Pathophysiology of Ischemic Stroke
Question:
Discuss about the Pathophysiology and Clinical Management.
The rationale of this essay is to provide essentials of care for patients with ischemic stroke. It follows the case study of Mr. John a, a 52-year-old patient who is admitted in the hospital after a left-sided ischemic stroke. This is a type of stoke that is characterised by an abrupt loss of blood circulation in the brain leading to loss of neurological function (Elton and Evans 2016). The patient is unconscious with Glasgow coma scale (GCS) of 1.5 and is due for discharge in the next week. The GCS is a technique system used to describe the level of alertness in an individual after a severe brain injury. Ideally, it rates the severity of an acute brain injury, and at the rate of 1.5, it shows that it is most severe (Ellis et al. 2012). Symptoms presenting in the patient include hemiparesis (Partial paralysis or weakness restricted to a side of the body), expressive dysphasia (impaired sound or language production due to impairment in the brain) and severe weakness in both limbs.
According to Corbally et al. (2015), the pathophysiology of ischemic stroke is complex and includes numerous processes such as lack of energy, excitotoxicity, and disruption of the blood-brain carrier as well as infiltration of white blood cells among others. These are calculated and interrelated events that can result in ischemic necrosis that occurs in the affected.
However, after some minutes of infection, the tissue in the brain affected by the reduction of blood flow is damaged and then experiences the narcotic death of cell. This core tissue is enclosed by tissues which are less affected and which are regarded silent by a reduction in the flow of blood and are metabolically active. The characteristics of Necrosis are as follows; the nuclear structure disintegrates plus presence of extrusion cells components in the cytoplasmic organelles in the extracellular space (Gladman et al. 2015). During the early stages of Ischemic penumbra the lesion are half of the total volume. However, recent studies have shown that multiple neurons in ischemic penumbra after several days or hours they can undergo apoptosis; hence they’re regained for some time following the stroke onset. Cells that undergo apoptosis are damaged from within in a proper manner that minimises disruption plus damage of neighbouring cells.
Primary stroke prevention care is care and prevention techniques for persons with no history of stroke, while secondary care is a strategy of treatment in individuals with cases of stroke in the past. The risk factors can either be modified or non-modified. Non-modifiable factors can are race, age, family history of stroke, sex and ethnicity (Kruyt et al. 2014). On the other hand, modifiable factors include diabetes, lifestyle factors and hypertension to mention just a few.
Primary and Secondary Stroke Prevention Care
Durukan and Tatlisumak (2013) assert that nurses should develop proper strategies that will engage stroke survivors plus their relatives in achieving proper risk control as well as minimizingthe burden of stroke. For the nurses, the primary problem in secondary stroke care is educating plus encouraging strictness to prevention of secondary medication as well as lifestyle changes. Nurses have played a critical role in quality improvement care to ensure the well-being of the patients (Durukan and Tatlisumak 2013). They have the mandate to provide secondary stroke prevention care across the continuum of care. According to research, drug adherence fades away with time; hence information needs to be provided regarding secondary prevention drugs stroke patients should take following their discharge in the hospital. Post-stroke disabilities like difficulties in swallowing can interfere with medication management, hence involving family members in discussions regarding medication is very critical (Gladman et al. 2015).
Although promotion of health is an essential aspect in nursing care, some healthcare professionals provide less client service time to it. In secondary prevention, lifestyle need as well as minimal control among ischemic survivors of stroke shows necessity of action in such case. Lifestyle changes like increase of physical activities need to be administered to each person, with signs of stroke-related deficits (Stephanie Allen and Hp 2013). Ideally, empowering stroke patients to succeed in setting their goals around healthy lifestyle choices has shown to be a useful technique.
However, the trend of increasing ischemic stroke incidences globally undermines the need for working together with persons with a history of stroke to reduce or lower their recurrence risk. Hence, healthcare professionals play a pivotal role in screening for risk factors, raising awareness of risks as well as supporting stroke survivors in reducing risks especially when it comes to conforming to medications as well as lifestyle changes. However, the complexity, of behaviour change required shows that multifaceted as well as tailored techniques most probably are helpful when it comes to supporting as well as sustain change (Martino et al. 2014).
Mr John is a 52-year-old patient admitted in stoke unit due to a left-sided ischemic stroke. In the unit, the patient is assessed using GCS to determine his consciousness. This scale consists of three tests; motor responses, verbal and eye tests. The patient didn’t to respond to the verbal sounds, does not move and opens eyes only to painful stimuli. A CT scan is also vital to check for various brain structures to look out for stroke, a region with bleeding or blood clot and the type of stroke the patient is has; either ischemic or hemorrhagic (Sacco et al. 2015). However, as per the results, there is a blood clot in the brain, a sign of ischemic stroke. Mr. John used to work as an accountant before his admission in the hospital; he lives with his supportive wife and child who is 15 years. The rationale for using the case of Mr. John, a stroke patient it is because of the great public concern as per the Stroke Association. Stroke is the second largest death cause in Britain and it is mentioned that over half a million of people are disabled due to stroke, especially in England with a high disability as well as morbidity that is why it has been a keen interest to explore more about stroke, its management and essentials of care.
