Case Description
Presenting Condition History
Patient X is a 62-year-old member of the senior citizens working on a Dairy Farm. While eating his supper, he experienced sudden onset speech slurring, developed facial droop on his right hand, which subsequently developed weakness in the left side of the lower and upper body. He and his wife immediately detected these sudden symptoms and called for an emergency, whereby the hospital ambulance arrived within ten minutes.
Medical History
- Hypertension Grade one- (Diagnosed six years ago).
- Asthma- (Diagnosed nine years ago).
- Prediabetes (Diagnosed four years ago).
Medication History
Thiazide.
Ventolin (As prescribed-not required for over one year).
Seretide Accuhaler.
Social History
The 62-year-old patient recently reduced his working hours from 50-60 hours to 22-30 hours per week. In the next two to three years, patient X is planning to relinquish and he lives with his wife, a recently retired lawyer. He has adult daughters who are both having their families- two live close by while the other two live overseas. Lifestyle shifted following the prediabetes diagnosis over the past two years. He enjoys playing golf when he is in the afternoon and during off-days. Patient X embraces walking for the past four years after the diagnosis of prediabetes diagnosis. Walks 4-5 days per week for 20-40 minutes. Patient X was smoking for over forty over, consuming between 11-16 per day. He quit smoking four years ago due to the prediabetes diagnosis.
Pre-Hospital Assessment
Vitals:
- Pulse 75
- Blood pressure of 140/90 mmHg.
Physical Exam:
- Left Motor Weakness- Lower Appendage 3/5, Upper Appendage 1/5.
- Slurred Speech.
- Left Facial Droop.
Acute Hospital Assessment
Vitals:
- Pulse 82.
- Blood pressure of 146/90 mmHg.
Physical Exam:
- Confusion.
- Slurred Speech.
- Decreased Tone.
- Mild Left Sided Neglect.
- Altered Sensation.
Investigations
Labs:
- International normalized ratio of 1.2
Computed Tomography:
- Hypodensity in the Cerebral Artery (M1 segment) with no related Ischemic Stroke signs noted.
- Patient treated with Intravenous Tissue Plasminogen Activator (tPA) at 2 hours 35 minutes after the symptoms manifest.
Magnetic Resonance Imaging (MRI):
- Perfusion-weighted – larger perfusion abnormality exemplifying the existence of a salvageable penumbral muscle.
- A multimodal MRI scan is done 2 hours 11 minutes after the symptoms, demonstrating ischemic changes to the cerebral artery (right-middle).
Medical Management
Thrombolysis & Endovascular Mechanical Thrombectomy:
- Endovascular thrombectomy initiated at 2 hours.
- tPA prescription initiated within 2 hours 50 minutes after symptoms onset.
Stroke Unit:
- 24-hour monitoring.
- Admitted to Acute Stroke Unit.
- Multidisciplinary team referral received within twenty-four hours- Physical therapy, Selective Laser Trabeculoplasty, & Occupational Therapy.
Relationship Between Stroke and Rehabilitation
The longstanding rehabilitation aim is to help the stroke patient develop a sense of independence. According to the American Stroke Association (2019), rehabilitation commences in the hospital after an individual is diagnosed and treated with stroke. Afterward, suppose the healthcare professionals ascertain that the condition is stable and manageable by the patient and the immediate family. In that case, rehabilitation can subsequently commence in two days of the stroke and last after the patient’s hospital release. Connectedly, rehabilitation helps patients improve their health condition and also enhance the effective recovery process. Rehabilitation option for stroke patients is dependent on stroke severity. American Stroke Association (2019) opines that patients whose condition is worse are put in the healthcare institution’s rehabilitation unit, receiving inpatient therapy. The unit provides a subacute unit, home therapy, and finally, a continuing care facility providing remedy and professional tending care. Therefore, the rehabilitation environment is dependent on the severity of the stroke in the patients.
