Case Study: Hemorrhagic Stroke

Strokes are caused by a block in the blood supply to the brain which causes a decrease in oxygen and delivery of other important supplies which facilitate proper functioning. Fifteen million cases are reported worldwide annually, although not all of these cases are mortalities, the large prevalence of strokes ranks it as the fourth leading cause of death in the United States. (Figueroa) Because of the time sensitivity associated with the lack of resources to the brain, strokes are considered a medical emergency and early recognition of symptoms can help decrease the amount of damage caused . Although strokes do not always cause death, strokes most often leave the individual with some physical and cognitive impairment.

Mrs. Alice Palmer is a 54-year old married woman who has been admitted and is being treated with an ischemic stroke which she had 18 hours ago. This paper explores the nursing care of Mrs. Alice Palmer based on the clinical reasoning cycle by considering her situation first, collecting cues and information about her, processing the information gathered, then identifying problems or issues she is experiencing, and finally carrying out a detailed assessment. Also, the paper focuses on setting goals and establishing a nursing care plan in the community, and target ethnically safe practice. Ischemic stroke occurs when the brain tissue does not receive sufficient oxygenated blood due to an obstruction of the carotid artery (Brunner, Suddarth, & Smeltzer, 2008). When the brain does not receive enough oxygenated blood, some or all of its tissues may get damaged

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

The patient, Jane Doe (pseudonym to protect patient’s privacy under HIPAA), was admitted to the hospital on May 1st for bilateral lower extremity pain. She was diagnosed with lower extremity cellulitis, a bacterial skin infection. Though the infection was in her legs and she reported pain, she could ambulate with her cane. Her background showed that she has a history of hypertension, peripheral vascular disease that led to chronic venous stasis ulcer, and obesity. She had no known drug allergies, and was full code (full resuscitation). Her progression of hospitalization showed that she had increased swelling in leg, could not tolerate ultrasound to her legs, started on vancomycin (antibiotic), and was scheduled for biopsy on her right leg. She

At this point in time, I feel that the patient is gravely disabled, that he cannot provide food, shelter, or clothing for himself nor make decisions in regard3 to his medical or financial affairs in his best

A CVA occurs when a part of the brain is damaged or destroyed due to an interruption of blood flow to the area resulting in brain cell death (Martini, Nath & Bartholomew 2015 pp. 496-470).There are two main types of a CVA, Ischaemic stroke and Haemorrhagic stroke (AIHW 2013). The most common cause of stroke is ischaemic, which can be caused by embolism/thrombosis (AIHW 2013). An embolism/thrombosis occurs when there is a clot in an artery or vein, which stops blood flow to the brain (AIHW 2013). A haemorrhagic stroke is when an artery ruptures and bleeds into the surrounding brain tissue (AIHW 2013). This form of stroke occurs when blood pools and forms a clot therefore putting pressure on the area of the brain depriving it of oxygen and nutrients it needs to remain healthy (AIHW 2013).

The patient is married and lives with his wife in a suburban area. They have two children who are in good health who lives with their families. Patient is well established with family and friends as powerful support system; he experienced little stress. He has a master degree in engineer, and making decent money. He has no financial issues, and has great health insurance coverage. He does see his primary health care physician regularly. Patient lacks of knowledge on his health issues despite his high education in engineer. Patient does comply with his medication regimen and does not know the current resources available to him.

In the last three weeks my client G was experiencing tingling in his hands, decreased fine motor control in his hands and increased weakness in his back and legs. This all led to decreased mobility and he was not in a wheel chair with limited ambulation (transferring to and from his bed or toilet and walking with PT two times day). This was a drastic change to his ability to care for himself and move about freely. This was impacting his emotionally and physically. Gas expressed embarrassment of having someone to help his to use the toilet and bath him. Due to his decreased mobility and spinal damage, he was losing strength, possibly at risk embolism and

The patient is an 88-year-old gentleman who is brought to St. Joe's ER complaining of inability to walk. The patient 6 days ago began to having trouble walking with his walker. He reported left arm pain which radiated up his left arm. The patient had pain in the left foot. The patient was taken to St. Joseph's Hospital in Wayne. In the ER he was diagnosed with gout and begun on Colchicine. Since that time he has shown no improvement. He has become essentially chair-bound and unable to walk so he is brought to St. Joe's ER. His medical history is significant for atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease and the patient also has a colostomy bag he had a procedure done and they were unable to connect is

