1. Introduction
1.1. Introduction
Stroke is a leading neurological disorder and causes long-term disability worldwide. The World Health Organization estimated that 15 million individuals1 are suffering from stroke annually worldwide, most of them are from developed countries and Stroke is the third leading cause of death and primary cause of disability. Despite advanced medical treatment intervened still 58% of patients still die or end up with severe disabilities. Following stroke the disability is sever in older population comparing to normal survivors. After 6 month of post-stroke, the 50% of survivors represents hemiparesis, 30% were unable to walk without support, 26% were dependent on Activities of daily living and 26% were hospitalized
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After ensuring patency of airways, adequate general circulation and checking blood glucose levels, CT scan is done to differentiate between ischemic stroke and hemorrhagic stroke, the commonest being an ischemic stroke.
General modalities of treatment are (1) medical support, (2) intravenous thrombolysis, (3) endovascular revascularization, (4) antithrombotic treatment, (5) neuroprotection, and (6) rehabilitation, often in stroke centers. Modalities 2-4 are for ischemic stroke only.
Medical treatment specific to stroke is to ensure sufficient cerebral perfusion to the surrounding ischemic penumbra. High blood pressure is treated according to specific norms; routine lowering is detrimental. Fever and blood glucose levels are controlled and if there is increased intracranial pressure, it is treated. All these factors are shown to have a significant role in the outcome of stroke patients.
Thrombolysis is induced by the use of recombinant tissue plasminogen activator (rtPA) within 3 hours of onset of stroke is approved in most countries. Use of intravenous rtPA has proven to improve clinical outcome in ischemic stroke and is cost-effective and
It is important that the type of stroke is diagnosed quickly to reduce the damage done to the brain and also to determine the right type of treatment because one treatment for one kind of stroke can be harmful to someone who has had a different kind. A number of different medications may be given at the hospital to help break up the clot and prevent the formation of new clots. For Ischemic stroke the treatment can begin with drugs to break down clots and prevent further ones from forming. Aspirin can be given, along with an injection of a tissue plasminogen activator (TPA). TPA works by dissolving clots but it needs to be injected within 4.5 hours of stroke symptoms once they have presented themselves. Hemorrhagic stroke treatment can begin with drugs being given to reduce the pressure in the brain, overall blood pressure, prevent seizures and prevent sudden constrictions of blood vessels.(http://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/treatment/txc-20117296) Because strokes are life-changing events that can affect a person both physically and emotionally, temporarily or permanently. After a stroke,
(2016, December 07). Retrieved April 10, 2017, from http://emedicine.medscape.com/article/1916852-overview#a5 McArthur, K. S., Quinn, T. J., Higgins, P., & Langhorne, P. (2011). Post-acute care and secondary prevention after ischaemic stroke. BMJ: British Medical Journal, 342(7802), 861-867. doi:10.1136/bmj.d2083
Strokes are caused by pathophysiological changes. The two major mechanisms of stroke consist of ischemia and haemorrhage. Ischemia is when there is no oxygen or not, merely enough oxygen to fuel the tissue level in the body. Haemorrhage in the brain, causing strokes can be due to non-traumatic intracerebral haemorrhage (Shah, MD, n.d.) (see appendix 1). This essay will further discuss the implications of strokes on a cellular, organ and system level. Explain the clinical presentation of the signs and symptoms of strokes and how the condition will be managed by a paramedic.
The long term effects of a stroke are different from person to person. If the right side of the brain was damaged the left side of the body will be affected and if the right side of the brain is damaged the left side of the body will be affected, also the left side damage to the brain will affect Speech, Balance, Vision and breathing ("Treatment - Stroke - Mayo Clinic," 2015). Extensive therapies are require after a stroke these are physical therapy, occupational therapy and speech therapy. There is also rehabilitation services through in home care, hospitals or skilled nursing facility’s depending on the circumstances. Counseling is available to help cope with the new changes happening to the inside and outside of the body ("Treatment - Stroke - Mayo Clinic," 2015). There are a few alternative treatments available to they are not approves by the food and drug administration ("Stroke Alternative Treatments," 2013). Some of these natural therapies would include aromatherapy, massage therapy and yoga, these help reduce stress and relax the mind and body ("Stroke Alternative Treatments," 2013). Some patients controlled their diet by taking notice of the amount of cholesterol that they were taking in from foods they were eating ("Stroke Alternative Treatments,"
Mr X, a 60 year- old Caucasian male, admitted to the stroke unit with a diagnosis Left MCA infract. He presented to the emergency department right sided hemiparesis, neglect of affected limbs, dysphasia and right side facial droop. He was on cardiac monitor for close observation for 48 hours. Stroke critical care pathway and commenced and care provided as per protocol.. Stroke is a serious and deadly condition including cerebral circulation within the brain and can extremely affect a person ability to maintain a safe environment, communication and mobility as well as other activities of living. The purpose of this essay is to give an overview of the Pathophysiology of ischaemic stroke, the required nursing care and the rationale behind it, followed by medical management and treatment provided to the patient.
