Assignment Task:
REPLIES #1
Question 1: A Cerebrovascular Accident (CVA) is also commonly known as a stroke. It is a neurological disorder resulting from an interruption of blood flow to the brain and rapid loss of brain function (Banasik, 2022). The physical deficits observed with CVA include weakness, slurred speech, or paralysis. Mr. Kim presents with weakness and slurred speech.
The two major types of CVA are ischemic and hemorrhagic, with ischemic strokes occurring in 87% of cases (Kuriakose & Xiao, 2020). Ischemic strokes occur when blood flow to part of the brain is blocked. Hemorrhagic strokes happen when a blood vessel in the brain bursts and leaks into or around the brain.
Question 2: Cultural: It's essential to approach Mr. Kim's care with cultural sensitivity. In many Asian cultures, they attribute health conditions to factors like stress, diet, or imbalances (Qin & Ding, 2019). Many prefer to try home remedies or traditional treatments before seeking medical help. These values might affect Mr. Kim's compliance with doctor orders and plan of care.
Financial: Mr. Kim can expect to incur a lot in medical expenses. The bills will add up as he can anticipate a hospital stay, possible interventional procedures, medications, rehab, medical equipment, and home modifications (Miri et al., 2024). Mr. Kim has VA insurance to help assist him with the cost. Anything over her insurance allowance would be out of pocket.
Environmental implications: Hopefully Mr. Kim lives in an area near health care services or has a means for transportation to get to his appointments. Recovery will require follow-up appointments and therapy (Miri et al., 2024). His VA benefits should cover the expense to arrange this.
Question 3: Priority nursing intervention for Mr. Kim would include assessing his neurological status with the NIH Stroke Scale. This is used to determine if there have been changes in his level of consciousness, strength, speech, and motor skills. If he has a confirmed ischemic stroke, administer tPA if ordered to dissolve the blood clot. Also, managing his blood pressure is critical to protect the brain from further injury and supports recovery. Also, ensuring that Mr. Kim has good IV access is necessary for giving him medications quickly.
Question 4: A CT scan or brain MRI will be ordered immediately to determine if Mr. Kim has experienced an ischemic versus hemorrhagic stroke. Blood tests will also be used to measure his complete blood count, coagulation, electrolytes, and kidney function to get a necessary view of his overall state of health (National heart, lung, and blood institute, 2022).
Question 5: The first member of Mr. Kim's healthcare team is a neurologist who will guide treatment decisions, such as surgical versus medical intervention. The neurologist will manage Mr. Kim's ongoing neurological care. A physical and occupational therapist would also be integral in the healthcare team. Their job is to help the patient regain mobility and strength, and ability to perform activities of daily living as independently as possible (National heart, lung, and blood institute, 2022). Because managing such a drastic lifestyle change can get overwhelming, having a nurse care coordinator would be helpful for Mr. Kim. The nurse will monitor his progress; provide education about managing stroke risk factors and recovery.
REPLIES #2
Pathophysiology: Links to an external site.A cerebrovascular accident (CVA or stroke) is caused when there is a sudden change in the blood flow of the vessels in the brain. There are four major arteries that supply blood to the brain, with two of them coming from the neck and the other two coming from the spine. Two types of strokes can occur, one being an ischemic stroke, where the blood, and subsequently the oxygen, supply is decreased by either a thrombus or embolus. If it is a thrombotic stroke, plaque build up in the walls of the arteries causes decreased blood flow, leading to a stroke. In embolic strokes, an actual clot is present and restricts blood flow. The other kind is a hemorrhagic stroke, usually caused by trauma, where there is excessive bleeding in the brain or a blood vessel that is leaking. Hemorrhagic stroke have a higher mortality rate than ischemic strokes. There are also two types of hemorrhagic strokes: intracerebral and subarachnoid. An intracerebral hemorrhagic stroke is when the blood vessels rupture leading to a pooling of blood in the brain. This kind is usually caused by hypertension, overuse of blood thinners and anticoagulants or abnormal vessels. In a subarachnoid hemorrhagic stroke, the blood is accumulating in the subarachnoid area of the brain, likely caused by head trauma or an aneurysm (Kuriakose & Xiao, 2020).
