Clinical Case PowerPoint Presentation Ischemic Stroke

Sample Answer

Introduction

Older population considerably face more conditions or illnesses as compared to other populations. It is known that as people age, their immune systems become weaker, hence exposing them to the attack of several conditions or diseases (Zhao et al.,2020). One of the conditions common among the adult population is ischemic stroke. As individuals grow older, the blood vessels naturally lose their elasticity to become narrower and stiffer, hence impeding blood flow.

Consequently, blood clots may occur which then causes ischemic stroke. In addition, lifestyle changes such as higher rates of alcohol use and smoking, poor diet and reduced physical activity can all lead to complications among the older individuals. This presentation focuses on ischemic stroke among the older individuals or population.

Ischemic Stroke

Ischemic stroke is a condition which occurs when a blood vessel supplying blood to the brain gets obstructed by a blood clot resulting into a restricted flow of oxygen and the required nutrients to the brain tissues. Consequently, the cells can begin the dying with a few minutes. There are two major types of stroke; embolic and thrombotic.

Embolic stroke results when a clot or debris from other body parts such as heart goes into the narrower brain arteries through bloodstream and lodges in (Boot et al.,2020). comparatively, thrombotic stroke results when a clot form directly in the brain’s arteries. When stroke occurs, it is important to receive prompt medical treatment to minimize the negative impacts.

Incidence

A sufficient understanding of ischemic stroke requires that healthcare professionals understand it incidence. According to the recent epidemiological data, up to 92% of stroke in the US are Ischemic. In addition, the World Health Organization reports approximately 8.0 million individuals suffer stroke globally, each year (Saini et al.,2020). Majority of the cases are first time stroke. In the US alone, up to 0.8 million suffer stroke yearly.

Over 11% of all strokes occur in individuals 15-49 years of age while up to 58% of strokes occur in individuals under 70 years. While 45% of stroke occur in men, the remaining 55% occur in women annually. The incidence of ischemic stroke increases with age.

Prevalence

Epidemiological studies also help in revealing the prevalence of conditions such as stroke. Recent data indicates that there are over 77 million individuals currently living who have experienced ischemic strike. 19% of people who have experienced ischemic stroke and are currently living are individuals 15-49 years of age. Comparatively, 61% of the individuals who have experienced an ischemic stroke and are currently living are under the age of 70. While 43% are men, the remaining 57% are women (Saini et al.,2020).

Pathophysiology

The pathophysiology starts at the cellular level where an embolus or thrombus blocks artery to interrupt blood supply to the brain leading to glucose and oxygen deprivation. The early cellular events include energy failure and ionic imbalance. The energy failure stops the function of ATP-dependent ion pumps leading to a loss of ion homeostasis (Orellana-Urzúa et al.,2020). Ionic imbalance then lead to cellular damage and death.

Excitotoxicity then occurs due to the release of the excitatory neurotransmitter glutamate and impaired reuptake by astrocytes. Oxidative stress also occurs, where reactive nitrogen species and reactive oxygen species are produced, hence damaging the cellular components such as DNA, proteins, and lipids. Cell death occurs through necrosis and apoptosis.

Assessment

Appropriate care requires that advanced practice nurses posses the knowledge required to perform a comprehensive assessment. It is vital to explore clinical presentation and history. The symptoms to look out for include loss of coordination and balance, dizziness, visual disturbance, trouble understanding speech or speaking, confusion, and sudden onset of weakness or numbness on one body side.

It is vital to collect the necessary history including detailed patient history such as previous strokes and lifestyle factors (Hurford et al.,2020). Physical assessment is carried out as neurological assessment using tools like the National Institutes of Health Stroke Scale to explore the severity. Cardiovascular examination is also carried out. Diagnosis involves laboratory tests and imaging.

As part of genetics and genomics, it is vital to explore genetic risk factors including family history and genetic variants. Genomic testing include pharmacogenomics for personalized treatments.

Treatment

Immediate treatment of stroke involves thrombolytic therapy where an intravenous tissue plasminogen activator is administered within three to four and half hours of symptom onset. This medication focuses on dissolving clot and restoring blood flow. Endovascular is also carried out for patients with large vessel occlusions.

