Question

Neurological conditions are a major cause of disability. It is clear that the various conditions will rise as the world’s population is ageing and living longer. You are a new nurse working on a Neurological unit. You have been assigned to care for a 63-year-old patient with a diagnosis of Cerebral Vascular Accident (stroke). This is your first time caring for a patient with this type of diagnosis. Share your thoughts on how you would provide care for this patient and what obstacles you would expect to endure as a new nurse.  

Answer 1

Cerebrovascular accident ( CVA )

CVA is the loss of brain function arising when the blood supply to the brain is suddenly interrupted. Itis also called as Stroke. There are mainly two types of Stroke;

Ischemic stroke : It is the most common type of stroke , it occurs due to the presence of blood clots that plug the blood vessels .

Hemorrhagic stroke : It occurs due to rupture of a blood vessel that bteaks and bleads into brain.

The risk factors of Stroke are Hypertension, Heart disease, smoking, heart diseases , family history, old age, non healthy diet , alcohol consumption etc. The main sign and symptoms are paralysis / numbness of the arm , face and legs , trouble in speaking, walking and understanding.  

Nursing Interventions for a patient with Stroke: Medicines , surgeries and rehabilitation are the main treatment methods for Stroke. The main Nursing responsibilities are:

* Monitor vital signs

* Check the mental status of the person

* Check the ability to follow instructions

* Physical examination and Necessary history collection related to current medical conditions and medications.

* Administer Medications as per physician's order:

- tPA , tissue Plasminogen Activator: to dissolve the blood clot

- Blood thinner medications: to stop platelet aggregation

- Antihypertensives, to reduce blood pressure

* Elevate the affected arm to prevent edema

* Provide comfortable position for the patient and apply splint at night to prevent flexion of the affected side

* Provide passive exercises and full range of motion to prevent joint immobility.  

* Assist the patient's nutritional needs and eliminatiory needs.

As a new nurse, one can face many obstacles especially in dealing with the patient , who is suffering with a stroke:

*Special competencies , skills are needed to deal with the Stroke patient

* difficulties in handling and transferring the patient

* Difficulties in assisting the movement of the patient

* Stroke patient may have difficulty with sensory abilities. Sensory impairment like vision or hearing impairment may act as another challenge for the new nurse.  

* Meeting patient and family expectations are another challenge for the new nurses, as each patient and family members are different.  

* Establishment of an effective communication and rapport with the patient and family is also a challenge and if she fails in establishing the rapport, then it become an obstacle for patient care.