Impact of Stroke Case Study

Impact of Stroke Case StudyIntroductionJithra is in a flash 68 years of age. Her family consists of husband, daughter, nephew and nephews wife. She has been living with left side hemiplegia caused by stroke since she was 64. As this interview went, Jithra was holding her daughters hand and slowly elaborated her newsworthiness by word experience in tears. Before an episode of stroke damaged the right side of her brain and rig her in bed for the domiciliate of her life, Jithra was living a life of a healthy person. She stated that poverty and debt were the most important factors that motivated her to wake up at 430 am on regular basis in order to prepare food and beverage for her respective customers who kindly supported her small restaurant. A cockeyed belief that she did non select any health issue strengthened by the fact that an annual physical check-up was so expensive disguised Jithra from realising how inhering it was to have her rail line insisting and blood glucose l evel regularly monitored when she aged. As now that she spends her activities of daily living in bed, press sore has become the of import concern for both Jithra and her family. Though Jithra does not complain of soreness, redness on whittle does indicate that some areas need attention. This essay will provide an overview intelligence of stroke and its negative effects posed on Jithra. Furthermore, this essay will emphasise on the intervention and prevention of pressure ulcer in depth. envision StrokeAccording to World Health Organization (2014), stroke occurs when there is an interruption of the blood supply to a part of the brain. Stroke can be divided into two major types. The first type is called haemorrhagic stroke. This type of stroke accounts for approximately 13 percent of all strokes (Brown Edward, 2012). It proves from release into the brain tissue. The bleeding caused by a rupture of blood vessels results in the leakage of blood into the brain impairing the delive ry of oxygen and nutrients. Haemorrhagic stroke can be caused by a add of disorders affecting the blood vessels. Some of which are long-standing proud blood pressure and cerebral aneurysms, a thin or weak tip on a blood vessel wall. The weak spots that cause aneurysms are usually present at birth. The development of aneurysms happens over a number of years and dont usually cause detectable problems until they break (Stroke Foundation, 2014). Jithras daughter stated that Jithra complained of guideache and nausea approximately 48 hours, particularly during periods of activity, before an episode of stroke occurred. Headache particularly distinguishes haemorrhagic stroke from ischaemic stroke. Its other symptoms also include nausea, vomiting, decreased level of consciousness, neurological deficits and high blood pressure (Brown Edward, 2012).The second type is called ischaemic stroke. It accounts for approximately 85 percent of all strokes. According to Brown and Edward (2012), t his type of stroke occurs as the result of partial or complete obstruction, caused by a blood back up, of a blood vessel that supplies blood to the brain. This leads to an insufficient of oxygen supply and glucose needed for cellular metabolism. A clot may be formed by means of embolism or thrombosis. Both types of clotting formations can be differentiated by their characteristics. The term embolism in relation to stroke is characterised by a condition where an embolus is created in one part of the brain or the body, circulates in the bloodstream, and eventually blocks the flow of blood through a vessel in another part of the brain (Crosta, 2009). This is called embolic stroke. On the other hand, the term thrombosis is characterised by the formation of a clot resulted from fatty deposits or plaque blocking the passage of blood through the artery. This type of clot remains in one area of blood vessels without be carried throughout the bloodstream. This is called thrombotic stroke (Brown Edward, 2012).Stroke happen factors in that respect are multiple risk factors associating with stroke as according with (Brown Edward, 2012). The risk factors can be class into non-modifiable risk factors and modifiable risk factors. Non-modifiable risk factors include age, gender, race and heredity. Modifiable risk factors include diabetes mellitus, heart disease, atrial fibrillation, heavy alcohol consumption, hypercoagulability, hyperlipidaemia, hypertension, obesity, physical inactivity, reap hook cell disease and smoking.Jithra, at 68, was diagnosed with hypertension or high blood pressure and diabetes mellitus. Age, hypertension and diabetes mellitus have played a key role in contribution to stroke. Stroke risk increases with age, doubling each decade