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Scenario 4 Identify the factors that lead to Fainting Stroke (Ischemic, Hemorrhagic, Stroke in Evolution) Risk Factors for Stroke (Diabetes (Type 1&2), Hypertension (Primary & Secondary) Nursing Management of a patient with an Ischemic Stroke

Answer 1

Stroke is known as brain attack due to the cell death caused by decreased or disrupted blood flow to the parts of brain.

It is two types; ischemic stoke and hemorrhagic stroke. Ischemic stroke occur due to the poor blood supply to one part of the brain due to block in blood vessels which supply them. Hemorrhagic stroke occur due to the bleeding inside the cranium due to rupture blood vessels.The deterioration or gradual worsening of neurological deficits after an initial episode of ischemic stroke is known as stoke - in - evolution

Factors leading to ischemic, hemorrhagic and stroke evolution..

• Ischemic stroke can be from a thrombus formation (blood clot formation with in the vessels supplying to the brain) due to increased fat deposition in the arteries(Atherosclerosis) supplying the brain or emboli ( blood clot which formed in other part of the body travel through circulating blood) due to cardiac surgeries or heart disease.
• hemorrhagic stoke can be due to bleeding from rupture of blood vessels within the brain ( intracerebral) due to increase in pressure in condition like hypertension or due to bleeding from subarachnoid space due to aneurysm or congenital disorder like arteriovenous malformation.
• Sedentary life style. diabetes, high serum cholesterol levels, smoking , obesity, hormone replacement therapy also leads to stroke as the leads to hypertension and atherosclerosis.
• If the patient present with hypertension, a quick lowering of blood pressure using medications can leads to stroke evolution.

Risk factors for stroke

• Diabetes can make pathological changes in the blood vessels due to increased circulation blood glucose level and it can leads to stroke. Type one diabetes is also known as insulin dependent because of lack of insulin production by the pancreas. Insufficient insulin level leads to  more glucose level in blood. Type 2 diabetes is also known as non- insulin dependent because the inability of the cells to utilize the insulin for glucose metabolism. This also cause high blood glucose levels in blood. High glucose level leads to systemic inflammation and arterial stiffness due to which atherosclerosis occur in vessels. diabetes also cause endothelial dysfunction and leads to stroke.
• Primary hypertension is the increased blood pressure with unknown cause ore without secondary condition. Secondary hypertension is the increased blood pressure due to underlying conditions like damage to kidneys, arteries etc. Both have same effects on stoke. High blood pressure damage the inner lining of arteries and leads to narrowing of arteries.It reduces the elasticity of the blood vessels and leads to decrease in blood carrying capacity. The constant pressure on the artery walls make them weaker and leads to aneurysm. these all eventually contribute to stroke.

Nursing management of a patient with ischemic stroke

The nursing management of ischemic stoke include early identification of symptoms and use necessary planning and implementations to prevent or reduce the possible complication associated with.

• Assess for airway, circulation and breathing, clear the airway from secretions.
• monitor vital signs periodically.
• arrange and do CT scan as soon as possible.Avoid any delay in care.
• assess for neurological changes, oxygen saturation, evidence of seizure activity.
• Provide range of motion exercise
• Assist with daily living activities, initiate fall prevention precautions
• Monitor foe signs of deep vein thrombosis, apply pressure cuff or compression stockings.
• Assess bowel and bladder habits
• Assess skin integrity, provide comfortable positioning every two hours to prevent skin damage.
• Provide speech therapy, occupational therapy and physiotherapy as per the need of the patient.
• Provide patient and family education regarding stroke, causes, management and prevention.