Dec 18, 2018 in Medicine

Introduction

Stroke is one of the illnesses that results to many death worldwide due to the wide range of complications which afflict persons who have stroke. The complications that arise from stroke are usually caused by preexisting conditions or may be as a direct result of post stroke ailments.

Discussion

The patient Mrs. Amelia Middleton is aged 68 which makes her very vulnerable to stroke. Ischemic stroke has already been confirmed for Mrs. Middleton and hence her current illness may well be related to her ischemic stroke. The patient has had headaches that may be related to brain injury complications that may result from ischemic stroke that has been diagnosed. The patient is vulnerable to myocardial infarction since she has been diagnosed with ischemic stroke. The patient presents with symptoms of nervous defects on her right side that might be because of post stroke complications. History of the patient is an important aspect to take into consideration in the instance of transient ischemic attack. Being an only child makes the patient very difficult to diagnose as her as her family history is not as wide as would be preferable. However her history of depression, lower gastrointestinal bleeding predisposes her to post stroke complications. Her father’s death due to myocardial infarction also makes her vulnerable to the development of post stroke infections. The atrial fibrillation that has been recorded on the patient may be one of the reasons that has resulted in the symptoms portrayed such as loss of sensation on one side. Stroke medications she is taking may also predispose her to post stroke complications.

The patient Mrs. Middleton has enough of history that makes it easier for her current conditions or possible future complications to be diagnosed. The patient has been diagnosed with ischemic stroke, her father died of myocardial infarction, depression, gastrointestinal bleeding and atrial fibrillation make the patient predisposed to post stroke infections. The patient has also been put on drugs such as sertraline and Rectinol that may result in complications. An assessment of the patient would need to take all of these into consideration. The patient is currently living alone with her children living interstate. This would make her even more vulnerable to depression. Atrial fibrillation in her condition is also a very high risk that must be taken into account. A combination of depression, history of myocardial infarction and gastrointestinal bleeding may help to understand and diagnose future complications. Atrial fibrillation is highly related to age with people that are above 65 being highly susceptible to AF (Gattellari et al., 2011). The fact that she recently lost her husband may result in her current condition since she has lost her status as a married woman, she is depressed hence cannot process these events well. It is also quite common for stroke survivors to experience post stroke depression which may be diagnosed in this patient (Kumar et al., 2011).

It is normal for patients that have experienced stroke to undergo post stroke depression. It is also normal for atrial fibrillation to be enhanced after an incident of stroke. Nevertheless it has been found that post stroke complications are not as prevalent in persons at ages of 65 but rather those above 85 years. The most important information with regard to her depression is the instance of her losing her social status due to the death of her husband. The instance of her history of myocardial infarction and gastrointestinal bleeding ids very relevant to determine what she is predisposed to. There is a relationship between the instance of atrial fibrillation and her gastro intestinal bleeding and high blood pressure levels. From the analysis of the situation in this instance shows that the patient has a long history with some aspects which predispose her to depression and atrial fibrillation. While it is possible that the headache has been caused by the ischemia, it is also possible that it may be as a result of the sertraline which she is taking. The patient was diagnosed with ischemic stroke but did not spend time in the stroke unit. More evidence is needed in order to determine if the risk of post stroke complications would have been lesser had she stayed at the stroke unit (Al Khaled et al., 2013, pp. 725).

 
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A clinical analysis of the patient shows a high predisposition to depression and atrial fibrillation. The patient has presented with a temperature of 36.8 which is very near to the normal and hence this is not relevant. According to Robinson and Gianfranco (2010, pp. 243-344) established that patients who are more depressed are likely to be more predisposed to post stroke complications. Non depressed patients have been generally found to have lesser predisposition to post stroke disorders as opposed to those with depression (Robinson and Gianfranco 2010, pp. 344). The patient has a high predisposition to atrial fibrillation especially due to her history. It has also been established that about 30% of persons with transient Ischemic stroke have a cardioembolic substrate that results in atrial fibrillation. Nevertheless, there has not been enough research to show conclusive evidence that this substrate is responsible for the atrial fibrillation. The diagnosis of the patient is made complicated given that patients suffering from post-stroke disorders exhibit depressive syndromes and may exhibit difficulties in speaking (aphasia). Mrs. Middleton has exhibited these symptoms as she has difficulty speaking and is depressed. In order to diagnose depression there are several symptoms which are common; prolonged depressed mood, lack of concentration, diminished interest, feelings of guilt, significant weight loss, fatigue or loss of energy, insomnia and psychomotor agitation (Kumar et al., 2011, pp. 486-487).

