Types of Stroke
It is clear from the case report that Robert seems to have an ischemic stroke. Nevertheless, embolic stroke is perhaps the most probable culprit. If the blood supply to a segment of the brain gets blocked off, the brain structure within that location malfunctions, resulting in an ischemic stroke. Hui, Tadi and Patti (2021) make a point about Ischemic stroke mainly attributed to a lack of sufficient blood flow to perfuse the cerebral structures, as a consequence of blocked or constricted vessels leading to or within the brain. There seem to be two forms of ischemic strokes: thrombotic and embolic strokes. The middle cerebral arteries (MCA) appear to become the most often involved artery in stroke. Four components provide a large percentage of the brain’s lateral region, along with a piece of the basal ganglia as well as an internal capsule (M1, M2, M3, and M4). An M1 (horizontal) segment supplies the basal ganglia that are responsible for motor function, sensory, executive, and emotional functions. The M2 (Sylvian) segment feeds a parietal lobe, superior temporal lobe, insula, and inferolateral frontal lobe (Hui, Tadi, & Patti, 2021). The embolic event occurs whenever a thrombus originates in a separate place in the system. Embolic stroke may occur if a clot forms inside the atrium following atrial fibrillation and ejects into the arterial circulation. The cardiac chambers and valves appear as being the most apparent coagulation suspect. A loss of blood flow develops as the clog dislodges and lodges within the right MCA that provides blood inside the brain, causing injury to the brain’s basal ganglia (Navi & Ladecola, 2018). Motor impairment can result from injury to the basal ganglia. Here, Robert is experiencing left-sided numbness as a result of this.
One-sided paralysis, stiffness solely on a single side, facial droop, as well as dysphagia is common clinical manifestations of cerebrovascular accident (CVA). It is feasible, nevertheless, to have some respiratory problems. One-sided immobility can occur in even the direst of circumstances. It’s crucial to remember that injury to the right segment of a brain may influence the body’s left segment, and harm to the left portion of a brain may influence the right portion of the body. Here, Robert’s CVA should have happened on the right portion; as a result, his left side was afflicted (Phipps & Cronin, 2020). Tissue plasminogen activator (tPA), a clot-busting medication, can be used to re-establish blood circulation in the first stage of Robert’s CVA treatment (Uthayabalan 2018).
Peripheral vascular assessment
Throughout the peripheral vascular examination, the sufferer’s carotid, radial, femoral, and posterior tibial impulses are all checked. The peripheral vascular examination is a medical procedure, which examines the veins and arteries of the feet and legs for checking for the signs of abnormalities (Beckman et al. 2021). It’s performed depending on the physical examination or if a patient reports leg pain, which might signal a cardiovascular condition.
Throughout this situation, Robert exhibits lower-limb impairment as well as a cardiovascular condition. The major objective of doing this investigation, according to Kolls et al., (2016), is to see if the individual has peripheral artery disease (PAD). Ischemic strokes, particularly TIA, are prevalent in persons with severe PAD, according to Kolls et al., (2016). All-cause CVA was shown to be substantially associated with aging, atrial fibrillation, type 2 diabetes, hypertensive pressure, and place. Also, Robert has hypertension as well as atrial fibrillation throughout this example. In addition, Robert is 78 years old. As a result, he seems to be at a higher risk of having a stroke.
Neurological assessment
Effects of Stroke on the Body
The neurologic assessment is done to establish the location of the stroke, evaluate baseline competence following hospitalization, eliminate transient ischemic attack (TIA) as well as other similar conditions, and identify possible complications. It includes cranial functional status, operational mobility having a flexion and extension, muscular strength assessments, perceptual coherence, vibratory feeling, cerebellar engagement, locomotion, speech, psychological status, and level of consciousness assessments (Herpich & Rincon, 2020). The National Institutes of Health Stroke Scale (NIHSS) is utilised to assess basic performance, taking into account awareness, ocular and neuromuscular engagement, sensitivity and intellect, cerebellar characteristics, and verbal capacity (Zöllner et al., 2020).
