Scenario
Mr. Bill, a 62-year-old male experiencing housing instability, was found unresponsive on the street and brought in by EMS. He is Full Code. His medical history includes stroke, bladder cancer, cardiomyopathy, congestive heart failure, coronary artery disease, diabetes, hyperlipidemia, hypertension, methamphetamine use, NSTEMI, peptic ulcer, and TIA.
On arrival, he was alert to self only, with no pain, and tested positive for meth and heroin. Vital signs: HR 50 (sinus bradycardia), BP 98/64, SpO₂ 95% on room air. He received Zyprexa IM in the ED for MRI compliance, which caused QTc prolongation; Ativan and Zyprexa are now held per MD order.
Diagnostics: Cardiac echo revealed a left ventricular thrombus and ejection fraction of 17%. MRI showed multiple acute and subacute occipital lobe thrombi. He is not a candidate for thrombectomy or TPA.
Current Medications: Eliquis, Atorvastatin, melatonin.
Clinical Background
Mr. Bill is diagnosed with a cerebrovascular accident and stroke. The MRI findings supported the diagnosis by demonstrating the presence of multiple acute and subacute thrombi. The main reason for stroke is the disruption of blood flow to the brain, so the brain cells are damaged, and lethal consequences can be seen (Xia et al., 2019).
In this case, Mr. Bill’s brain thrombi are causing the disease, indicating that the patient has heart failure. All these factors contribute to the formation of thrombi in Mr. Bill’s organism. The lab’s results and diagnosis emphasized the presence of substance abuse, which increases the risk of stroke. The cardiac echo showed a low ejection fraction, which leads to congestive heart failure.
Interdisciplinary Team Approach
The disease is severe, so it is advisable to involve various specialists in the healthcare team. The neurologist and cardiologist, as the patient, have issues with the brain and heart. A neurologist would evaluate the patient’s brain condition, whereas a cardiologist would evaluate Mr. Bill’s heart. In addition, the psychologist can be involved, as the patient faces substance abuse, so there is a need to research the patient’s mental health and assist him in finding opportunities for stable housing and reducing the negative impact of external psychological factors that negatively contribute to the recovery process.
Cultural Assessment and Patient-Centered Approach
The patient’s cultural background is also crucial; therefore, a patient-centered approach should be used. The primary goal of the patient-centered approach is to be with patients, care for them, and address any issues that may disrupt the recovery process. The immediate delivery of this approach is for nurses (Hearn et al., 2019).
The nurse should consider the patient’s social background, such as homelessness and abuse. Firstly, the patient faced substantial abuse, negatively affecting his treatment acceptance and overall recovery process. In this case, nurses should inform relevant specialists to help Mr. Bill start the treatment and choose the most appropriate treatment plan regarding his negative substance abuse experience.
Secondly, the patient’s homelessness should be considered and addressed. For instance, nurses can contact social workers and shelter the patient. Lastly, nurses and doctors should be aware of the possibility of trauma. Based on the patient’s past and negative experiences, it is possible to predict the availability of trauma. That is why relevant specialists should be involved in the process.
Recommendations
It is recommended to implement different treatments to address stroke and brain damage. Firstly, thrombotic therapy and the most helpful care for patients with stroke can be used. It is reported that this treatment is the most effective, as it reduces disability and shows positive results (Hollist et al., 2021).
Secondly, cooperation between neurologists and cardiologists can be established to jointly address brain damage and stroke, making treatment more efficient. Thirdly, the specialists should be involved in examining the patient’s mental health conditions, and the patient should receive assistance from psychologists and social workers to improve their quality of life and find suitable shelter. Lastly, the negative impact of external factors should be examined and reduced to provide the most appropriate care for the patient.
The location of the thrombus limits the medical interventions, so additional resources and therapies can also be considered. Social support is crucial for Mr. Bill to achieve the most effective treatment. Especially, peer social support plays a significant role, as people with such support are more likely to engage with society and actively improve their quality of life (Griffin et al., 2019). In this case, the lack of motivation and resource difficulties would be reduced. Lastly, Mr. Bill’s homelessness can lead to limited access to healthcare, so it is essential to address the issue and improve the patient’s quality of life.
References
Griffin, A. M., Sulkowski, M. L., Bámaca-Colbert, M. Y., & Cleveland, H. H. (2019). Daily social and affective lives of homeless youth: What is the role of teacher and peer social support?. Journal of School Psychology, 77, 110-123.
Hearn, J., Dewji, M., Stocker, C., & Simons, G. (2019). Patient-centered medical education: a proposed definition. Medical teacher, 41(8), 934-938.
Hollist, M., Morgan, L., Cabatbat, R., Au, K., Kirmani, M. F., & Kirmani, B. F. (2021). Acute stroke management: overview and recent updates. Aging and disease, 12(4), 1000.
Xia, G. H., You, C., Gao, X. X., Zeng, X. L., Zhu, J. J., Xu, K. Y. & Yin, J. (2019). Stroke dysbiosis index (SDI) in gut microbiome are associated with brain injury and prognosis of stroke. Frontiers in Neurology, 10, 444987.