Physiologic basis for the symptoms; Identify the two types of strokes
Physiologic basis for the symptoms; Identify the two types of strokes:
Stroke is the fifth most common cause of death in the United States and it is higher incidence in the African American Community . There are two major pairs of arteries that supply blood to the brain , thus internal carotid and vertebral arteries . The types of stroke that can occur namely ischemic and hemorrhage . Ischemic stroke is when there is inadequate blood flow to the brain. This broken down into two thrombotic and embolic stroke .The other of stroke is hemorrhage stroke , bleeding into the brain and results in death of brain cells. Hemorrhage stroke is also broken down into intracerebral and subarachnoid . Stroke normally affects functional abilities such as movement , sensations , thinking , talking or emotions .
2) Subjective: what data the patient/family may give; questions the nurse would ask to elicit necessary information on the symptoms?
What brings you here today?
When did it start / how long has it been going on?
Is this a new problem / first time having this problem?
Intermittent or constant?
What makes it worse Any other symptoms that you have?
3) Objective: what would the nurse assess, and what diagnostics are anticipated to evaluate symptoms?
The nurse will use the following assessment tools, inspection , palpation, auscultation and percussion . Assess for vital signs ( temperature, blood pressure, pulse and respiratory rate,) assess body systems such as the cardiovascular ( Lung sound and breath sounds) musculoskeletal systems( reflexes ) Neurological ( motor function , balance test )
4) How does/will/could the symptoms affect the patient’s functioning?
Mobility, respiratory , swallowing , gag reflex , aphasia , self care ability
5) Find a recent NURSING journal article that speaks about symptoms in stroke diagnosis & management (5 years or less)
This journal that about the common symptoms of stroke in the left hemisphere include aphasia, right hemiparesis and right hemianopia, and in the right hemisphere, left hemispatial neglect, left hemiparesis and left hemianopia. The majority (90%) of strokes are supratentorial; as such, the public can be taught to recognize and act upon stroke using the acronym FAST, for facial droop, arm drop, speech disturbance and time. Posterior circulation or infratentorial stroke has a multitude of additional symptoms, including diplopia, bulbar palsies, dysphagia, unilateral dysmetria and incoordination, as well as reduced levels of consciousness. Although headache or head, facial or neck pain may be an ancillary symptom, stroke is typically painless. The most important historical feature of stroke is the sudden onset.
Check ABCs (airway, breathing and circulation) first. In some patients with stroke, the level of consciousness is reduced, and intubation may be required. Rarely, there is circulatory instability due to arrhythmia or other concurrent cardiac disease.
Perform a quick assessment of degree of disability:
Speech and spatial perception: Aphasia or hemispatial neglect?
Vision: Hemianopia or quadrantanopia?
Coordination and walking: If possible, have the patient get out of bed and try to walk.
Use the National Institutes of Health Stroke Scale (NIHSS) to guide assessment of disability:
NIHSS = 0–5: transient ischemic attack (NIHSS = 0 and no signs on examination) or minor stroke (NIHSS 1–5)
NIHSS = 6–10: moderate disabling stroke
NIHSS = 11–20: moderate to severe disabling stroke
NIHSS ≥ 20: severe, life-threatening stroke
6. Include Treatment and Diagnostic measures and Nursing considerations.
Diagnostic : MRI, non contrast CT scan, CTA, MRA , Cardiac markers ( troponin, creatine, kinase- MB, ECG, CBC, Lipid profile, Renal & hepatic studies, Electrolytes panel .
Treatment: Drugs therapy :Antiplatelet drugs: (Aspirin, plavix,) Anticoagulant drugs ( warfarin )
Occupation and Physical Therapy ( Rehabilitation)
Surgically :Carotid endarterectomy, Stenting of carotid artery, Transluminal angioplasty
Recombinant tissue plasminogen activator (tPA)Used to establish blood flow through a blocked artery to prevent cell death Must be administered within 3 to 4 ½ hours of onset of clinical signs of ischemic stroke
7. Are there any safety issues? What are the safety issues?
Yes there are safety issues such as aspiration , fall, skin breakdown , spasticity of muscle
Reference :
Kwong, J., Harding, M. M.,
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