Question

Presentation: You inherit a new patient F. L. who has a history of "recent stroke." He was recently (approximately 3 months ago) hospitalized, but you don't have his records at the moment. The patient's wife wanted him "checked out," and states that his "cat scan" showed a stroke. She claims, "They did a bunch of other tests but didn't find anything." She does not think he has hypertension but adds, "He does not like to go to doctors." The past medical history is unknown. He does report taking aspirin 81mg daily and does not have any known drug allergies. Patient F. L. smoked one pack a day but quit five years ago, however he does drink socially. As for his family history, his mother died at the age of 79 from a stroke and his father died at the age of 64 from a myocardial infarction; he is the only child. He is 57 years old, married to his wife for 29 years and has three children. He works Monday through Friday as an accountant.

Medications: Aspirin 81mg daily

Review of systems: Subtle left hemiparesis; increased tone and hyperactive reflexes; very mild neglect of his left side.

Physical exam: Vitals: height = 72″, weight = 225, body mass index = 30.5, blood pressure = 150/99 mm Hg; heart rate = 93 beats per minute at rest.

please type to answer the following

1. What are three nursing interventions for this patient?

2. What are three things you would discuss with a stroke patient and his family during your discharge teaching?

3. What are two medications (other than aspirin) that could be provided for this patient and why?

1. What is the mechanism of action of each?

2. What are some of the possible side effects associated with these medications?

3. How would the patient benefit from taking these medications?

4. What are three recommendations for follow-up care?

Answer 1

Three nursing interventions

1.Change the position every two hours and provide extra pillows for support to prevent contractures, relieve pressure, maintain body alignment, and prevent pressure ulcers.

2.Provide full range of motion exercise to the left arm and leg maintain joint mobility, to prevent venous stasis ,

3. Frequently assess skin, especially on bony areas and left side for signs of breakdown.

Discharge teaching for stoke patient and family

1.Changes in daily activities; teaching the patient to do self care as much as possible to resume body strength and co ordination with the help of assistive devices

2. Teach the importance of rehabilitation therapies in regaining balance and co ordination of body and speech.

3 Teach the family members about the behavioral changes (due to memory loss or post stoke depression) and limitations of patient and hoe to assist him to overcome it.

Home assessment of development of contractures or skin breakdown and its preventive measures can be explained.

The importance of taking medications and follow up care can be explained.

Two medications (other than aspirin) that could be provided for this patient

The patient could be provided with antihypertensive drugs (like diuretic,ACE inhibitors, beta blockers) and cholesterol lowering medication like statins because these medication can reduce second chance of stroke.

a)

• Mechanism of action of antihypertensive is to lower the blood pressure. for example diuretics act by helping the kidneys to excrete extra water and sodium from the body.
• Statins work in liver by inhibiting HMG-CoA reductase enzyme which helps the production of(bio synthetic pathway) cholesterol.

b) Some of the possible side effects associated with these medications

1. Diuretics ; Low potassium or sodium levels, headache, fatigue,muscle cramps,high blood sugar levels

2. Statins ; Most common side effects include problems with gastrointestinal tract like diarrhea, indigestion, or constipation, loss of appetite. high blood sugar levels, headache, muscle and joint pain.But most of the patient can withstand well with statins therapy.

c) Benefit from taking these medications

Hypertension and high cholesterol ( accumulation of cholesterol in blood vessels and narrowing) are two major risk factors of recurrent stoke events. Thus providing these medications to a patient with stroke will reduce the chance of a second attack and prevent further complications.

Recommendations for follow up care

1. Follow up care should mainly focused on the improvement of physical ability and medication compliance.

2. Provide rehabilitation care like physiotherapy, speech therapy and occupational therapy to regain the body function and balance

3.Providing community support and resourses like providing information about groups working together who had the same condition and recovered from stoke. it will improve the patients mental status as well as coping with his new life style changes

4. Emphasize the need of continuing medications, changes in dietary pattern, daily exercise to prevent further episodes of stoke is very important.