Task Three Case Study - Ischemic Stroke

Introduction: Task Three Case Study - Ischemic Stroke

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The following case study is based on Mr. Arthur Smith, a 75 years male, confirmed a case of ischemic left middle cerebral artery alongside the history of depression, type two diabetes, dyslipidaemia and atherosclerosis and TIA. Following context is intended to address the pathophysiological changes of the patient's body in relation to the ischemic stroke, planning nursing intervention, managing potential complications of the identified disease by using assessment information of the case study to provide an individualised discharge plan. This also includes following specific nursing standards in the given context for the management of intervention plans and nursing care while making decisions for the patient.

Discussion

Pathophysiology

Ischemic stroke is considered responsible for approximately 80% of all strokes and causes intracerebral haemorrhage for approximately 15% of patients alongside subarachnoid haemorrhage for 5% patients (Aihw.gov.au, 2023b). While the non-modifiable risk of this condition refers to the older age and gender male alongside prior history of stroke, the following case study of Mr. Arthur consists of meeting the criteria of these specific risk factors. Besides, while the modifiable factors include the lifestyle and behavioural factors, Mr. Arthur living alone in lowset house at the age of 75 refers to the possibility of deterioration of health with a previous history of depression. On the other hand, non-lifestyle-based symptoms of the patients regarding the same disease has shown the history of arterial hypertension, dyslipidaemia and atherosclerosis.

The primary pathophysiological changes that occur during the identified disease refers to the reduction of blood flow and low level of blood that reaches the brain (Qin et al. 2022). While a normal and healthy person consists of a normal blood flow of 50 to 55 ml/100 g/minutes, in case of ischemic stroke, this reduces up to 18 ml/100 g/minutes (Kuriakose & Xiao, 2020). The reduction of blood flow up to 8 ml/ 100 gram/minute is capable of causing death among patients (Babu et al. 2022) and limiting the upper and lower blood flow for the patients. On the other hand, the identified disease can impact on inducing rapid and gradual changes of the brain membrane of patients and are capable of causing reversible or irreversible injury including necrotic and apoptotic cell death among patients (Babu et al. 2022). In case of addressing prevalence statistics of the identified disease, approximately 7.5% of the prevalence has been shown among men and 9.4% among women in Australia (Aihw.gov.au, 2023a).

Figure 1: Prevalence of stroke among different aged population in Australia

(Source: Aihw.gov.au, 2023a)

On the other hand, with the contribution rate of 85% casualties among patients, the pathophysiological aspects of the disease sheds light on the intracerebral bleeding alongside generating thrombosis in the brain (Kuriakose & Xiao, 2020). This is followed by affecting blood flow by narrowing blood vessels due to the presence of atherosclerosis and lead to the embolism by causing severe stress and necrosis. It also includes disruption of plasma membrane and followed by other primary events such as inflammation, energy loss alongside reduction of homeostatic acidosis, elevated level of calcium, infiltration of leukocytes and many more (Song et al. 2023).

Figure 2: Molecular mechanism of ischemic stroke

(Source: Kuriakose & Xiao, 2020)

Nursing Care Process

Management Of Potential Complications Of Identified Disease

For the case of complicated strokes among patients, the use of acute interventional therapy is considered a significant step for managing treatment and in case of impossible intervention, the strategic plan relies on managing potential complications of the identified disease conditions (Rymer & Summers, 2020). This is followed by maintaining attention to prevent complications and the prevention of secondary strokes to substantially improve the overall outcome for the patient. The implications of standardised clinical tools such as clinical pathway and standing order set to collaborate among highly trained nursing staff and physicians are essential states to provide best practices for patients (Popiela et al. 2022).

In terms of managing optimal outcome for the identified disease patient, the providence of careful attention to the primary aspect of care alongside the continuum are considered significant to provide care for patients (Maheshwari et al. 2022). This is followed by the providence of acute stroke intervention and management with the goal of hospitalisation to prevent further complication. This also includes identification of the primary cause of stroke and addressing the modifiable risk factor for the patient and institution of antithrombotic therapy to prevent the secondary chance of stroke (You et al. 2022).

The context of complication in case of ischemic stroke refers to the deep vein thrombosis, pulmonary embolism and aspiration pneumonia and urinary tract infections, falls, sensory and bladder dysfunction (Guida et al. 2022). In the following case study, Mr. Arthur was presented with the complication symptoms of right sided hemiparesis which indicates the result of injury in the left side of his brain due to stroke and altered sensation. This is followed by the presence of aphasia which resulted with the problems in communication alongside dysphagia while facing difficulty to find current words and hemianopsia in case of dysfunction of sensory aspects (Popiela et al. 2022).