It is carried out within six to twenty four hours to physically do away with the clot (Hurford et al.,2020). Long-term management is also used. As part of secondary prevention, anticoagulation is used for patient with atrial fibrillation to lower embolic stroke risk, in addition, antiplatelet therapy like aspirin is used to prevent recurrent stroke

Education For Management

Patient education plays an important role as it boosts patient knowledge regarding different illnesses. Therefore, it vital to offer patient education regarding ischemic stroke. One of the most important points of patient education is the need to have life style changes. Life style changes can be vital alongside the medication use.

Therefore, if a person is smoking, then it is important to quit smoking, since smoking is a risk factor of another stroke (Herpich & Rincon, 2020). Regular exercise and healthy diet is also necessary. diet rich in fruits, vegetables, fish, and low-fat dairy products, and low in red meat, sweets, and refined grains (such as white bread and white rice) should be used. Intake of sodium should be minimized

Cultural Considerations

It is important to consider cultural consideration regarding ischemic stroke and patient education on the same. Cultures may have different cultural beliefs and perspectives which affect the understanding of diseases such as ischemic stroke, its prevention, treatment and management. Therefore, it is also vital to understand the patient’s cultural backgrounds and beliefs to offer relevant education regarding ischemic stroke (Hussein et al.,2020).

Other cultural aspects such as language barrier may affect stroke education, as such, there may be a need for translators in the case where individuals do not understand English well. Cultural competence should also be considered since the advanced practice nurses can offer better education when they are culturally sensitive and culturally competent.

Spiritual Considerations

Spirituality and religious factors also play a role. Therefore, the factors should also be considered. Cross-sectional studies of stroke survivors have shown that spiritual coping has a positive influence on psychological function (psychological well-being and reduction of anxiety and depression) (Pucciarelli et al., 2020).

Nurses should focus on the spiritual care when offering care to patients with ischemic stroke to offer them hope and ensure that they have better chances of survival and healing. It is important to understand the religious and spiritual beliefs of the patient with ischemic stroke to better offer a holistic care with the components of spiritual care.

References

• Boot, E., Ekker, M. S., Putaala, J., Kittner, S., De Leeuw, F. E., & Tuladhar, A. M. (2020). Ischaemic stroke in young adults a global perspective. Journal of Neurology, Neurosurgery & Psychiatry, 91(4), 411-417. https //doi.org/10.1136/jnnp-2019-322424
• Herpich, F., & Rincon, F. (2020). Management of acute ischemic stroke. Critical care medicine, 48(11), 1654-1663. 10.1097/CCM.0000000000004597
  Hurford, R., Sekhar, A., Hughes, T. A., & Muir, K. W. (2020). Diagnosis and management of acute ischaemic stroke. Practical Neurology, 20(4), 304-316. https //doi.org/10.1136/practneurol-2020-002557
• Hussein, H. M., Droegemueller, C., Xiong, P., VanDyke, S., Mettner, J., Xiong, Z., & Catha, G. (2020). Hmong cross-cultural adaptation of stroke educational material. WMJ, 119(2), 115-118. https //wmjonline.org/wp-content/uploads/2020/119/2/115.pdf
• Orellana-Urzúa, S., Rojas, I., Líbano, L., & Rodrigo, R. (2020). Pathophysiology of ischemic stroke role of oxidative stress. Current Pharmaceutical Design, 26(34), 4246-4260. https //doi.org/10.2174/1381612826666200708133912
• Pucciarelli, G., Vellone, E., Bolgeo, T., Simeone, S., Alvaro, R., Lee, C. S., & Lyons, K. S. (2020). Role of spirituality on the association between depression and quality of life in stroke survivor–care partner dyads. Circulation Cardiovascular Quality and Outcomes, 13(6), e006129. https //doi.org/10.1161/CIRCOUTCOMES.119.006129.
• Saini, V., Guada, L., & Yavagal, D. R. (2021). Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology, 97(20_Supplement_2), S6-S16. https //doi.org/10.1212/WNL.0000000000012781
• Zhao, M., Song, J. X., Zheng, F. F., Huang, L., & Feng, Y. F. (2021). Potentially inappropriate medication and associated factors among older patients with chronic coronary syndrome at hospital discharge in beijing, China. Clinical Interventions in Aging, 1047-1056. https //doi.org/10.2147/CIA.S305006