A healthcare professional team will strategize the rehabilitation program, helping the patient meet the stroke recovery objectives. Wray et al. (2019) assert that every member in the healthcare system has a role to play in enhancing the stroke patient’s effective recovery. Moreover, the rehabilitation nurse will help manage the patient’s other conditions, including diabetes, hypertension, and asthma, and simultaneously adjust to normal life after the stroke ordeal. The speech-language pathologist will help talk without stuttering and general body coordination. Thus, hospital rehabilitation assures patient X of expeditious patient recovery as compared to allowing him to get home.
Adaptation to Stroke Among the Elderly
The adaptation process to psychosocial and physical consequences after an individual survives from a stroke is a significant challenge. An intervention and educating the victims on the different approaches they can embrace to restore their health and live a comfortable life is necessary. According to the Cleveland Clinic (2018), the stroke patients’ houses from the kitchen, washroom, and bedroom should be renovated to accommodate the patient’s requirements. For instance, the patient’s kitchen should have an enormous slicing board on open kitchen shelves to aid in preparing food while the individuals are seated. House renovation to billet the needs of the stroke patients is a critical adaptation intervention. Connectedly, the public should receive education concerning the diverse stroke symptoms and ways to respond to reduce the high mortality rates as a result of a stroke.
Advocating for physical activities is another adaptation strategy for patients recovering from a stroke. According to the Cleveland Clinic (2018), physical exercises are a cornerstone of the risk-reducing interventions for improving life quality among stroke survivors. Significantly, exercises ensure that patients have strong muscles and improved mobility. As a result, it becomes easier for individuals to restore their lost body functionality and coordination. Therefore, engaging in routine exercises is a good health restoration formula for elderly stroke survivors.
Incorporating a nutritious diet is the last intervention that supports the older adults’ adaptation to stroke. The Cleveland Clinic (2018) develops an argument that stroke survivors should incorporate a variety of vegetables and fruits into their diet. For instance, the elderly can eat cereal foods, including rice, barley, oats, pasta, and bread, among many other high fiber and wholegrain varieties. Thus, a nourishing diet forms part of the stroke recovery process among elderly individuals.
Nurse’s Role in Assisting Older Adults with Stroke
Nurses have prudent roles in providing care to adult persons with stroke. The first responsibility is physiological maintenance and monitoring of homeostasis. Royal College of Nursing (2020) alludes that a nurse ensures that the patient’s body functions well during the whole recovery process. Therefore, nurses check for the temperature and other traits in the stroke patients, including facial appearances and other coordination, hence concluding whether the patient is recovering or the condition is worsening.
Another role of a nurse in managing a patient is to prevent and detect cerebral edema and lesion extension. Royal College of Nursing (2020) mentions that nurses ensure quick detection of edema to enhance quick response in an aim to save the life of the stroke survivor. The professionals identify the abnormalities on the skin, hence checking for other conditions which might have led to the lesion’s extension. Holistically, the involvement of nurses helps reduce the mortality rate among stroke patients.
Healthcare System Improvement
Opportunities that can be improved in the healthcare system to improve care for older adults with stroke and other chronic diseases are to make the existing treatment program more patient-centric. This can be achieved by integrating the case and disease management, and equally behavioral health and life management into a consolidated chronic diseases care management scheme. As a result, the integration will increase patient engagement, preventing service duplication and other related missed opportunities.
Conclusion
Stroke is a hazardous disease that is contributing to the high mortality rate globally. Stroke management requires an integrated system of professionals. Rehabilitation is essential for patients to recover effectively and embrace their normal lives and become independent. Above all, there is a need for the public to be educated about stroke symptoms and the first aid application to reduce home-death rates due to poor attendance by the family members.
References
American Stroke Association. (2019). Rehab therapy after stroke. A division of the American Heart Association. Web.
Cleveland Clinic. (2018). Best tips for adapting your home after a stroke. Health essentials. Web.
Royal College of Nursing. (2020). Stroke. Neuroscience nursing. Web.
Wray, F., Clarke, D., & Forster, A. (2019). How do stroke survivors with communication difficulties manage life after stroke in the first year? A qualitative study. International Journal of Language & Communication Disorders, 54(5), 814-827. Web.