Nursing Crisis Intervention: Stroke

Nursing Crisis Intervention slice shaft is a global line of the increasing antique population. According to the department of Health (2007a), chance event is the trinity leading cause of death in the UK, with more than 110,000 individuals falling victim to a solidus each year at a equal to the National Health Services exceeding 2.8 billion. The Stroke association (2007) places this scrap at 130,000 with a mortality rate at 67,000 per year, including indirect cost of 1.8 billion and costs for informal healthc atomic number 18 spare-time activity scene at 2.4 billion. Incidence of shot is equally as prevalent elsewhere, such as in the United States where, as the third leading cause of US deaths (Becker Wira 2006 Nolan Naylor 2003) guess is the leading cause of disability (Becker Wira 2006 Stroke Association as cited by Amber 2003, p. 316 Stroke Association 2007). Becker and Wira (2006) state the incidence of blastoff within the United States is 400,000 individuals pe r year with an anticipated growth to over 1 million yearly stroke victims by 2050. The the Statesn Stroke Association (as cited by Amber 2003, p. 316) states every 45 seconds, some ane in America has a stroke. Every 3.1 minutes, someone dies of one.Nolan and Naylor (2003) state an average of 35,000 individuals suffer strokes when hospitalized for separate unrelated illnesses. Such was the case for Ms. C., who suffered an ischemic stroke plot of land hospitalized for a pacemaker implant.As the unit nurse assigned to c are for Ms. C., crafty signs of her stroke were noticed and reported to the Code rusty1 aggroup for immediate repartee. The some(prenominal) roles of a unit nurse in the presence of a crisis are vital in providing adequate foreboding to her patient, including the need to maintain a calm demeanour in the face of chaos. A number of quick physical assessments mustiness be performed including the use of the unfluctuating criteria2 (Mathiesen et al, 2006), respon se teams must be alerted and the nurse must keep the patient calm and orient finishedout the flurry of activity that layabout easily upset an elderly individual. While all emergencies call for rapid response, it is even more searing in the case of stroke when, if the patient is eligible for recombinant tissue plasminogen activator (t-PA)3 a detailed physical history and examination, a neurological assessment, computed tomography (CT) study and additional stock work must be performed before irreparable damage from the stroke occurs.With a focus on patient pertain and nursing interventions, this paper will present the case study of Ms. C. subject area presentationMs. C., a 78-year-old, ambulatory, Caucasian female was admitted to the hospital for the replacement of a cardiac pacemaker. Ms. C. was widowed 5 years prior to her current hospital care and lived alone having two married children living in Scotland and Wales. Prior to opening Ms. C. was diagnosed with high blood pres sure (HBP), high cholesterol, was diabetic, and was on pharmaceutical medication for all three conditions. In spring 1995, Ms. C. had recurrent bouts of tachycardia alternating with bradycardia. chase an attempt to control the situation by means of pharmaceutical intervention, her cardiologist recommended she suck up a cardiac pacemaker which was implanted without complication the same year. She reports rest in good health since that time although additional medical notes read the onset of dementia, as she appears disconnected at times.Upon admission, vitals were normal, with the exception of her blood pressure (BP) which was 175/95. Her atomic number 101 ordered Ms. C. be started on Losartan4. accompanying vitals indicated a fluctuation in BP ranging from a low of clxx/90 at 1AM to a high of 195/110 at 10AM. As Ms. C. was not responding to medication or fluid balancing recommended by her physician and her BP continued to climb, her cardiologist postponed surgery until he r BP was brought under control. At 1148am, when pickings Ms. C.s vitals, she appeared confused, her speech was slurred, on that point was slight facial droop and she could not extend her arm for the blood pressure cuff. At 1150am a Code Gray alert was sounded.Impact on the patientWhen assessing the tint to the patient when a stroke occurs, the nurse must be awake of the implications on a variety of levels, including biological, psychological and sociological. In the case of Ms. C., there were additional implications for each of these imputable to the combination of her low-level, yet progressive dementia.biological changes in an ischemic stroke (confirmed by the CT scan as opposed to hemorrhagic) were the result of a thrombolytic occlusion at the rational artery branch point due to atherosclerosis. On the cellular level, neuronic damage occurs when neurons become depolarized and allow for inordinate amounts of calcium to cross the cellular tissue layer that ultimately leads to a destruction of said cellular membrane and other structures within the neuron (Becker Wira 2006). Becker and Wira (2006) also comment on the nervous damage caused by free radical, arachidonic acid and nitric acid contemporaries that takes place during the ischemic cascade5. Genetic activation also takes place and leads to the fruit of cytokines in response to and as a cause of inflammation that can consume the ischemic penumbra (Becker Wira 2006). If one can limit the degree of wound to the ischemic penumbra located within the origami, the degree of permanent damage due to the ischemic episode is limited and is the goal of immediate stroke response (Becker Wira 2006).A combination of diagnostic laboratory tests6 and rapid nursing assessments would be required to assess the level of damage. Although the Code Gray approach is geared towards rapid response to allow for administering t-PA within the three-hour window, Ms. C. was not eligible for t-PA intervention due to her u ncontrolled hypertension (Bonnono et al. 2000, p. 300).The psychological impact on Ms. C was the most dramatic as her post-stroke status left her more confused and fearful than one might find in a arrive at victim due to the comorbid dementia. In addition to being frightened of the unbeknown(predicate) and feeling very alone as a widow and without her children present, Ms. C. snarl betrayed by her body and didnt understand what was dislodgeing to her or why. psychologically Ms. C. had to be