Question

You are caring for a 52-year-old female Muslim patient in the emergency room with a rule-out Cerebrovascular Accident (CVA). Based on your knowledge of the pathophysiology of a CVA address the following:

• Thoroughly explain the epidemiology of the disease process. Examine each of the following three elements:) The cultural; 2.) The financial; and 3.) The environmental implications related to this disease process. Support all three with a scholarly source!
• What would 3-5 priority nursing interventions be for the client with this disease process? This can include labs and diagnostics. What are the critical indicators? Support with a scholarly source.
• Provide three areas of patient education you feel are critical to teaching the client with a diagnosis of this disease. Consider medical product safety and the length of time the client has had the disease. Support with a scholarly source.
• What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and Support with a scholarly source.

Answer 1

CEREBROVASCULAR DISEASE

Age-- 52 years

Sex-- female. Religion--- Muslim

1.) Epidemiology -- a) more common in females than males.

b) more than 15-16 million people all over the world suffer from cerebral stroke, annually ,outof which nearly 5 million die and major % suffer permanent disability .

c) it is 3rd most common cause of death in developed countries.

d) more common below 40 yr of age .

e ) prevelence of strok in India is 1.54 pr 1000.

2.) A-- Culture implications -- include a) diet modification b) stop smoking c) regular BP monitoring d) early physical examination e) regular physical exercise f) proper careing of cvd patients g) proper management of their disability

Diet -- fat intake should be ideal that is less than 20%

Dietary cholesterol and complex carbohydrates must be in normal level. Salt intake less than 5 gm/ day .

Alcohol should avoided, special counseling , regular medical checkup for risk factors assessment is imp .

B -- Financial implications -- since this disease leads to physical impairment , special teaching , encouragement, training and support are needed for theses patients . Individualized training and exercise program must be involved for both unaffected and affected parts of body .

Speech therapy, mental support are continuously required for patients.

Continuous goal regulations and patient ability to meet that goal is monitored on regular basis.

C-- Environment implications -- both families and patient needs support and directions in coping with problems releted to stroke ,both physically and mentally.

Proper instructions to family for some emotional liability such as crying , outburst, laughing and crying are given.

Instructions given to family and friends to provide happy surrounding near patients .for fast recovery.

3--- Priority nursing interventions are - nursing care direced in two phase .

A)the emergency phase or hyper acute phase-- once the potential of stroke is suspected ,the EMS nurses and doctors must determine the time at which the person was last known to be well( before stroke).this time is single most imp factor for determining the treatment options in hyperaute condition.(within first 24 hours) imp intervention are - 1. Proper monitoring of stroke symptoms as it evolves within min to hours .2.nurses should be aware of unusual stroke presentation.3.ED assessment , neurological assessment ,vital assment should be done within 30 mins. 4. Proper oxygen monitor,bp monitor ,heart rate should be done.

B) acute phase ---1.ensure patient airways 2.remove denture 3. Proper performance of pulse oximetry 4. Proper maintenance of oxygen level 5.iv assess of normal saline and bp monitoring should imp intervention in acute phase .

And goal of stroke intervention include-

a) removal of clothing b) imidiate CT scan c) baseline lab testing d) position head midline and elevation of bed at 30 degree angle e) monitoring of vital signs and neurological status f) recombinant tissue plasminogen used to clear bolcked artery .

Main goals of nursing are 1. Keep patient alive 2 minimize cerebral damage by providing proper oxygen 3.support airway , breathing and circulation. 4 . maintain neurological charts .5 maintain adequate flow of fluid and electrolyte by IV. 6 . remove and insertion of different medical divices

4 ) Area of teaching of patients include a.proper diet and regular exercise to prevent joint deformity and to improve mobility .b.proper education for neurological symptoms such as anxiety , palpation , tremor c.proper education releted to medication which are given to paitent.

5) Member of(EMS) emergency medicinal survices and EMS nurses along with Emergency department doctor are included in holistic care of patients.

Eds should be required for establishment of proper or standard operative procedure and protocol to triage stroke patients and EMS nurses are required for proper 24/7 monitoring of patients after operative treatment.they prepare patient for various testing and provide bed side support to stroke patients.