Case Study Assignment #1- Stroke Patient Assessment
Introduction
Stroke is the single leading cause of adult disability in Canada, also accounting for one third of all deaths (Ontario Stroke Network, 2017). Approximately 14,000 Canadians die from strokes annually, and around 430,000 Canadians live with the debilitating effects of stroke (Ontario Stroke Network, 2017). For the purpose of this assignment and to maintain patent confidentiality, the examined patient will be referred to as a pseudonym of “FA”. The case study that I will be examining will revolve around a 60-year old, Filipino man (non-smoker) being rushed into the emergency department for signs and symptoms of a suspected stroke. FA is a married man, living with his wife and two …show more content…
The occlusion can either be is in the form of a thrombosis or emboli. The thrombotic stroke occurs when a blood clot is formed in the carotid arteries. This can be caused by the build-up of fat deposits that stick on the walls of the arteries, thereby promoting atherosclerotic activity (Moustafa & Baron, 2008). On the other hand, an embolic stroke occurs when a blood clot or other matter forms away from the brain, moves through the bloodstream and is dislodged into the brain arteries. The regions of the brain affected with the highest degree of hypo perfusion transforms into irreversible damage, also known as the ischemic core (Moustafa & Baron, 2008). The remaining areas of hypoperfused tissue are divided into two compartments known as the ischemic penumbra and oligaemia. In the ischemic penumbra, oxygen metabolism is preserved based on the cerebral blood flow (Moustafa & Baron, 2008). The tissue lying within the ischemic penumbra tends to have reduced blood flow, yet still salvageable (Levine, 2004). The oligaemic compartment suffers a milder level of impairment with normal oxygen consumption and an elevated cerebral blood volume. This area tends to not be at risk for infarction, however continual occlusion and related events may transform the oligaemia into a penumbra state, …show more content…
For the stroke patient, interventions are based on the phase of the stroke (Silvestri, 2014). In the acute phase, the nurse informed the medical doctor about the patient’s condition, specifying the signs and symptoms of stroke found on assessment. At this point, the doctor could give specific instructions and may take over the care of the patient momentarily. The nurse assured that the airway is patent and that oxygen is given as needed. The nurse then meticulously checked the patient’s level of consciousness and blood pressure at each 15 minute interval. The nurse understands that a blood pressure of around 150/100 is to be maintained in order to maintain adequate perfusion to the brain (Silvestri, 2014). The nurse then monitored the patient for signs and symptoms of intracranial pressure, as patients with stroke are at great risk during their first 72 hours of onset. The patient is then immediately positioned in the low-fowlers position, on the side to relieve pressure and increase brain perfusion (Silvestri, 2014). The nurse then ensured the preservation of a quiet environment, clustered care and minimized movement. The nurse then plans to place pillows under the right side to prevent adduction. The affected right extremities are to be elevated to prevent edema build-up. The nurse may administer intravenous fluids and medications (anticoagulents, antiplatelets, diuretics, antihypertensives) as
Introduction
Stroke is the single leading cause of adult disability in Canada, also accounting for one third of all deaths (Ontario Stroke Network, 2017). Approximately 14,000 Canadians die from strokes annually, and around 430,000 Canadians live with the debilitating effects of stroke (Ontario Stroke Network, 2017). For the purpose of this assignment and to maintain patent confidentiality, the examined patient will be referred to as a pseudonym of “FA”. The case study that I will be examining will revolve around a 60-year old, Filipino man (non-smoker) being rushed into the emergency department for signs and symptoms of a suspected stroke. FA is a married man, living with his wife and two …show more content…
The occlusion can either be is in the form of a thrombosis or emboli. The thrombotic stroke occurs when a blood clot is formed in the carotid arteries. This can be caused by the build-up of fat deposits that stick on the walls of the arteries, thereby promoting atherosclerotic activity (Moustafa & Baron, 2008). On the other hand, an embolic stroke occurs when a blood clot or other matter forms away from the brain, moves through the bloodstream and is dislodged into the brain arteries. The regions of the brain affected with the highest degree of hypo perfusion transforms into irreversible damage, also known as the ischemic core (Moustafa & Baron, 2008). The remaining areas of hypoperfused tissue are divided into two compartments known as the ischemic penumbra and oligaemia. In the ischemic penumbra, oxygen metabolism is preserved based on the cerebral blood flow (Moustafa & Baron, 2008). The tissue lying within the ischemic penumbra tends to have reduced blood flow, yet still salvageable (Levine, 2004). The oligaemic compartment suffers a milder level of impairment with normal oxygen consumption and an elevated cerebral blood volume. This area tends to not be at risk for infarction, however continual occlusion and related events may transform the oligaemia into a penumbra state, …show more content…
For the stroke patient, interventions are based on the phase of the stroke (Silvestri, 2014). In the acute phase, the nurse informed the medical doctor about the patient’s condition, specifying the signs and symptoms of stroke found on assessment. At this point, the doctor could give specific instructions and may take over the care of the patient momentarily. The nurse assured that the airway is patent and that oxygen is given as needed. The nurse then meticulously checked the patient’s level of consciousness and blood pressure at each 15 minute interval. The nurse understands that a blood pressure of around 150/100 is to be maintained in order to maintain adequate perfusion to the brain (Silvestri, 2014). The nurse then monitored the patient for signs and symptoms of intracranial pressure, as patients with stroke are at great risk during their first 72 hours of onset. The patient is then immediately positioned in the low-fowlers position, on the side to relieve pressure and increase brain perfusion (Silvestri, 2014). The nurse then ensured the preservation of a quiet environment, clustered care and minimized movement. The nurse then plans to place pillows under the right side to prevent adduction. The affected right extremities are to be elevated to prevent edema build-up. The nurse may administer intravenous fluids and medications (anticoagulents, antiplatelets, diuretics, antihypertensives) as