kept calm and be reminded of what was occurring and why, with such orienting comments as You are going to be examined by Dr. X or You are going to have a test done that wont hurt you. There is no need to be afraid Ill be with you to assure youre safe. With the unknown of any comprehension deficits caused by the stroke it was also important to remind other team members that Ms. C. had problems with confusedness and that it was important for patients with dementia in particular to understand wh at is about to happen to them (Cunningham McWilliam 2006, p. 14). Cunningham and McWilliam (2006, p. 14) suggest that nursing staff must compensate in their communication with dementia patients and that this often requires nurses to re-prioritize their tasks and sense of immediacy in order to set up the patient the greatest level of psychological and/or emotional support. Lipley (2005) states one of the most important nursing tasks is offering support to a stroke patient.The sociological impact relating to Ms. C.s crisis was limited for the immediate future while hospitalized, although she indicated that she wanted her children contacted and requested they come to the hospital. The biggest sociological change and challenges facing Ms. C. would be next her discharge from the hospital. Depending on the amount of total damage suffered from her stroke and the subsequent progress with therapy to regain lost functionality, it was probable that Ms. C. would relocate to every live with one of her children and/or settle in a folk for the aged. This required the nurse to contact a social worker to booster Ms. C. with her adjustment.Implications for the organizationOne of the six strategic goals established by the Department of Healths National Stroke Strategy (2007b) is to accelerate the collar response to stroke and improve coordination between different agencies and professionals involved including through improved access to CT scanning. Fortunately, the hospital where Ms. C. suffered her stroke complied with this goal and had a Code Gray team assembled. National Health Services (2007) approximates 90 percent of hospitals in England as prepared to administer specialized stroke services.The number of stroke victims is increasing every year. The nurses must be aware of required interventions. This paper has highlighted the ischemic stroke and patient impacts, as rise as those on the organization and nurse. The charts below presents required nursing interventions in response to an inpatient stroke.ReferenceAmber, R., Watkins, W., 2003. The community impact of Code Gray. critical Care Nursing Quarterly, 26 (4), pp. 316-322.Becker, J. U. Wira, C., R. 2006. Stroke, Ischemic Online. Available from http//www.medscape.com/emerg/topic558.htm cited March 16 2007.Bonnono, C., Criddle, L. M., Lutsep, H., Stevens, P., Kearns, K., Norton, R., 2000. Emergi-paths and stroke teams An jot department approach to acute ischemic stroke. ledger of Neuroscience Nursing, 32 (6), pp. 298-305.Cunningham, C. McWilliam, K., 2006. Caring for people with dementia in AE. Emergency Nurse, 14 (6), pp. 1216.Department of Health, 2007a. Stroke Online. Department of Health. Available from http//www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Stroke/index.htm cited March 16, 2007.Department of Health, 2007b. Developing a national stroke dodge Online. Department of Health. Available from http//www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Str oke/DH_4132138 cited March 16, 2007.Department of Health, 2007c. sound practice examples and case studies standard five (strokes) Online. Department of Health. Available from http//www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Olderpeoplesservices/Olderpeoplepromotionproject/DH_4002291cited March 16, 2007.Lipley, N., 2005. Different strokes Emergency Nurse, 13 (5), p. 5.Mathiesen, C., Tavianini, H. D., Palladino, K., 2006. Best practices in stroke rapid response A case study. Medsurg Nursing, 15 (6), pp. 364-369.Nolan, S., Naylor, G. Burns, M., 2003. Code Gray An organized approach to inpatient stroke. Critical Care Nursing Quarterly, 26 (4), pp. 296-302.Spilker, J., Kongable, G., Barch, C., Braimah, J., Bratina, P., Daley, S., Donnarumma, R., Rapp, K. Sailor, S., 1997. Using the NIH stroke scale to assess patients. Journal of Neuroscience Nursing, 29 (6), pp. 384-393.Stroke Association, 2007. Facts and figures about stroke Online. The Stroke Association. Availabl e from http//www.stroke.org.uk/media_centre/facts_and_figures/index.html cited March 16, 2007.Wojner, A. W., Morgenstern, L., Alexandrov., A. V., Rodriguez, D., Persse, D., Grotta, J., 2003. Paramedic and emergency department care of stroke Baseline data from a citywide performance improvement study. American Journal of Critical Care, 12 (5), pp. 411-417.1Footnotes1 The term generally accepted in the medical community for multidisciplinary stroke response teams. The typical composition of a Code Gray team entangles a primary care RN, charge RN from the Stroke/cardio care unit, an ICU RN, ICU resident, a neurologist, CT technologist and an individual trusty for telecommunications (Nolan Naylor 2003, p. 297). The Department of Health (2007c) reports that other Code Gray teams also include occupational therapists, physiotherapists, speech and language therapists, dieticians, pharmacists, a clinical psychologist and social worker.2 FAST criteria is the acronym also known as the Cinci nnati Pre-hospital Stroke Scale, such that F = facial Droop, A = Arm drift, S = Speech and T = Time (Mathiesen et al. 2006 Lipley 2005).3 t-PA must be administered within three hours of the first onset of symptoms (Amber 2003).4 Losartan is an angiotensin receptor blocker. The choice was made to use this type of intervention based on the muscle relaxing nature of the medication rather than incorporating those that lowered BP through a modification of electrical activity within the nervous or cardiac system due to the reliance on her pacemaker and the potence other such forms of medication might have on recurrent tachycardia or bradycardia.5 Ischemic cascade is the term referring to the chain of events that takes place following an ischemic stroke.6 Although a variety of diagnostic blood work was already performed on Ms. C, a CBC, chemistry panel and cardiac biomarkers were ordered following the stroke for comparison against pre-stroke values along with coagulation studies (Becker Wira 2006).