This examination ought to be a concern for Robert’s management since it may assist distinguishes the kind of stroke, and if this is a TIA, the treatment strategy will be distinct from the conventional CVA approach. In this scenario, the correct moment of the attack is also unknown. As a result, doing this examination may aid in determining the extent of Robert’s brain’s neurological problems (Furlanis et al. 2018). The results of this analysis would also assist assess how much Robert’s cognitive function has been impacted by the CVA. This should assist in determining whether Robert’s requirement for extra assistance, such as ambulatory assistance or fall risk monitoring. This examination should be completed first since it takes less time, and also helps to stabilise the patient.
Oxygen therapy
Since Robert was having seizures, it is possible that his brain isn’t getting enough oxygen. It’s related to a low degree of plasma oxygen saturation. As a result, the caregiver will have to give more oxygen to enhance the plasma oxygen saturation concentration. This has to be done as fast feasible and as efficiently as possible. Following the assessment, the nurse must begin delivering the appropriate concentration of oxygen (Gupta et al., 2020). Since Robert’s illness is not life-threatening, a regular Hudson mask could be utilised rather than the high-flow technique. Such a mask offers about 35-45 per cent oxygen and therefore is usually used as the primary oxygen delivery method in the event of a respiratory crisis. Nevertheless, since it has a 45 per cent restriction, this equipment cannot be employed in the event of severe oxygen shortage (Millette et al. 2018).
The airways and breathing can be improved by placing the individual in a certain manner. As a result, the nurse must adjust to Robert in order to optimise his airways and breathing. Robert could be repositioned in the semi-Fowler posture by the caregiver. This posture can aid with breathing improvement. The diaphragm drops downwards within the semi-posture, Fowler’s according to Mezidi and Guérin (2019). This can make breathing easier while also increasing lung capacity as well as ventilation. Such posture could also aid in lung dilatation, which improves gaseous exchange which, in turn, leads to increased oxygen saturation rates. The nurse must raise the elevation of Robert’s bed by 30-45 degrees to keep this posture (Maria & Hasaini 2019). Additionally, the legs must also be straight because seizures can be prevented by increasing blood oxygen levels.
Airway management
Diagnostic Procedures
The cuff on the endotracheal as well as tracheostomy line is required to offer airway occlusion. Whenever the cuff is adequately inflated, Robert requires the right ventilator parameters, comprising TV along with oxygenation (Alkhouri et al., 2017). For a caregiver, it appears that filling the cuff as per hospital protocol and afterwards testing for proper inflation pressure that uses a minimal leak technique and minimal occlusive capability is required. To minimise tracheal pain and harm from high cuff tension, the caregiver should execute these operations with the assistance of a skilled expert or a pulmonary practitioner. Furthermore, while pumping air to the cuff, it is critical to always employ the right procedure for Robert.
Mode of action
Lorazepam engages with the benzodiazepine receptors within GABA-A ligand-gated chloride channel neurones within the central nervous system (CNS). Lorazepam increases the inhibitory action of GABA, which enhances chloride ion permeability throughout a cell. As a result of the alterations inside the chloride ions, the plasma membrane of the cell becomes hyperpolarised and stabilised. Also, Lorazepam’s inhibitory action on the amygdala assists with clinical depression, while its inhibitory activity within the cerebral cortex assists with convulsions (Ghiasi et al., 2021). As a result, Robert was administered Lorazepam to reduce his stress as well as the frequency of convulsions.
Robert is offered this drug to help him deal with his anxiousness. Anxiety that isn’t controlled properly might lead to strokes and heart attacks. Lorazepam could also help to avoid convulsions in those who are having such issues (Sellami et al. 2021).
Lorazepam can be administered orally. It can be administered intravenously (IV) as well as intramuscularly (IM). It requires 1-3 minutes for it to take action if administered IV; 15-30 minutes for it to take full effect if administered IM. Nevertheless, doses must be adjusted in accordance with the medical illness (Ghiasi et al., 2021).
