Cerebrovascular Disorders Essay Assignment Paper
Cerebrovascular Disorders Essay Assignment Paper
Cerebrovascular Disorders Essay
Kaorou Kashin, a 74-year-old patient, is admitted to the telemetry unit with the diagnosis of acute ischemic stroke. The patient is experiencing paroxysmal atrial fibrillation with a controlled ventricular rate on the monitor. The CT of the head without contrast reveals no evidence of hemorrhage. The transesophageal echocardiogram reveals moderate mitral valve insufficiency and embolism as a primary cause of the stroke. Cerebrovascular Disorders Essay The patient is on a weight-based heparin protocol. The patient received digitalis to keep the ventricular rate of the atrial fibrillation controlled. The patient has right-sided paralysis and global aphasia. The patient has unilateral neglect of her right side and has right field homonymous hemianopsia. There is papilla edema present bilaterally. The patient is drooling from the right side of her mouth and coughs periodically. The patient was found by her daughter after her daughter had gotten out of work and arrived at her mother’s home. The daughter stated her mother was normal before she left for work, and 10 hours later the mother exhibited the symptoms described above. The time of onset for the stroke could not be safely determined so no interventions could be used to treat the stroke.
Stroke and cerebrovascular disorders are important causes of morbidity and mortality in children; they are already amongst the top 10 causes of childhood death and are probably increasing in prevalence. Acute treatment of stroke syndromes in adults is now evidence based. However, paediatric stroke syndromes are far less common and the differential diagnosis is very wide, but the individual health resource implications are much greater because of the life-long treatment costs in survivors. Recognition and consultation with a paediatric neurologist should be rapid so that children can benefit from regional services with emergency neurological, neuroradiological and neurosurgical intervention and paediatric intensive care. This review focuses on the epidemiology, presentation, differential diagnosis, generic/specific emergency management and prognosis of acute stroke in children. Its aim is to educate and guide management by general paediatricians and to emphasise the importance of local guidelines for the initial investigation and treatment and appropriate transfer of these children.Cerebrovascular Disorders Essay
A cerebral vascular accident (CVA), or commonly known as a stroke, impact approximately 500,000 individuals in the United States each year. According to the Encyclopedia of Aging (Scherer, 1982), a stroke occurs with a neurologic deficit from a disruption of vascular function. This may be the result of a partial or total blockage of blood vessels to the brain by a hemorrhage or blood clot. In the U.S.,
50 percent of those suffering their first stroke are 70 or older; most are males.
The most at risk for a stroke are those individuals with transient or mild neurologic events, a cardiac disease that predisposes them to embolism, and asymptomatic with a carotid bruit that indicates a blockage. Those who have experienced transient ischemic attacks, or indications of cerebrovascular disease, also have a high risk for stroke.
Strokes caused by an embolism occur suddenly. There usually is not a loss in consciousness, but an alteration in the state of consciousness. Some neurologic symptoms such as paralysis of one side of body, inability to speak, or loss of side vision of both eyes may also occur. Strokes from a hemorrhage may occur suddenly or progress slowly. Normally it is caused by an aneurysm that bursts or a congenital malformation of the vessel. Nausea, vomiting, headaches, and stiff neck are symptoms of a hemorrhagic stroke (Sherer, 1982).Cerebrovascular Disorders Essay
Hypertension is the single most important risk factor for stroke. Other factors include heart disease, diabetes, smoking, and elevated blood cholesterol. Once a stroke occurs, there is nothing that can be done to restore the dead brain tissue. Treatment includes preventing a recurrence with anticoagulation medication and medical control of the hypertension. Some forms of aneurysms and hemorrhages can be treated surgically. Rehabilitation is important to maximize the degree of functional adaptation and self-care. Because of the seriousness of strokes
Cerebrovascular accident, or stroke, is the third leading reason for death in the United States and the number one cause of disability, with 3 million people permanently disabled as a result of stroke (Schonbeck, 2012). A cerebrovascular accident occurs when there is death of brain cells due to oxygen deprivation; in addition there is the loss of nutrients to the blood supply to the brain being diminished both a result of either a rupture, or blockage of an artery to the brain (Schonbeck, 2012). Once the brain is deprived of oxygen, brain cells rapidly start to die, causing permanent damage. Depending on which area of the brain is affected, the result may be paralysis, difficulty speaking, and loss of memory or even death (Stroke, 2011). The degree of the damage to the brain will be determined by the type of cerebrovascular attack, the area or areas of the brain involved, and the length of time that passes before treatment is initiated.Cerebrovascular Disorders Essay
The majority of strokes, approximately 90 percent, are ischemic strokes (Stroke, 2010). Some of the main types of stroke are cerebral thrombosis and cerebral embolism, both caused by a blockage of the blood supply to the brain, occurring in a main artery of the neck, the carotid, or other arteries that supply blood to the brain, or an artery in the brain itself (Stroke, 2010). Blood clots are formed, as a result of plaque deposits in these arteries. Another type of ischemic stroke is an embolic stroke, which happens when a blood clot develops in a blood vessel a distance away from the brain ordinarily in the heart. The embolus then is carried through the bloodstream to imbed itself in brain arteries which are narrowed, slowing the flow of blood (Stroke, 2010).
