Stroke Patient’s Journey
Slide 1 – Intro/Confidentiality
The aim of this digital narrative is to explore the journey of a patient and the planning, delivery and coordination of their care. The Nursing and Midwifery Council (2018) makes certain that all adult nurses should demonstrate a high level of competence in caring for patients. For the purposes of this video, the patient will be addressed as Bill and the wife will be addressed as Rachael. This is in accordance with the Nursing and Midwifery Council (2018) which entails that nurses should respect and maintain patient’s confidentiality.
Slide 2 – Admitted to Stroke Unit – Presenting Situation – Medical History
Bill is a 61- year- old man who is a senior Engineer. Bill had an abrupt onset slurring of speech, facial drop on his left-hand side, and weakness in his left side upper and lower limbs while eating breakfast. Bill’s wife, Rachael, noticed immediate symptoms and contacted an ambulance, which came within 15 minutes. Bill was admitted at the Cardiac Stroke Receiving Unit and was transferred to a Hyper Acute Stroke Unit after 24 hours. I encountered Bill in the Hyper Acute Stroke Unit in which I introduced myself and asked for consent to take his observations (NMC, 2018). Bills observations showed that BP 140/90 mmHg / Pulse 75 / Respirations 16/ Temperature 36.4 degrees / Oxygen Saturation 95%. This showed that Bill’s observation were stable (add reference) The handover revealed that Bill had gone for a CT Scan which showed that he had no evidence of bleed in the brain which meant that he was a candidate for thrombolysis. Thrombolysis is …Bill also had a physical examination from the specialist doctors, MRI scan, ECGs..
Conditions Medication
Asthma – Diagnosed Age 5 Seretide Accuhaler
Hypertension 5 years ago Ventolin (PRN) – not required for over one year
Pre-diabetes – 3 years ago Thiazide
Slide 3 – Bills Social History
| q Working hours 20 – 30 hours per week, previously worked 50 – 60 Hours |
| q Planning on retirement in 1 – 2 years |
| q Lives in a Bungalow with his wife Rachael, who is a recently retired Social Worker |
| q Two Daughters – Both married with their own children – One lives close by, the other lives overseas. |
| q Lifestyle changes implemented over past 2 – 3 Years following diagnosis of diabetes. |
| q Plays golf – at least 2-3 per week. Also enjoys cycling with friends. |
| q Walks – took up walking 3 Years ago following diagnosis of Prediabetes. |
| q Ex-Smoker – 30 Years – Quit 3 Years ago following prediabetes diagnosis |
| q Social Beer Drinker – Not often |
Slide 4 – What type of Stroke is Bill presenting? – How was it identified? – Signs & Symptoms?
Slide 5 – What we did for Bill when he was admitted & health needs identified?
Slide 6 – Impact on family and the patient? (ADLs – Activities of Daily Living)
Slide 7 – Effective care plans on Stroke patients – Why is this important for Bill?
Slide 8 – Nursing Management (ADPIE Model/ Theory, MDT Referrals to Physios, OTs and Speech and Language Therapists – why? , 24 Hour Monitoring)
Slide 9 – Policies and Legislations in relation to Stroke patients
Slide 10 – Student Reflection – From the time you were involved in their care to were you left them, what you saw, what you learnt and what you could do better
Slide 1 – Intro/Confidentiality
The aim of this digital narrative is to explore the journey of a patient and the planning, delivery and coordination of their care. The Nursing and Midwifery Council (2018) makes certain that all adult nurses should demonstrate a high level of competence in caring for patients. For the purposes of this video, the patient will be addressed as Bill and the wife will be addressed as Rachael. This is in accordance with the Nursing and Midwifery Council (2018) which entails that nurses should respect and maintain patient’s confidentiality.
Slide 2 – Admitted to Stroke Unit – Presenting Situation – Medical History
Bill is a 61- year- old man who is a senior Engineer. Bill had an abrupt onset slurring of speech, facial drop on his left-hand side, and weakness in his left side upper and lower limbs while eating breakfast. Bill’s wife, Rachael, noticed immediate symptoms and contacted an ambulance, which came within 15 minutes. Bill was admitted at the Cardiac Stroke Receiving Unit and was transferred to a Hyper Acute Stroke Unit after 24 hours. I encountered Bill in the Hyper Acute Stroke Unit in which I introduced myself and asked for consent to take his observations (NMC, 2018). Bills observations showed that BP 140/90 mmHg / Pulse 75 / Respirations 16/ Temperature 36.4 degrees / Oxygen Saturation 95%. This showed that Bill’s observation were stable (Chester & Rudolph 2011, p. 4) The handover revealed that Bill had gone for a CT Scan which showed that he had no evidence of bleed in the brain which meant that he was a candidate for thrombolysis. Thrombolysis is a treatment to dissolve or break up clots in blood vessels and enhance blood flow. Bill also had a physical examination from the specialist doctors, MRI scan, ECGs..