As with other benzodiazepines, CNS and respiratory stress are frequent dose-dependent side effects of lorazepam. Larger doses, on the other hand, will have more significant negative effects. Sedation, vertigo, asthenia, stiffness, hypersensitivity at the puncture site, pulmonary depression, IV usage produces hypoventilation, hypotension, weariness, forgetfulness, and disorientation are all major side reactions, which Robert might experience (Sellami et al. 2021).
The actions of furosemide, along with LORazepam, on blood pressure, may be significant. Symptoms include headaches, vertigo, confusion, fainting, and/or changes in vasculature and heartbeat. Enalapril and LORazepam may potentially function in tandem to lower blood pressure. As a result, because Robert is on furosemide as well as enalapril, more measures must be implemented (Ghiasi et al., 2021).
Reducing the chance of epileptics
A crucial criterion for this drug’s examination would be to eliminate the possibility of epilepsy. Serious seizure issues can lead to epileptics. Any seizure enduring over five minutes or more than a seizure the 5 minutes without returning to normal consciousness between occurrences is considered status epilepticus. It could result in serious brain injury. As a result, the absence of epilepsy would be a key requirement for this treatment (Kobata et al., 2020).
Reduce the chance of seizing an issue
Another key benefit of using lorazepam is that it reduces the risk of seizures. As a result, it is predicted that Robert’s seizure status would improve when this drug is administered. A neurological examination could be used to determine this. Robert earlier had a GCS rating of 10, indicating mild – to – moderate brain damage. As a result, it is anticipated that Robert would have a GCS rating of 15 following receiving lorazepam and would be totally focused. This may be determined by evaluating his linguistic, perceptual, visual, and motor functions (Ohtsuka et al. 2019).
Reduce the rate of anxiety
Treatment
The primary function of lorazepam seems to be to reduce anxiety. As a result, the major review in this scenario would be a decreased degree of stress. Long-term worry may raise blood pressure along with increase the risk of stroke. As a result, it’s critical to assess Robert’s psychological state to ensure he doesn’t acquire major anxiety issues. Furthermore, a high degree of anxiety raises the risk of depressive episodes. As a result, throughout this scenario, the caregiver must participate in a therapeutic interaction with Robert, utilising a series of questions to evaluate his psychological state (Ghiasi et al., 2021).
Agnes’ psychological condition may be significantly impacted by Robert’s stroke. Therefore, As a result, offering family-centred care (FCC) is important in this circumstance to handle the condition. The priority of FCC would be on involving Robert’s family as often as feasible throughout the overall treatment plan. As per the FCC idea, the caregiver must accept Agnes’ choice (Banerjee et al., 2018). In addition, the caregiver may include her in Robert’s decision-making process. This phase would assist to minimise tension and enhancing patient comfort, which would result in a good result. The nurse should concentrate on obtaining Agnes’ informed permission for Robert’s alternative treatments. The service that is offered should be more collaborative and participatory. Agnes has to be told about the treatment regimen by the caregiver. Also, they need to include Agnes’ ideas in the care plan as well. Agnes’ worries must be acknowledged by the nurse, who must respond empathically (Banerjee et al., 2018). To deal with stress, it is also vital to provide the required health knowledge and motivation.