after age 55 (Brown Edward, 2012, p. 1622). The rate of atherosclerotic development is usually increased by the stress of a constantly elevated blood pressure. The term atherosclerosis is referred to as hardening of t he arteries resulting from the formation of fatty deposits or plaques. The narrowing of the blood vessels is its consequence. The carotid artery in the neck is a common site where these plaques develop and tend to break away and lodge in the vessels of the brain (Sander, 2013). Likewise, diabetes mellitus increases tendency towards the dysfunction of the inner linings of the blood vessel walls leading to an increase in the tendency towards the development of plaques. In addition, high cholesterol and triglyceride levels are highly likely among mint with diabetes mellitus (Brown Edward, 2012, p. 863).Impact of StrokeAccording to Brown and Edward (2012), stroke is a leading cause of serious, long-term disability. Jithra has been living with left side paralysis since she was 64 as a consequence of stroke. Immobility and the weakness in Jithras right arm and leg are the key limitations. She relies greatly on her family members when repositioning in bed is attempted and a combination of self-care abilities and activities of daily living, such as eating or drinking, are performed. Dysarthria, a disturbance in the muscular prevail of speech, is also experienced. Impairment may involve pronunciation, articulation and phonation. This helps explaining why Jithra feels uncomfortable communicating with strangers. As the interview went, a sudden change in sense was spotted. Persons who have had a stroke may have difficulty controlling their emotions. Emotional responses may be exaggerated or unpredictable (Brown Edward, 2012, p. 1628).The daughter verbalise that Jithra some sentences cried without any reason. The interchanging surrounded by laughing and crying took only minutes to do so. Besides pressure, shearing force, friction and excessive moisture contribute to pressure ulcer formation (Maklebust Sieggreen, 2001). As mentioned above that Jithra is bed-bound and greatly relies on her family members when repositioning is attempted, manual handling is used in or der to lift and move her nigh the bed. However, the incorrect techniques combined with non-supportive equipment, such as sliding sheet, have put the maintenance of Jithras skin integrity becomes much more difficult. drive ulcerationAccording to Sydney South West (2008, p. 4), pressure ulcers are defined as any lesion caused by unrelieved pressure when soft tissue is compressed in the midst of a bony prominence and an external surface for a prolonged period. Factors that influence the development of pressure ulcers include the intensity of the pressure the length of time the pressure is exerted on the skin and the ability of the tissue to tolerate the externally applied pressure. Intrinsic factors that put Jithra at risk in developing pressure ulcers consist of advanced age, malnutrition and diabetes mellitus. Extrinsic factors include pressure, shear and moisture Sydney South West (2008).InterventionAlthough the skin remains intact, the appearance of persistent redness, particul arly in sacrum, followed by itchy sensation indicates that stage one pressure ulcer has already developed. Stage one pressure ulcer can be intervened as referred to pressure ulcer intervention guidelines (Jones, 2013) by strictly maintaining the skin integrity. This can be through with(p) by relieving the externally applied pressure, protecting fragile skin and bony prominence, preventing friction and shearing and protecting skin from moisture.In relieving the externally applied pressure, a regime of repositioning combined with the use of pressure relieving devices has already been utilised by Jithras daughter. However, it might not be enough in terms of the frequency. The frequency of repositioning depends on the ability of the tissue to tolerate the externally applied pressure. In this case, Jithra should move or be repositioned frequently enough in allowing reddened area of affected skin to recover from the effects of pressure. A turn clock may be a helpful reminder of correct b ody positions and appropriate turning times. Additionally, a 30-degree side prevarication position may well be utilised for Jithra as it diverts pressure from the sacrum. Maintaining a 30-degree side lying position can simply be done by using pillow or foam positioning wedges. However, lying on the side may increase pressure on extremities, especially knees and ankles. Placing pillows between the legs helps preventing opposing knees and ankles from exerting pressure on one another (Maklebust Sieggreen, 2001).In protecting fragile skin and bony prominence, an appropriate