Treatment of stroke, in general and ischemic stroke specifically, in particular, is aone of the most pressing issues in both nursing and medical science today. This is due to the fact that there are very few available treatment options for the various kinds of stroke. Acute ischemic stroke carriesis a prominent medical issue with a high risk of death or morbidity (Kakma, Stofko, Binning, Liebman & Veznedaroglu, 2014). Stroke, including ischemic and other types, is recognized, further, as a one of the most prominent leading causes of disabilities (Saver et al., 2015). While cerebral infarction resulting from thrombotic occlusion of brain arteries is the most common stroke type, ischemic stroke is also quite common. Each year ischemic stroke affects over a half-million victims in the United States alone;. o Of this group, about 150,000 deaths occur, along with 300,000 victims suffering from any number of disabilities following a stroke (CITE)after the fact.
The stroke from a blocked artery is called ischemia, and the ruptured artery is hemorrhagic. As time is critical after the cerebrovascular accident, lack of treatment will lead to brain cell apoptosis and neural injuries are permanent. Evaluation using brief tests of cognitive impairment includes analysis of executive functioning, memory, language, and visuospatial performance, neuropsychiatric as well as depressive symptoms (Grant and Adams, 2009).
Neuroradiological imaging plays an important role in the process of diagnosing ischaemic stroke. The different imaging modalities that can be used to diagnose ischaemic stroke include computed tomography (CT), magnetic imaging resonance (MRI), and radionuclide imaging. In this article, the different modalities that contribute to the diagnostic process are discussed, with a focus on CT scan protocols.
Ischemic stroke is the blockage of blood vessels in the brain as a result of blood clots (thrombi), causing the portions of the brain nourished by the vessel and its tributaries to be starved of nutrients, poisoned, and to eventually die (“Symptoms
Aneesh Singhal, MD, author of Recognition and management of stroke in young adults and adolescents, from the Clinical Journal of the American Academy of Neurology states
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.
A cerebrovascular accident more commonly known as a stroke or brain attack is the term used to describe the sudden death of brain cells in a localized area due to inadequate blood flow. In order to woke the brain needs a constant supply of oxygen and nutrients. This supply is carried to the brain
Mariam background is 60 year old lady admitted with left sided weakness and facial droop. Once confirmed stroke using the Recognition of Stroke in the Emergency Room (ROSIER) scale. Catangui (2015) states ROSIER scale is used to distinguish whether the patient is having a stroke or stroke mimics e.g. seizures or brain tumours. Computed tomography CT brain showed ischemic stroke. Ischaemic stroke is lack of sufficient blood supply to perfuse the brain/ cerebral tissue due to narrowing or blocked arteries in the brain (Morrison, 2014). According to Stroke Association (2015) statics shows that 1520000 strokes occur in the United Kingdom.
To have their symptoms diagnosed, a person must first seek medical treatment. Only 20-25% of patients who are admitted to the hospital with a stroke arrive in the emergency department within 3 hours of the onset of symptoms (3). Once a doctor is able to determine what kind of stroke has occurred, it is important the appropriate medicine be given. If the wrong medicine were given to treat a stroke victim, it could result in death. Treatment for an ischemic stroke will focus mainly on restoring blood flow
If doctors agree that a stroke has taken place, they may do other tests to determine where the stroke occurred, how large of an area is damaged, and how the blood flow with in the brain has been effected; they do this by taking a CAT scan. They may also take an ECG to determine if there is any heart disease that may have caused the stroke. In addition, they take tests to see if the patient has high blood pressure or they may test the arteries themselves because this is a major cause of stroke in most people. Catheterization, injecting dye into the arteries, and blood tests are the most common tests done. A high glucose level in the blood may reveal diabetes and high blood fats indicate thickened red blood and arteriosclerosis. There may also be a high level of red blood cells, changing the consistency of the blood. These conditions must be treated to prevent further strokes.