Cultural implications: Mr. Kim's diet and activity levels play a big role in his risk level of having a stroke. If he is eating a high fat, high cholesterol, high sodium diet, he is increasing his risk of having a stroke. If he smokes, or has ever smoked, his chances of having a stroke go up. If he is not very active, which I would assume he is not due to his hypertension, then his risk of having a stroke also goes up (American Heart Association News, 2019).
Financial implications: Mr. Kim is at the age where he might be retired. If that is the case, he is probably living off of social security income. This might not be enough for him to afford healthy food and all of his medication. If he is on prescribed anticoagulants or blood thinners and he is unable to afford to fill these prescriptions, his risk for stroke will go up and his risk for developing a clot will increase. He also might be eating a lot of sodium as prepackaged foods with high sodium levels are cheaper than healthy, fresh food (American Heart Association News, 2019).
Environmental implications: It is unknown what Mr. Kim's neighborhood he lives in looks like, but if if has poor sidewalks, is unsafe or not easily walkable, he might not be able to partake in physical activity like he should. Also, if he is constantly surrounded by cigarette smoke, leading to secondhand smoking, he is at a higher risk of having a stroke as well (American Heart Association News, 2019). There has also been a study done that proves air and water pollution as well as chemical contaminants lead to an increased risk of stroke (Ranta, et al., 2023).
Priority Nursing Interventions: Neuro checks as ordered by the doctor to ensure there are no changes in mental status or level of consciousness.
DVT prophylaxis administration to help reduce the risk of clot formation, especially if the stroke was caused by a clot.
Place the patient on an NPO diet until speech therapy can come evaluate Mr. Kim. This is because strokes can cause dysphagia and it is important to do everything possible to prevent aspiration pneumonia or choking.
Place the patient on telemetry and monitor their rhythm status to assess for a possible MI or PE due to the travelling of a clot from the brain.
Make sure physical, occupational and speech therapy are all on the patients care team. This will help the patient regain strength and as much motor function as possible (Tadi, et al., 2023).
Labs and diagnostic testing: Computed tomography (CT) of the head to identify if a stroke is present, specifically a hemorrhagic stroke.
MRI to identify if the patient had a stroke, specifically an ischemic one.
EKG to analyze patients heart rhythm in case the clot has travelled to the heart.
Carotid duplex scan since the internal carotid arteries are two of the main supply arteries to the brain.
Blood glucose monitoring to ensure neurological changes are not due to a low blood sugar.
Coagulation studies such an INR, PT, aPTT, especially if the patient is on anticoagulant therapy to help visualize if they are in therapeutic levels or not.
CBC and CMP to identify the patients baseline for their hospital stay.
(Jauch, 2024)
Interdisciplinary team: Mr. Kim's team would be comprised of many people. He would first need a hospitalist and nurses to help coordinate and manage his car. Next, a vascular neurologist would be a part of the team. They are the ones who diagnose and treat the CVA. A radiologist would be needed to interpret all imaging. A vascular surgeon may also be needed if an occlusion is found in the arteries that supply the brain. Physical, occupational and speech therapy will be important in helping the patient regain as much motor strength and movement as possible. They will also be the ones who assess the impact the stroke had on the patients ability to move around in the world and perform their own ADL's. Case management and social services will also be included in the patients care team as they will help find Mr. Kim outpatient, or inpatient if indicated, rehab and recovery resources based on the insurance Mr. Kim has. Since he is a veteran, he will also have to have the VA involved, however it is not known if he is a veteran here in American or back in Korea. His family will also be a huge part of his care team as Mr. Kim is going to need love and support to help get him through this time. A stroke can severely alter someone's life and having his family by his side will help him tremendously.