There is a need to reduce manage the instance of atrial fibrillation and depression. The goal of the clinical nursing practitioner is to ensure that the patient gets the necessary clinical guidance with regard to what they should avoid and what they ought to do in. Ischemic stroke has already occurred for this patient and hence the goal of the clinical nursing team is to determine the causes of the post stroke complications that resulted in the current complications. The nurse must compile all the data and medical history of the patient in order to determine what mode of treatment would be most effective. The patient ought to be transferred to a stroke rehabilitation center in order to be closely monitored. A number of factors cause atrial fibrillation and depression and these ought to be addressed in order to serve the needs of the patient. The gastrointestinal bleeding and the high blood pressure most likely cause atrial fibrillation. High blood pressure is most likely the result of a combination of cardio embolism and depression. The nursing practitioner must ensure that the patient is removed from a stressful environment by being placed in a stroke rehabilitation center. The patient diagnosis is possible major depression coupled with atrial fibrillation that is the cause of her symptoms.

The treatment and management of Mrs. Amelia’s condition could be done through several alternatives available. Patient s with cerebral ischemia usually have issues with blood pressure. The patient has exhibited high blood pressure and likely cardio embolic substrate. This means medications to increase blood pressure would be needed for treatment and management. It is most likely as a result of improperly diagnosed or untreated hypertension which the patient may be suffering from (Saver, 2014, pp.469-470). Long-term oral anticoagulation can be very effective in the prevention of atrial fibrillation. It has been established that only about 4% of patients will suffer from ischemic stroke when they use oral anticoagulants (Rizos et al., 2012, pp.416-417). Atrial fibrillation is responsible for about 15%of all ischemic stroke cases and hence it is important to take it into account. Atrial fibrillation may be reduced through the use of anticoagulation agents such as warfarin. Warfarin has been shown to reduce atrial fibrillation by between 40 and 60% in meta trials (Davis and Donnan, 2012, pp.1920). Treatment with antiplatelet therapy is also one of the alternative therapies available for persons with atrial fibrillation as it has been shown to reduce its incidence by up to 34% (Leys et al., 2009, pp.121). The reduction of stress is also one of the alternatives that may be employed particularly with regard to behavior change. Positive behavior and thinking is usually encouraged to reduce stress and depression.

There is a need to opt for one course of treatment and management or a combination that will ensure that both depression and atrial fibrillation are dealt with effectively. In order to do this there is a need to follow clinical guidelines regarding the treatment of stroke. The patient needs treatment for the cardio embolic substrate which is likely the cause of her ischemic stroke condition. In order to reduce this there will need to be put in place a mechanism to deal with her gastrointestinal bleeding which is resulting in cardio embolic substrate (Davis and Donnan, 2012, pp.1920). The patient will be made better by being put on anticoagulant or antiplatelet therapy. This will serve to increase the blood pressure and reduce the instance of blood clots. However, it will also put the patient at risk of hemorrhagic stroke if enough care is not taken. A course of treatment that deals with her depression is one in which she is removed from her stressful environment and placed in a rehabilitation center (Rizos et al., 2012, pp.416-417).  Mrs. Amelia needs a lot of encouragement and behavioral management training if she is to survive her ordeal with ischemic stroke. By reducing her stress levels she can be made to feel worthy to society and this will serve to normalize her blood pressure levels.

This exercise on how to deal with an aged patient suffering from Ischemia stroke has been a very useful learning experience. I have learnt the importance of systematic nursing care and reflective practice in coming up with workable solutions. I have also come to realize that each case is different and has to be analyzed from its unique perspective. My learning has also exposed e to the importance of clinical research as a source of data and information in the treatment and management of disease. I have come to acknowledge that there is a need for more research in order to fill gaps in knowledge in clinical practice. If I were to perform the same exercise again I would change a few things in order to make my work more effective. I believe I would look for more research based resources on clinical procedures. The law and ethics of clinical practice would also be important in determining what course of action is right or ethical.

Conclusion

This has been a very enjoyable exercise that I have enjoyed undertaking. I do believe that my research and work in this area would be useful in my future clinical practice. This work has made me a better nursing practitioner by opening my mind to the practicalities and objectivities of clinical practice.

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