Nursing Care
The main reason for using Roper Tierney’s activities of the daily living model is that it shows the daily living activities related to the basic human needs. They include maintaining environment safety, communication, drinking and eating, breathing, mobilising, body temperature control, sexual expression, playing and working, sleeping and dying.
Maintaining environment safety is an activity that relates to patient care. According to the Human Rights Act (2012), no person shall be subject to torture, punishment or inhuman treatment. This shows that the environment in which a person is cared for needs to be maintained to ensure patients physical, psychological and mental wellbeing while also lowering the risks of infections. The Roper et al. model of activities of daily living is, therefore, a useful model for ensuring that patient needs are met, particularly the essentials of care. The model also includes care for the internal environment which is on cellular stage. Such aspect forms the basis of the recovery process for the case study of Mr. John.
Through this model, a nurse can give planned care for Mr. John which will execute assessment on him. According to (Mao et al. 2016) assessment is one of the most significant elements which is considered to be first during individualised nursing. It gives vital information to the development of the action plan that improves personal health status. In this write-up we will concentrate on eating and drinking habits, mobilising, personal cleansing as well as the dressing. The rationale for choosing these activities is because they are life essentials. When a person is not mobilising state, he/she cannot execute his care as well as eating and drinking that can affect that person from socialising, giving him depress plus isolation from others.
Evidently, over half of the ischemic patients admitted in hospitals have difficulties in swallowing, and their mortality is very high. Although the swallowing function of Mr. John is not mentioned in the case study, it is evident that if he cannot swallow food properly, he is at risk of choking. Individuals who have difficulties in swallowing may require fluids and nutrition delivered through a tube put in the nose. According to (Maeda et al. 2012), during admission, patients with acute stroke need to have a screening of their swallowing by a proffessional healthcare expert prior to the giving of any fluids, food or oral medication.
After the admission in the unit, the swallowing test should be done by a health professional. This is done by administering small spoonful of water to the patient plus various thickening drinks to listen to the chest whether the patient can swallow without any problem. Although coughing and struggling to swallow is not mentioned for the case of Mr. John, he should be referred to the speech as well as language therapist since from his symptoms we have been told that he had expressive dysphasia. Swallowing difficulties affects about a third of persons following a stroke. When an individual cannot swallow properly, there’s greater risk that food materials might block into the windpipe as well as into the aspiration thus leading to both pneumonia and chest infections. An ischemic stroke would affect Mr. John’s ability to swallow. In the past, difficulties in swallowing were once seen to occur where hemisphere was involved over the years by the stroke. However, in early days after ischemic stroke, over one-third of people with single hemiplegia would have difficulties in swallowing (Lakhan et al. 2012).
Roper Tierney’s Activities of Daily Living Model
For the nursing care, you can allow the patient to see and smell the food for stimulation of salivation as well as placing the food on the sensitive areas of the mouth. When doing spoon feeding to the patient, pass the food beneath his chin to allow flexion of the neck and give small portions using verbal coaching to emphasise holding of the food, chewing as well as swallowing hard. Kruyt et al. (2014) hold that you can pause between feedings to allow the patient rest and ensure all the food in the mouth is swallowed. During the meal time ,to help Mr. John seat on his bed in a proper position, make sure the surrounding area is clean as well as free from four smell. Get rid of urinals, bedpans plus such objects away from Mr. John’s sight.
It is paramount that the table and a clean room provide a condusive environment for eating (Maeda et al., 2012). As he can’t use his left side, when feeding, you can keep a tray on his left hand side to remind him that he can use left hand to eat. Through such, you will be encouraging the patient to use his weakened side of the body.
Washing is also of great essence not only for hygiene purposes but also for self-esteem. Mr. John was unable to wash himself as well as dress due to paralysis on one side of the body. The plan here is to help the patient get full assistance from another person for personal care. This is evident from his supportive wife and child who always ensure that they meet his needs. Personal hygiene is important aspects of daily living routine for patients who cannot take care of themselves. To keep a patient remain fresh throughout the day, ensure you assist him in brushing the teeth, showering and deodorizing him, clean his nails and hair and lastly give clean clothes (Huijbregts et al. 2015). A break from such routine will give the patient a feeling of being dirty as well as cause frustration and depression. Unfortunately, personal hygiene is a challenge for Mr. John due to ischemic stroke. However, it is evident that maintaining personal hygiene boosts a person’s physical as well as emotional well-being.