Conditions Medication
Asthma – Diagnosed Age 5 Seretide Accuhaler
Hypertension 5 years ago Ventolin (PRN) – not required for over one year
Pre-diabetes – 3 years ago Thiazide
Slide 3 – Bills Social History
| q Working hours 20 – 30 hours per week, previously worked 50 – 60 Hours |
| q Planning on retirement in 1 – 2 years |
| q Lives in a Bungalow with his wife Rachael, who is a recently retired Social Worker |
| q Two Daughters – Both married with their own children – One lives close by, the other lives overseas. |
| q Lifestyle changes implemented over past 2 – 3 Years following diagnosis of diabetes. |
| q Plays golf – at least 2-3 per week. Also enjoys cycling with friends. |
| q Walks – took up walking 3 Years ago following diagnosis of Prediabetes. |
| q Ex-Smoker – 30 Years – Quit 3 Years ago following prediabetes diagnosis |
| q Social Beer Drinker – Not often |
Slide 4 – What type of Stroke is Bill presenting? – How was it identified? – Signs & Symptoms?
Based on the physical examination and other pre hospital assessment scale, Bill presents an Ischemic stroke. Ischemic stroke is characterized by interruption of blood supply in the part of the brain blocking brain tissue from getting nutrients and oxygen. Such cause brain cells to die in minutes. Bill was taking his breakfast when he expressed immediate symptoms as his wife noticed. He developed an abrupt onset slurring of speech, facial drop on the left-hand side, and weakness on the left side upper and lower limbs. Paralysis in the limbs in either side of a patient is an identifiable symptom of ischemic stroke. The sudden changes in his physical presentation confirmed a possible contraction of ischemic stroke. Besides, a CT scan indicated no evidence of bleed in the brain which ruled out the possibility of hemorrhagic stroke.
Slide 5 – What we did for Bill when he was admitted & health needs identified?
Bill was admitted at the Cardiac Stroke Receiving Unit and later to Hyper Acute Stroke Unit. The Nursing and Midwifery Council (2018) requires that practicing nurses act in the best interests of people at all times. Part of this requirement is to ensure that you obtain a properly informed consent before carrying out any action (the Code 07). On this note, upon introduction to Bill, the clinician sought his consent to conduct his observations. Observations regarding body temperature, blood pressure, oxygen saturation, and respirations revealed that the conditions were stable. The CT scan also indicated that there was no evidence of bleed in the brain and hence, he was recommendable for thrombolysis. Throbolyis is recommended for the emergency treatment of heart attack and stroke and this should be conducted immediately. Bill’s conditions indicated insufficiency in blood supply to the brain and hence thrombolysis is critical to limit the stroke disability and damage. After physical examination by the specialist doctors, Bill presented various health needs. These included asthma which Bill was diagnosed with at the age of five years. However, while he has used Seretide Accuhaler, it is important to perform a physical examination, spirometry, chest x-ray, and electrocardiogram to diagnose the health condition. A test of the lungs’ diffusing capacity for carbon monoxide is critical and chest computed tomography will helpt to identify air trapping and increased wall thickness. According to Boulet (2016). asthma diagnoses in elderly can also be done through the measurement of plasma brain natriuretic polypeptide, echocardiography to assess cardiac function, and exhaled nitric oxide as a measure of control.
While Bill is an older adult, he is at a high risk of drug interaction due to high rate of comorbidities associated with this age. In this regard, he may benefit from monitoring of adverse effects of corticosteroids and bronchodilators to ensure therapeutic adherence. Further, Bill was diagnosed with diabetes three years ago which prompted his change of lifestyle. Smoking cessation and seldom alcoholism are vital lifestyle changes adopted by Bill. However, the types of foods taken by the patient affect their blood sugar levels. In this regard, Bill should eat plenty of fruits, vegetables, nonfat dairy foods, and whole grains. He should also limit foods that are rich in fat and sugar. Besides, carbohydrates are converted into sugars and hence their intake should also be limited. Other health need included managing stress. High-stress levels accelerate blood sugar levels which worsen the diabetes condition (Boulet, 2016). Bill should engage in hobbies that relax his body and mind, and venture into activities that relieve stress. The hypertension condition diagnosed five years ago also prompts significant health needs. The patient also needs to observe a healthy body weight, eat healthily, limit alcohol intake, and exercise regularly. Exercise is vital in maintaining a healthy weight while reducing blood pressure. A number of studies confirms that a period of consistent exercise reduces systolic BP and diastolic BP independent of weight changes (Nguyen et al. 2012, p. 148). Generally, pharmacological interventions should be coupled with lifestyle modifications including body exercise.
