NRS440VN Trends And Issues In Todays Health Care

Case Study 1 – Mr Sam Kwon is a 74-year-old man (UR number 684421). He was brought in by paramedics with right-sided hemiparalysis, aphasia and facial drooping. He has a history of hypertension, congestive heart failure and type 2 diabetes mellitus. He takes oral hypoglycaemic agents. He has also smoked a pack of cigarettes a day for approximately 40 years.

Case Study 2 – Mr Patrick Drew is a 74 year old man (UR number 452342). He was referred by his GP to the neurology team for investigation and management of his Parkinson’s disease, dysphagia and falls. On assessment he demonstrated bradykinesia, gaze limitations (in all directions) a persistent unilateral tremor in his right arm, and a shuffling gait (with limited arm swing). His limb rigidity is ‘lead pipe rigidity’ but he also has ‘cogwheel rigidity’ in his wrists.

Introduction:

Cerebrovascular accidents or stroke is mainly seen to occur when the artery supplying blood to the brain is blocked or are ruptured and thereby begins to bleed. The former condition is called the ischemic stroke or the later one is called the hemorrhagic stroke. These might result in the gradual dying of the brain that not only leads to sudden impairment of the ranges of actions. Stroke is often associated with the causing of paralysis on the different parts of the body that are usually controlled with the area of the brain where the stroke had affected (Campbell et al., 2015). Different types of speech problem and other symptoms are also seen to occur such as vision, swallowing and even thinking. Researchers are of the opinion that stroke is preventable because most of its risk factors are mainly modifiable like that of the high pressure, abdominal overweight and obesity, physical inactivity as well as tobacco smoking (Arch et al., 2016). The assignment is mainly based on the case study of a patient who had been affected by the stroke. Proper assessment and care plan would be developed for him in order to ensure best quality life.

Prevalence of stroke in the nation:

In the year 2012, 2% of the people of the nation of Australia had been seen to have faced a stroke at some point of their lives which gives an estimation of about 377000 people. Most of the affected individuals for about 71% were aged over 65 while the prevalence of stroke had more or less remains the same over the last 15 years. Data shows that in the year 2013 to 2014, about 37000 hospitalizations had taken place with the diagnosis of acute stroke and about 28000 patients who took rehabilitation services. The stroke hospitalization rates were seen to be more common among the males than the female that was about 1.3 times higher (Powers et al., 2015). United Kingdom also shows similar rates of cardiovascular accidents stating more than 10000 strokes occurring every year with around one stroke occurring in every five minutes. This had been the fourth single leading cause of death in the UK. The average age for the occurrence of stroke in males in UK is 74 and that is about 76 in that of the females. Over 40000 people have been seen to have died from stroke in the year 2015and the situation is seen to be similarly grave in both the nation.

Diagnosis and the assessment:

The CT scan should be one of the first tests that need to be done in order to undertake stroke evaluation. This test is mainly seen to be helpful in the determining of the different arenas of abnormalities in the brain. This should be extremely helpful in the determining the areas, which have insufficient blood, flow as in case of ischemic stroke or also helps to show if there is any rupture of blood vessels as in case of hemorrhage (Rizos et al., 2015). These had been conducted for the patient which showed the proves of left cerebrovascular accident, with increased density in the left middle and cerebral artery and possible early signs of edema.

Neurological assessment needs to be done in order to find out the needs and requirements of the patients and accordingly would help the professionals to develop the care plan for the patient help in him to come back to normal flow of life. The initial evaluation of the neurological assessment is mainly based on comprehensive procedures that cover many critical arenas. These would mainly include analyzing the level of consciousness. These would cover the domains of being alert, drowsy, and stuporous or coma. The patient was found to be conscious but was not being able to answer as his communication capability had impaired (Saber et al., 2017). After evaluating the level of consciousness, the professionals should analyze the orientation phase seeing whether the patient is able to give correct answer to places like hospitals and city and the time like month or year.  The patient was not being able to answer but was nodding head to answer close-ended questions that helped to know whether the patient was oriented or not.  The speech of the patient also needs to be assessed. The patient would be asked questions that should be both expressive and receptive in order to consider that the patient was normal. The patient might be asked about different questions regarding objects, what they are used for and others. The patient must also obey and answer different questions like closing of the eyes, pointing to ceiling and others to find out whether he is receptive or not. All these would help in understanding his neurological condition and the care that he would be requiring. Glasgow comma scale is also a helpful tool that might be helpful in this situation (Powers et al., 2018). Moreover, the assessment of the pupil size, equality as well as shape both before and after the exposure of the light should be included in the neurological assessment of the patient. Researchers are of the opinion that unequal as well as dilated pupils helps in providing warning signs of the different increasing of the intracranial pressures. The patient is suspected to have homonymous hemianopia and this test would help in finalizing on it.

The healthcare professionals should also be conducting a bedside neuro-assessment. This would help in the evaluation of the sensory functions and at that time, the patient needs to be cooperative as well as oriented. The face, arm, and leg of the patient should be assessed where the professionals should be providing instructions to the patients should follow. The professionals should note down the performance of the patients accordingly. In case of the comatose patients, painful or other noxious stimulus needs to be provided towards the central part of the body (Berkhemer et al., 2015). This might include trapezius muscle squeezing, or application of supra-orbital pressure. Then the motor response should be noted. Here, in the patient in the case study, face, arm and leg motor tests should be done to understand the performance and accordingly develop interventions.

