroke treatment now follows the model of myocardial infarction treatment. Hospitals are categorized into four levels based on stroke treatment capability. The most specialized treatment is available in comprehensive stroke centers followed by primary stroke centers, acute stroke-ready hospitals, and community hospitals. The use of telemedicine now enables even community hospitals, with limited specialized capabilities, to care for stroke patients. Telemedicine puts emergency hospital personnel in contact with neurologists providing expertise in the evaluation of a stroke patient and determination of their eligibility for treatment with thrombolytic medication (Jefferey, 2013).
Researchers reported that 39% to 65% of community-dwelling people with stroke reported limitations in daily activities and restrictions in reintegration into the community. Research on persons with disabilities has shown that a satisfactory return to the community, compared with the performance of daily activities (ADLs and IADLs), is more strongly correlated with enhanced QoL5. Stroke-specific research indicates that decreased in participation after stroke has been linked to negative outcomes. In particular, limitations in participation have been linked to worse health and functional status, depression, increased health care utilization, decreased independence, increased social isolation, and declines in overall QoL and life satisfaction6,7. Stroke survivors unable to continue their previous meaningful activities, including social role, have demonstrated increased post stroke depression6, 8.
Cerebrovascular Accident a) Overview - definition and the effects of the stroke on the body A stroke is a serious, life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. (http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx) This condition is a common cause of death and disability, especially in older people. Some predisposing factors include: • hypertension • atheroma • cigarette smoking • diabetes mellitus It occurs when blood flow to the brain suddenly interrupted, causing hypoxia. The effects include paralysis of a limb or one side of the body and disturbances of speech and vision.
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
McDonnell, M.N., Bryan, J., Smith, A.E., & Esterman, A.J. (2011). Assessing cognitive impairment following stroke. Journal of Clinical & Experimental Neuropsychology, 33(9), 945-953.