support surfaces shall be used and up to now its cost has to be taken into consideration. Poverty and debt make it very difficult for Jithra to afford buying or renting them. Charges can range from $24 to barter for a foam overlay to a daily rental fee of $125 for a highly technical therapy bed (Maklebust Sieggreen, 2001, p. 75). Regardless of the variations in price, There is no scientific evidence that one sup port surface consistently works better than any others. Nevertheless, pressure points require protection whether at risk persons are in a bed or on a chair. Using pillows to bridge vulnerable areas, again simple, is an effective way to eliminate pressure. A regime of repositioning, together with the use of pillows has proved to be highly effective in protecting fragile skin and bony prominence.In preventing Jithra from friction and shearing, a family education on how friction and shearing occur and correct usage of manual handling techniques and appropriate equipment shall be provided. Shear is greatest when a health professional drags an at risk person along the surface of the sheets during repositioning or allows the person to slide from high-fowlers position. In order to minimise shearing force, the head of the bed shall not be raised exceeding a 30 degree angle, unless the patient is eating. Furthermore, friction, a precursor of shear, is commonly caused by pulling a patient ac ross the bed linen. Rubbing the protective layer of skin away increases the potential for deeper tissue damage.Excessive moisture may be the result of sweating, wound drainage, soaking during bathing and faecal and urinary incontinence. Moist skin is five times as likely to become ulcerated as prohibitionist skin. The intervention guidelines suggested that protecting skin from moisture can be done by using continence management systems, using barrier skin cream to prevent skin maceration and keeping the site clean and dry. Living in a hot and humid country like Thailand may put Jithra at a higher risk of developing pressure ulcer due to sweating. Thailand normally has its temperature sitting at around 30 degree Celsius. cardinal fans, together with the application of baby powder are used in maintaining the dryness of Jithras skin.RecommendationAccording to Jones (2013), it is highly recommended that risk assessments must be done on Jithra by using the Waterlow scale. In doing so, her body mass index is required. The scale will give a score which helps identifying if Jithra is at risk, high risk or very high risk in developing pressure ulcers. Therefore, repositioning regime can be precisely arranged in order to ensure optimum pressure redistribution. Manual handling, together with the use of equipment such as hoists or slide sheets, effectively helps avoiding shear and friction. Education on the use of the mentioned equipment shall also be provided. A dietician shall be involved in discussing knowledge of healthy diet and considering the need for food fortification and nutritional supplements. Make sure that Jithra consumes adequate fibre and well hydrated as she is more prone to constipation due to immobility.ConclusionThis can be cerebrate that the maintenance of skin integrity plays a key role in avoiding the development of pressure ulcers. Being rich or poor might not be the factors in treating and preventing pressure ulcers. This essay has shown how b eneficial it is to have carers or family members who strictly put pressure ulcer intervention and prevention guidelines into practice to reflection after Jithra. The mattress that Jithra lays her body on might not be the best that the family can afford but frequently turning and maintaining dry skin have proved in lowering the risk of developing pressure ulcers. Only stage one pressure ulcer developed though, Jithra has been suffering from disability for 4 years.ReferencesBrown, D., Edwards, H. (Eds.). (2012). Lewiss medical-surgical nursing assessment and management of clinical problems. NSW, Australia Elsevier Australia.Crosta, P. (2009). What Is Embolism? What Are The Different Types Of Embolism?. Medical News Today. Retrieved from http//www.medicalnewstoday.com/articles/153704.phpJones, D. (2013). Pressure ulcer prevention in the society setting. Nursing Standard, 28 (3) 47-55. 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(2010). Setting the scene. In Williams, J., Perry, L., Watkins C. (Eds.), Acute Stroke Nursing (p p.1-16). Retrieved fromhttp//0-onlinelibrary.wiley.com.alpha2.latrobe.edu.au/store/10.1002/9781444318838.ch1/asset/ch1.pdf?v=1t=ht43cw4ls=1791526b00be208b196d718b1c2189904267ad40World Health Organization. (2014). Stroke, Cerebrovascular Accident. Retrieved from http//www.who.int/topics/cerebrovascular_accident/en/