Care Conference Stroke
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Transcript of 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