Planning Nursing Interventions

As most of these complications are frequently developed within the first four days () and the use of order set and intervention process are considered significant for achieving positive outcome in case of treating stroke patients. For the following context, the planning of nursing interventions requires efficacy and cost effectiveness to mobilise the stroke patients within the first 24 hours. As Mr. Arthur was presented with initial vital checking, the next step refers to the transferring him from bed to an upright position while monitoring closely to detect neurological issues and movement (Alijanpour et al. 2022). He was also detected with high blood pressure (BP 168/69) and normal respiratory rate of 18, 96% saturation and normal temperature. The nursing intervention plans also require the use of alternating pressure mattresses and a range of motion and positioning techniques with the aim of helping the patient with preventing pressure sores, joint contracture and atrophy while he is awaiting initial physiotherapy, occupational therapy and speech therapy (Gao et al. 2022).

Individualised Discharge Plan For The Patient With Ongoing Requirements

The primary objective and requirement for discharging a patient with ischemic stroke refers to the restoration of blood flow to the affected area of the brain (Alijanpour et al. 2022) as quickly as possible alongside maintenance of the proper blood flow for the person. This is followed by the providence of acute facility level differences to indicate the requirement for careful consideration for the patient and facility factors during the discharge procedure (Hong et al. 2018). Besides, consider the functional status of the patients for the next three months in case of ischemic stroke to make decisions during the discharge procedure for making further progress and a positive outcome.

Most of the discharge plans consist of various clinical and non-clinical factors. The clinical factors include patient 's condition alongside co-morbidities functional abilities to influence the overall discharge procedure (Wan & Qiu, 2022). In the case of the following study, the discharge plan for Mr author requires identification his conditions on morbidity factors and his functional abilities while making decisions and taking care of himself. While he has a history of depression, type 2 Diabetes and hypertension, he is considered to be under critical care and supervision of a care provider at his home instead of living alone. This is also followed by consideration of regular medication and consumption of proper food for the patient at the post discharge state (Hong et al. 2018). Besides, the non-clinical factors include distance geography which are capable of contributing towards the acute care for the patients after the discharge decisions (Abdelhady et al. 2022). Here, the patient has shown the history of living alone and approximately 1 hour away from his only son. The distance is considered a crucial factor while monitoring and taking care of a person in the post discharge condition and Mr author is required both to achieve a positive outcome.

The identification of risk factors which are needed to be monitored during a post discharge plan for the patient refers to the monitoring of blood pressure, cholesterol level, smoking habits, diabetes alongside other disease conditions and diet in terms of removing salty and fried foods (Cohen et al. 2022). This is followed by the recruitment of an occupational therapist and physical therapist with the aim of associating the patient to learn new ways of doing things. The identified patient is required to consult with the speech therapist as well to help him with normal conversation communication and swallowing food to maintain the proper diet in the post ischemic condition. The role of diet is considered a significant state in the post discharge plan and it requires the patient to maintain a contact with a registered dietitian to cope up with the diet changes (Yulanda et al. 2022). The identified patient is required to improve his cholesterol level and blood pressure and blood sugar by reducing the amount of fat and cholesterol from the overall diet alongside reduction of salt. Mr author is required to maintain this diet alongside including fresh vegetables and fruit and lean protein and low-fat dairy products in his diet to improve the dairy aspect in the post discharge plan. On the other hand, the management of follow-up care by keeping medical appointments and attending stroke rehabilitation is important for any patient to recover quickly (Yulanda et al. 2022). This would help Mr. Arthur to manage his vitals and check his present condition and recovery process at home under the supervision of a care provider. Apart from this dialling 000 would help the patient to access ambulance service police and urgent medical help in future in Australia. Apart from that the role of medication is considered a significant step which helps the discharged person to manage his health properly. The use of anti-platelet medicine alongside diuretic, beta-blocker and Ace-inhibitor medicines are effective for patients to keep reducing blood clotting alongside controlling blood pressure (Kamarova et al. 2022).

Application of professional healthcare standards such as NMBA

As per the use of NMBA standards to use decision making framework it helps the nursing staff to guide the practice decisions and using evidence-based contemporary documents for any health issues while maintaining conjunctions with the standard of practice and policies, regulations and legislation related to nursing (Nursingmidwiferyboard.gov.au, 2023). For the given case study which is as follows -

Table 1: Nursing decision making by NMBA standards

(Source: Nursingmidwiferyboard.gov.au, 2023)

This also includes the implementation of Orem 's theory of self-care which explains the individual ability to perform self-care (Hartweg & Metcalfe, 2022). This theory is applicable for the following context as it helps the nursing staff to work towards the goal of improving patient care and the patient to participate in a care plan for active decision making.

Conclusion

The following report has successfully addressed the pathophysiology of the identified disease to address the symptoms of disease in the form of the deficiency of blood and oxygen supply to the brain and excessive blood clot. This is followed by addressing evidence-based context to plan the proper nursing intervention for Mr. Arthur and managing potential complications in case of identified disease. This also includes discussion on customised discharge plans for the patient and using NMBA standard to implement the nursing intervention.

References

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