References
Alkhouri, H., Vassiliadis, J., Murray, M., Mackenzie, J., Tzannes, A., McCarthy, S., & Fogg, T. (2017). Emergency airway management in Australian and New Zealand emergency departments: a multicentre descriptive study of 3710 emergency intubations. Emergency Medicine Australasia, 29(5), 499-508. DOI: 10.1111/1742-6723.12815
Banerjee, J., Aloysius, A., Platonos, K., & Deierl, A. (2018). Family-centred care and family delivered care–What are we talking about?. Journal of Neonatal Nursing, 24(1), 8-12. https://doi.org/10.1016/j.jnn.2017.11.004
Beckman, J. A., Schneider, P. A., & Conte, M. S. (2021). Advances in revascularization for peripheral artery disease: revascularization in PAD. Circulation Research, 128(12), 1885-1912. https://doi.org/10.1161/CIRCRESAHA.121.318261
Furlanis, G., Aj?evi?, M., Stragapede, L., Lugnan, C., Ridolfi, M., Caruso, P., … & Manganotti, P. (2018). Ischemic volume and neurological deficit: correlation of computed tomography perfusion with the national institutes of health stroke scale score in acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases, 27(8), 2200-2207. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.04.003
Ghiasi, N., Bhansali, R. K., & Marwaha, R. (2021). Lorazepam. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532890/
Herpich, F., & Rincon, F. (2020). Management of Acute Ischemic Stroke. Critical care medicine, 48(11), 1654–1663. https://doi.org/10.1097/CCM.0000000000004597
Hui, C., Tadi, P., & Patti, L. (2018). Ischemic stroke. https://www.ncbi.nlm.nih.gov/books/NBK499997/?report=classic
Kobata, H., Hifumi, T., Hoshiyama, E., Yamakawa, K., Nakamura, K., Soh, M., … & Japan Resuscitation Council (JRC) Neuroresuscitation Task Force and the Guidelines Editorial Committee. (2020). Comparison of diazepam and lorazepam for the emergency treatment of adult status epilepticus: a systemic review and meta?analysis. Acute Medicine & Surgery, 7(1), e582. https://onlinelibrary.wiley.com/doi/abs/10.1002/ams2.582
Kolls, B. J., Sapp, S., Rockhold, F. W., Jordan, J. D., Dombrowski, K. E., Fowkes, F. G. R., … & Patel, M. R. (2019). Stroke in patients with peripheral artery disease: insights from the EUCLID study. Stroke, 50(6), 1356-1363. https://doi.org/10.1161/STROKEAHA.118.023534
Maria, I., & Hasaini, A. (2019, October). The effect of semi fowler position on the stability of breathing among asthma patients at ratu Zalecha hospital Martapura. In Third International Conference on Sustainable Innovation 2019–Health Science and Nursing (IcoSIHSN 2019) (pp. 242-245). Atlantis Press. https://doi.org/10.2991/icosihsn-19.2019.52
Mezidi, M., & Guérin, C. (2019). Effect of body position and inclination in a supine and prone position on respiratory mechanics in acute respiratory distress syndrome. Intensive Care Medicine, 45(2), 292-294. https://doi.org/10.1007/s00134-018-5493-1
Millette, B. H., Athanassoglou, V., & Patel, A. (2018). High flow nasal oxygen therapy in adult anaesthesia. Trends in Anaesthesia and Critical Care, 18, 29-33. https://doi.org/10.1016/j.tacc.2017.12.001
Navi, B. B., & Iadecola, C. (2018). Ischemic stroke in cancer patients: A review of an underappreciated pathology. Annals of neurology, 83(5), 873–883. https://doi.org/10.1002/ana.25227
Ohtsuka, Y., Nakasato, N., Nakazuru, Y., & Terada, M. (2019). Efficacy and safety of lorazepam intravenously administered in subjects with status epilepticus or repetitive seizures. Brain and nerve= Shinkei kenkyu no shinpo, 71(8), 901-910. DOI: 10.11477/mf.1416201373
Sellami, S., Mami, H., Moalla, M., Oumaya, M., & Bouzid, R. (2021). Lorazepam causing drug-induced liver injury: Rare entity. European Psychiatry, 64(S1), S773-S774. doi:10.1192/j.eurpsy.2021.2046
Uthayabalan, S. (2018). Examining estradiol neuroprotective abilities and mechanisms of action in cerebrovascular accidents and neurodegenerative conditions. University of Ottawa Science Undergraduate Research Journal, 1, 42-46. https://doi.org/10.18192/osurj.v1i1.3699
Zöllner, J. P., Misselwitz, B., Kaps, M., Stein, M., Konczalla, J., Roth, C., … & Strzelczyk, A. (2020). National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases. Scientific Reports, 10(1), 1-7. https://doi.org/10.1038/s41598-020-60628-9
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