What principles of nursing management should the nurse provide the patient during the acute stage of the ischemic stroke based on the assessment findings from the case study? Place the assessment findings that are supported by the nursing principle(s) in parenthesis.
Right-sided paralysis – (ROM – To help maintain or increase joint function and prevent contractures.)
Global aphasia – (Speech therapy – To help aphasic patient)
Unilateral Neglect (right) –
Papilla Edema – Assess Glasgow Coma Scale
Drooling (right side of mouth) –
Coughing – (Back Clapping – Cerebrovascular Disorders Essay
Case study 2
Luke Skywalker, a 71-year-old male patient, is being discharged from the rehab unit 8 weeks after an ischemic stroke. The patient’s spouse stated that they used to enjoy going to golf outings with their friends, but the patient has not golfed since her husband had the stroke, and she does not want to try to golf once her husband is discharged home because he has to use a walker and can barely ambulate. She also states that her husband still has trouble speaking, and his short-term memory is not very astute so it would be embarrassing to be on a golf outing with him. The patient’s spouse has worn the same outfit to the rehab unit the past 3 days, and the nurse notices the patient’s hair is unkempt and her affect is flat. The rehab nurse has made arrangements with the social worker for a physical therapist, speech therapist, and occupational therapist to provide three sessions of therapy at the patient’s home for the next 4 weeks, and then a reevaluation will follow to determine if the patient will need further therapy. The patient is able to sit independently, stand independently, and use a walker. The patient is able to ambulate 30 feet with the walker, and then he requires a short rest before he is able to ambulate another 30 feet. The patient slurs words occasionally and has hesitant speech. The patient has problems with short-term speech.Cerebrovascular Disorders Essay
What educational topics should the nurse provide the family about home care for the patient after stroke?
When providing patient-family teaching, it should focus on sensory information. We should include verbal and written information about the following:
Symptoms that needs prompts attention: sudden weakness, numbness (especially on one side of the body), vision loss or dimming, trouble talking or understanding speech, unexplained dizziness, unsteadiness, or severe headache.
Interventions for safe swallowing and aspiration prevention.
Significance of minimizing or treating the following risk factors: diabetes mellitus, hypertension, high cholesterol, high Sodium intake, obesity, inactivity, smoking, prolonged bed rest, and stressful lifestyle.
Importance of taking prescribed medications regularly and on schedule. Do not discontinue medications abruptly.
Encourage patient/family to keep drug and seizure chart diary.
Reinforce drug administration instructions.
Importance of keeping with the appointments.
Explain or inform family side effects of medications.
Notify health care provider if there is a significant weight gain or loss.
Teach to avoid alcoholic drinks and OTC drugs.Cerebrovascular Disorders Essay
Encourage oral hygiene
What assessment of the spouse does the nurse need to make, and what should the nurse suggest?
Can barely ambulate – Positioning: Bedrest, it will help improve the patient’s condition, which will help increase activity level.
Trouble speaking – Speech therapy; Encourage patient to perform facial muscles exercises; provide a supportive and relaxed environment for patient; provide alternative methods of communication
Short term memory
Same outfit and unkempt hair – assist performing independently self-care; demonstrate ability to adaptive devices
Affect is flat
GROUP OUTPUT CHAPTER 63 EO4
Case Study 2
Luna Lovegood, a 23-year-old-patient, is admitted to the neuro intensive care unit after a diving accident leading to a C-6 spinal cord injury. The patient is diagnosed with neurogenic shock. The patient has the following vital signs: T: 97°F, BP: 84/44, P: 40 bpm, 16 breaths per minute. The patient has lower extremity edema and peripheral vasodilation. The patient is perspiring above the C-6 lesion, but there is no perspiration below the C-6 lesion and the skin is warm and dry. The patient has a paralytic ileus.Cerebrovascular Disorders Essay
What clinical management should the nurse anticipate for the patient?
The care given to a patient with a neurologic shock is also similar to the general management provided for any patient with shock. Airway control should be secured with spinal immobilization and protection. The patient should be immobilized to minimize further movement and injury to the spine. We should keep the patient warm because spinal injury can disrupt the thermoregulatory mechanisms of the body. Another concern is related to fluid therapy. We determine the needed IV fluids based on the patient’s hemodynamic status. We maintain the patient’s adequate hydration and volume status to keep at 90 mm Hg/higher. General hemodynamic resuscitation includes volume loading with normal saline IV fluid. If possible, warm fluid is given to prevent hypothermia. Profound bradycardia in extreme cases become asystole and some patient needs to have a pacemaker fitted. Medications such as vagal blockers, for example atropine, by rapid IV push is given if the pulse remains bradycardic, while pressor agents, such as dopamine drip, may be used for better hydrating the patient. We should monitor the patient’s response to vasopressors because it may compromise the sympathetic nervous system.Cerebrovascular Disorders Essay
What are signs that the neurogenic shock is resolving?
The symptoms resolve when spinal cord edema resolves. Another sign of resolving shock is Spasticity, which is the return of reflexes. Improved cardiac output of the patient is also a sign of resolving neurogenic shock. Cerebrovascular Disorders Essay
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