1. Every 40 seconds someone in the United States has a stroke (National Stroke Association, 2014). Some symptoms related with a stroke are headache, blurred vision, trouble speaking, confusion, dizziness and numbness on one side of body. These symptoms are very important to know. Due to how common strokes are it's good to know the warning signs. For every person that dies from stroke, more than 5 times that many will survive, and for them the physical damage it causes can be enormous (National Stroke Association, 2014). Most people who have a stroke are depressed after it's all said and done. They may be paralyzed on one side, have a speech impairment or worse. When you are used to living a certain way and that suddenly changes it can be hard for people to deal with.

My patient was a 68 year old female that was brought to ER via EMS on Feb 15 with nausea, vomiting, and diarrhea x2 days. The pt had not been able to eat or drink for the last 1.5 days, and felt weak and dizzy for the past 2 days. The patient lives at home alone in Kitchener, her spouse resides in a long term care home as he suffers from advanced dementia, they have no children. For IADL’s the client is able to cook her own meals, drive, and do her own shopping. However she receives help with heavy items and house cleaning from a

K.K is a 43 year old male with a history of an advanced Friedreich’s ataxia and chronic pain. He is on hospice through Heartland Hospice. Staff reports that resident had a fall over the weekend from his wheel chair while he was trying to put a hot cup of coffee on his bed side table and landed on his buttocks and he spilled his coffee on his left foot and he sustained a second degree burn. Staff has been treating his burn with silvadene and gauze dressing. When I asked resident if he is has pain, he stated has pain everywhere most of the time. States that he has had pain for more than 20 years. He describes the pain as a “stabbing ” when it’s worse. When I asked K.K what his pain level was on a scale of 0-10, he would not give me a number,

This patient is an 80 year old female who required inpatient hospitalization due to: She was brought by the ambulance to the Emergency Department with complaint of chest pain for the past week, worsening over the past 2 days. She also had non-productive cough, nausea, diaphoresis, shortness of breath, and bilateral inspiratory crackles with mild expiratory wheezing in her lungs, as well as one plus pitting edema on the lower extremities. Her medical histories were significant for diabetes mellitus type 2, hypertension, hyponatremia, status post for PCI or coronary artery bypass graft with pacemaker, and a recent hip fracture status post left hip replacement. In the Emergency Department, her vital signs included a blood pressure of 150/78mmhg, and a respiratory rate of 24 breaths per minute, with an oxygen saturation of 95 % on 3 Liters of oxygen per minute. She had a troponin I of 227 and BNP level of 1539 (noted as elevated). At that time, she was given aspirin to chew, sublingual nitroglycerin , 40 mg of IV Lasix, morphine, was placed on oxygen which helped with her breathing , telemetry monitoring, and EKG was done.

Approximately 15 million people suffer a stroke worldwide each year, of those 5 million die and another 5 million are permanently disabled Mackay et al (2004). Stroke tends to affect people over the age of 75 (Scarborough et al 2009). Since almost 70% of people over 75 retain some teeth (Todd and Laden 1998), maintaining a healthy mouth is important for elderly stroke patients. Not only does effective oral care play a central role in the prevention of infection, a healthy mouth also makes a real difference to a person’s quality of life (McGrath and Bedi 1998) and maintenance of nutritional status (Jones 1998) .For these reasons, this dissertation will examine the benefits of good oral hygiene for elderly stroke patients and nurses role in

The over the counter medication once known only for its ability of easing aches and pains or fighting off fever and inflammation is proving itself to be quite the miracle drug. Aspirin has become part of the protocol for stroke victims as a preventative measure due to its neuro-protective benefits. Stroke can cause lesions in cerebral white matter, which may result in cognitive impairments such as deficits in learning and memory. White matter lesions (WML) have also been linked to increasing the risk of post-stroke dementia. Cerebral white matter damage has been widely overlooked. Comprised of oligodendrocytes that form the insulating myelin in the CNS, white matter is evidentially just as vulnerable to ischemia as gray matter.