care conference stroke

At the end of this session, you will be able to :

State the definition of stroke. List the etiology of stroke. Identify the pathophysiology of

stroke. State the sign & symptom of

stroke.

LEARNING OBJECTIVES cont.

Identify the complication of stroke. Understand regarding treatment of

stroke. Identify the nursing intervention &

appreciate the nursing care for stroke patient.

PATIENT’S PROFILE

MRS. M

FEMALE

75 YEARS OLD

HOUSEWIFE

PATIENT’S PROFILE TROLLEY

ANXIOUS

ALLERGICS - NIL

D.O.A 9/4/12 @ 1015 Hrs

Mrs M was admitted to 5XX-1 with complaint of right sided weakness, slurred speech,

numbness right arm, giddiness, dysphagia, nausea and

vomiting X 1/7.

Doctor = Dr AA

Diagnosis 1.Stroke2.High Cholesterol

PATIENT’S PROFILE MEDICAL HISTORY Nil

SURGICAL HISTORY Left eye removal of cataract (2 years ago) Right eye removal of cataract (1 year ago)

FAMILY MED HISTORY HPT (mother)

CURRENT MEDICATION

Nil

VITAL SIGN TEMPERATURE : 36.8˚C BLOOD PRESSURE : 170/100mmHg PULSE : 88 bpm RESPIRATION : 18 bpm PAIN SCORE : 1 Dextrosmeter : 8.2 mmol/L Weight : Unfit

ACTIVITY DAILY LIVING Having difficulty in swallowing

Loss of appetite, nauseated and vomiting

Anxious and asking many questions.

Need assistance in ADL and personal hygeine

On pampers

PHYSICAL EXAMINATION

S/B Dr AA in A&E

17K CT BRAIN IV Drip D5% slow Low fat diet KIV anti HPT Dietician advice ROM exercise

ISCHEMIC STROKE

• Occurs when blood clot or thrombus formed and blocked blood flow to part of the brain.

HAEMORRHAGIC STROKE

• Occurs when blood vessel ruptured and blood fills space between brain and skull (subarachnoid haemorrhage) or when a defective artery burst and blood fills the surrounding tissue (cerebral haemorrhage).

WHAT CAUSES IT? High blood pressure High cholesterol Aging Stress Cardiovascular disease Smoking and alcohol Diabetes

• Family history• Age over 40• High BP• High cholesterol• Smoking

RISK FACTORS

• African American or Asian• Male• Diabetes• Obesity• Cardiovascular disease• Stress

RISK FACTORS

• Previous stroke or TIA• High level of homocysteine

(amino acid) in blood• Birth control or hormonal therapy• Cocaine usage• Alcohol

RISK FACTORS

• Paralysis• Vision loss• Difficulty speaking or swallowing•Memory loss• Death

COMPLICATION

• ESR- 56 (0 – 20 mm/hr)

• Neutropil- 79.9% (40 – 75%)

• Lymphocyte- 16.0% (20-45%)

• Glucose- 6.9 (3.9 – 6.1mmol/L)

17K

• Total cholesterol- 8.0mmol/L (<5.2)

• LDL cholesterol- 5.7mmol/L (<2.6)

• Chol/HDL Chol- 4.4 (up to 4.0)

17K

• Multifocal small cerebral white matter ischemia

CT BRAIN

DRUGSIN WARD

DATEORDERED

DATE OFF

IV Nootropil 3gm TDS 9/4/13 12/4/13

Tab Cardiprin 1/1 OD 9/4/13 12/4/13

Tab Vascor 20mg ON 9/4/13 12/4/13

Tab Plavix 75mg Daily 9/4/13 12/4/13

DRUGSON DISCHARGE

DATEORDERED

Tab Vascor 20mg ON 12/4/13

Tab Cardiprin 1/1 ON 12/4/13

Physiotherapy

• To normalise muscle tone• To restore muscle function• To control compensation strategies• To maintain muscle length• To re-educate balance• To retrain walking and restore mobility• To maximise functional ability while allowing on-

going neuromuscular recovery

Knowledge deficit related to management of blood pressure control.

NURSING DIAGNOSIS

SUPPORTING DATA Patient will verbalize understand

regarding the management of blood pressure.

Patient will maintain optimal normal blood pressure.

NURSING INTERVENTION Reinforce about doctor’s

explanation.

Monitor blood pressure 4 hourly.

NURSING INTERVENTION Explain the sign and symptom of

high blood pressure : Headache Blurring vision Numbness

NURSING INTERVENTION

Advise patient on dietary plan and provide :

Low salt diet Low fat diet

NURSING INTERVENTION

Advise patient to do regular follow up.

NURSING INTERVENTION

Advise patient to maintain healthy lifestyle :

Avoid stress Consume healthy diet and avoid

salty and high fat food

NURSING INTERVENTION

Advise patient to do regular exercise.

Encourage family members support.

NURSING INTERVENTION

Explain the complication of high blood pressure :

Influences of cardiovascular Cerebral Renal system

Alteration in emotional status anxiety related to symptoms of stroke and treatment.

NURSING DIAGNOSIS

Alteration in ADL related to right sided weakness and numbness of right hand.

NURSING DIAGNOSIS

Knowledge deficit related to management of blood glucose control.

NURSING DIAGNOSIS

Potential fall related to right sided body weakness.

NURSING DIAGNOSIS

Alteration in nutritional status less than body requirement related to nausea, vomiting and dysphagia.

NURSING DIAGNOSIS

Potential infection related to intravenous cannulation.

NURSING DIAGNOSIS

NURSING DIAGNOSIS

Knowledge deficit related to post stroke attack management.

NURSING DIAGNOSIS

Potential alteration in skin integrity related to immobility.

• Reduce your blood pressure• Improve your diet • Stop smoking• Consider how much alcohol you drink • Exercise more• Watch your weight• Relaxation and stress management• Diabetes management