In the case study presented, the patient becomes dependent due to the long-term condition; he experiences a profound low self-esteem and independence. Also, helping him to be fresh as well as looking good can be of great help to the patient. Following the brain damage due to stroke, the healthy muscle tone is lacking. Ideally, the normal movement depends entirely on the healthy muscle tone and with absence of such the patient cannot gain healthy movement. There could be a benefit in regard to the motor, sensory recovery as well as patient motivation. Mr. John can be taken to a physiotherapist for assessment of his mobility to help his condition, wellbeing and help his rehabilitation process by restoring and developing his body systems. An occupational therapist can also be of help in examining his mental, physical as well as social challenges and devices, treatments and help him with tackling of the difficulties personally.
Because of lying on the bed all the time due to immobility as well as unexpected disability it has made Mr. John depressed. Depression can affect a person’s life since a person cannot go out and socialize with others as he used in the earlier past without assistance. Though this, an individual can become isolated as well as frustrated plus have a feeling of worthlessness. This is presented in the case study where we know that Mr. John was an accountant and loved playing soccer. It is also mentioned in the case study that the patient was a soccer enthusiast and had team members who he had a close relationship with for a couple of years.
Ultimately, the Roper, Logan and Tierney model of nursing is very helpful when it comes to assessing a patient to provide a holistic care straight from the admission of the patient to discharge. The model allows a multidisciplinary team to get involved to deliver essentials of care for patients, especially ischemic patients. It also helps identify what the stage the patient is and also provides an idea of the kind of care the patient needs. Overall, throughout this write up a learner can learn more about ischemic stroke, the causes, symptoms plus its management. It also allows a nurse or health professional know the patient, how he felt about the illness as well as how it affects a person’s socially, emotionally and psychologically.
Reference List
Cameron, J.I., Cheung, A.M., Streiner, D.L., Coyte, P.C. and Stewart, D.E., 2014. Stroke survivor depressive symptoms are associated with family caregiver depression during the first 2 years poststroke. Stroke, 42(2), pp.302-306.
Corbally, M., Macri, G. and Hawkshaw, S., 2015. An examination of the role and activities of nurses caring for patients who are admitted to a model 4 hospital as part of the National Acute Medicine Programme. Dublin City University.
Durukan, A. and Tatlisumak, T., 2013. Acute ischemic stroke: overview of major experimental rodent models, pathophysiology, and therapy of focal cerebral ischemia. Pharmacology Biochemistry and Behavior, 87(1), pp.179-197.
Ellis, G., Mant, J., Langhorne, P., Dennis, M. and Winner, S., 2012. Stroke liaison workers for stroke patients and carers: an individual patient data meta?analysis. The Cochrane Library.
Elton, J. and Evans, J., 2016. Long-term health 18 needs and rehabilitation. Nursing Practice and Health Care 5E: A Foundation Text, p.391.
Gladman, J.R., Lincoln, N.B. and Barer, D.H., 2015. A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. Journal of Neurology, Neurosurgery & Psychiatry, 56(9), pp.960-966.
Huijbregts, M.P., Myers, A.M., Streiner, D. and Teasell, R., 2015. Implementation, process, and preliminary outcome evaluation of two community programs for persons with stroke and their care partners. Topics in stroke rehabilitation, 15(5), pp.503-520.
Kruyt, N.D., Biessels, G.J., DeVries, J.H. and Roos, Y.B., 2014. Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management. Nature Reviews Neurology, 6(3), pp.145-155.
Lakhan, S.E., Kirchgessner, A. and Hofer, M., 2012. Inflammatory mechanisms in ischemic stroke: therapeutic approaches. Journal of translational medicine, 7(1), p.97.
Maeda, N., Kato, J. and Shimada, T., 2012. Predicting the probability for fall incidence in stroke patients using the Berg Balance Scale. Journal of International Medical Research, 37(3), pp.697-704.
Mao, H.F., Hsueh, I.P., Tang, P.F., Sheu, C.F. and Hsieh, C.L., 2016. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke, 33(4), pp.1022-1027.
Martino, R., Pron, G. and Diamant, N., 2014. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia, 15(1), pp.19-30.
Sacco, R.L., Toni, D., Brainin, M. and Mohr, J.P., 2015. Classification of ischemic stroke. In Stroke: pathophysiology, diagnosis, and management. Elsevier Inc..
Stephanie Allen, R.G.N. and Hp, C., 2013. Sponsored By: The Mary Seacole Development Awards September 2009.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