Slide 6 – Impact on family and the patient? (ADLs – Activities of Daily Living)
Despite the advancement in modern technology to acquire interventions for stroke, the disease institutes substantial impacts to the patients and the family. Some of the impacts to the patient include increased morbidity and mortality rates. Firstly, the health conditions affects the ability of the patient to participate in professional activities and social events. Poststroke cognitive impairment is a common occurrence and coexists with other neuropsychological problems such as depression, language disorders, and apathy (Lui & Nguyen 2018, p. 2). For instance, Bill presented an abrupt onset slurring of speech which would restrain him from performing his professional activities – a senior engineer whereby he should communicate effectively with colleagues and juniors in his workplace. Bill would also face challenges interacting with other people in the social events due to his inability to speak fluently. Further, stroke imposes impaired mobility to patients, hence predisposing them to deep vein thrombosis (DVT) and pressure sores (Lui & Nguyen 2018, p. 2). In other words, patients are subjected to long periods of a one-sided sitting which accelerates pressure ulcer due to an imbalance between external mechanical forces on skin and soft tissue and the internal susceptibility of skin and its underlying soft tissue to injury. According to Lui & Nguyen (2018), pressure ulcer increases poststroke mortality in patients especially those above 60 years. Besides stroke patients experience recurrent pains that happens immediately weeks, or months after the disease occurrence. These also institute physiological and behavioural changes that affect the patient’s daily activities. Further, ischemic stroke has significant impact on patient’s family members. The patient’s cognitive inabilities due to the disease has effects on their Activities of Daily Living (ADLs).
According to Pei et al. (2016), stroke survivors depict high rates of disabilities due to emotional, physical, and cognitive problems. These subject them to depend on their family members to carry out daily activities such as dressing, bathing, and eating. The need for ADL assistance initiates a feeling of social, isolation, abandonment, and overwhelm. Disability initiates a difficulty in doing activities including hobbies, hygiene, and errands due to physical problems (Pei et al. 2016, p.2). Besides, the condition constitutes them to place burden to their family caregivers which restrains their relationships. Caring for the patients requires the family members to assume the ADL duties of the patients to aid their survival, which is time consuming. In this regard, the family feels burdened since the patient is no longer productive and the need to depend on others for daily activities poises extra burdens. ADL dependence by the patient is also costly in terms of finances especially when the family has to hire a carer. Family members may be tired by their career demands and hence opt to hire a carer for their ischemic stroke patient. This instills extra financial burdens which could impose consequential family conflicts. While the patient loses productivity due to mortality and morbidity, the financial burdens are heavily laid on family members which may provoke frustrations. Generally, ADL independence is a crucial factor whose absence creates chaos in pharmacological and nonpharmacological interventions for stroke patients.
Slide 7 – Effective care plans on Stroke patients – Why is this important for Bill?
The nursing care plans primarily of stroke patients primarily depends on the face of the disease in which the patient is in. Acute phase of stroke focuses to enhance chances of survival while preventing further complications. Such revolves around ensuring efficient support of respiration, neurological assessment, and monitoring of vital signs. Careful positioning should also be ensured to avoid contractures and aspiration. Further, stroke patients experience speech impairment. In this case, care plans include consulting a speech therapist for swallow evaluation before oral intake. Insufficient blood supply in the brain causes impaired ability to swallow safely. In this regard, a nurse should evaluate the swallow by the bedside to provide the necessary assistance. This is vital because the patient can easily swallow unchewed food and cause chocking, leading to more complications. A speech therapist will also help the patients in minimizing the risk of choking and aspiration. Bill presents a slurring of speech which constrains his ability to express his needs. A therapist is vital to interpret some of the needs expressed by Bill, while guiding him to socialize effectively. Bill is also prone to feelings of embarrassment when eating or drinking in the presence of other people, hence social isolation. A therapist will aid in instilling confidence to the patient and make them enjoy food and drinks safely. Additionally ADL dependence could be frustrating and care plans should include teaching coping skills to the patient. Early mobilizaiton is relevant to prevent atrophies and bed confinement (Cavalcante et al. 2011, p. 3). Functional rehabilitation will also help the patient to integrate newly-learned activities and skills to perform such activities to guarantee safety. Bill lives with his wife – Racheal while their two daughters are married off. Fully depending on his wife for ADL can be overwhelming to her and initiate the risk of depression as she focuses on his well-being. In this regard, functional rehabilitation will help Bill to learn new skills that help in attempting some of the daily activities on his own.