The patient is believed to have suffered from ischemic disorder

Signs and symptoms of the patient	Justification for ischemic or hemorrhagic stroke
The patient has high blood pressure	These symptoms show that both stroke might occur and cannot be the indicating factor.
The patient smokes higher number of cigarettes	Strong causes both types of stroke and therefore, this symptom cannot justify the stroke type.
Another symptoms is that he has ill managed high blood glucose level	Researchers are of the opinion that people with diabetes are four time more likely to develop carotid artery which in turn increases chances of ischemic stroke (Holliday et al., 2015).
The patient had the history of congestive heart failure	Researchers have conducted studies that patients who have congestive heart disorders are more prone to develop ischemic strokes.

Interventions:

The patient suffering from stroke requires multidisciplinary treatment as the nursing professionals themselves would not be able to provide specialized treatments that experts of different backgrounds can provide. The rehabilitation nurses should be providing direct care to the patient and would educate the patient and the families about the disabilities that the patient is facing. They should be also helping the patient by medication administration, ensuring the daily activities of lives of the patients and similar other care. They would be coordinating among all the members to ensure smooth flow of communication and coordination among the multi-disciplinary teamwork. The physical therapists should be evaluating as well as treating the problems that the patient would face with moving, coordination as well as balancing (Sposato et al., 2015). They would help the patient by providing training for their improvement of the walking, getting out of the bed, sitting on a chair, moving around without losing of the balances. The occupational therapist should be helping the patients to learn ways by which they can conduct normal activities of life like that they used to do before stroke affected them. This would be helping them in developing activities like eating, bathing, dressing, cooking, writing and many others. The speech language therapist would be also working with the patient. The patient is having aphasia and he would help the patient to get back his language skills and thereby develop the ways to communicate. They would be also helping the patient in developing swallowing techniques if the patient is identified with dysphasia or difficulty or impairment in swallowing (Kleindorfer et al., 2015). The patient might also need the support of psychologist. Traumas that stroke results might cause anxiety, depression, anger and disappointment in the patient and in such conditions, psychologists would be helping the patient to develop better quality life. Besides, the nurses should educate the patients about the ways by which glucose levels need to be maintained and follow the teach-back process to ensure compliance (Kishore et al., 2014).

Conclusion:

From the above discussion, it is seen that for patients who suffer ischemic strokes, it is very important for the nursing professionals to undertake proper neurological, sensory as well as motor assessment. Accordingly, nursing professionals need to work with multi-disciplinary system so that all the needs and requirements of the patients are met helping them to get back in normal quality lives.

References:

Arch, A. E., Weisman, D. C., Coca, S., Nystrom, K. V., Wira III, C. R., & Schindler, J. L. (2016). Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke, 47(3), 668-673.

Berkhemer, O. A., Fransen, P. S., Beumer, D., Van Den Berg, L. A., Lingsma, H. F., Yoo, A. J., … & van Walderveen, M. A. (2015). A randomized trial of intraarterial treatment for acute ischemic stroke. New England Journal of Medicine, 372(1), 11-20.

Campbell, B. C., Mitchell, P. J., Kleinig, T. J., Dewey, H. M., Churilov, L., Yassi, N., … & Wu, T. Y. (2015). Endovascular therapy for ischemic stroke with perfusion-imaging selection. New England Journal of Medicine, 372(11), 1009-1018.

Holliday, E. G., Traylor, M., Malik, R., Bevan, S., Falcone, G., Hopewell, J. C., … & Boncoraglio, G. B. (2015). Genetic overlap between diagnostic subtypes of ischemic stroke. Stroke, 46(3), 615-619.

Kishore, A., Vail, A., Majid, A., Dawson, J., Lees, K. R., Tyrrell, P. J., & Smith, C. J. (2014). Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke, 45(2), 520-526.

Kleindorfer, D., Khoury, J., Alwell, K., Moomaw, C. J., Woo, D., Flaherty, M. L., … & Kissela, B. M. (2015). The impact of Magnetic Resonance Imaging (MRI) on ischemic stroke detection and incidence: minimal impact within a population-based study. BMC neurology, 15(1), 175.

Powers, W. J., Derdeyn, C. P., Biller, J., Coffey, C. S., Hoh, B. L., Jauch, E. C., … & Meschia, J. F. (2015). 2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, STR-0000000000000074.

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., … & Jauch, E. C. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46-e99.

Rizos, T., Quilitzsch, A., Busse, O., Haeusler, K. G., Endres, M., Heuschmann, P., & Veltkamp, R. (2015). Diagnostic work-up for detection of paroxysmal atrial fibrillation after acute ischemic stroke: cross-sectional survey on German stroke units. Stroke, 46(6), 1693-1695.

Saber, H., Yakoob, M. Y., Shi, P., Longstreth Jr, W. T., Lemaitre, R. N., Siscovick, D., … & Mozaffarian, D. (2017). Omega-3 fatty acids and incident ischemic stroke and its atherothrombotic and cardioembolic subtypes in 3 US cohorts. Stroke, 48(10), 2678-2685.

Sposato, L. A., Cipriano, L. E., Saposnik, G., Vargas, E. R., Riccio, P. M., & Hachinski, V. (2015). Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. The Lancet Neurology, 14(4), 377-387.

Van Der Hoeven, E. J., Dankbaar, J. W., Algra, A., Vos, J. A., Niesten, J. M., Van Seeters, T., … & Velthuis, B. K. (2015). Additional diagnostic value of computed tomography perfusion for detection of acute ischemic stroke in the posterior circulation. Stroke, 46(4), 1113-1115.