Question

Although impaired cognitive functioning is often viewed as an irreversible condition, many impairments are the result of specific physiological stressors and may be reversed with appropriate treatment. Identify one such reversible condition, and discuss nursing interventions that would support its reversal. What primary prevention activities could decrease the incidence of the disruption that you selected?

Answer 1

Stress is defined as (1) ischemia (inadequate blood flow) to a part of the brain or (2) haemorrhage into the brain that results in the death of brain cells.

Stroke is one of the main disease condition or a physiologic condition that may result in impaired cognition.

Cognition includes the mental activities associated with thinking, knowing, remembering and communicating

*Cognition (normal) is described as an individual exhibits cognitive behaviours that are considered to be within the range of normal for age and culture.

*Cognition (Impaired) is described as an observable or measurable disturbance in one or more of the cognitive processes resulting from an abnormality within the brain.

After an episode of a stroke, functions such as movement, sensation, or emotions that were controlled by the affected area of the brain are lost or impaired. The severity of the loss of function varies according to the location and extent of the brain damage.

*Nursing Interventions to improve cognitive function:

1. goal rating: client and other assess progress toward behavioural goals

2. self-prediction: the client is asked to predict their performance on a task, then the task is performed, then they rate their performance afterwards and compare to prediction

3. videotape feedback: client watches and analyzes their performance

4. self-questioning: "did I double-check my work?"

5. journaling: client documents and reflects upon participation in activity and self-reflect

*Visual scanning: Teach them to visually scan the left side regularly to get input

*Sustained attention and self-alerting: Place something on that side and redirecting them to look in that area. Can use visual-motor or verbal cues e.g. a piece of tape on the floor in front of them and have them follow that tape. Imagery can help e.g. imagine you are a lighthouse beam and need to scan the floor from right to left.

* Limb activation therapy:

1. Active preferred, FES as an adjunct, mirror therapy: Moving that side actively, increasing inputs to draw attention to that side
2. Sit in front of the mirror especially useful if don't have control of the hemorrhagic limb. Move uninvolved arm and perceive it in the mirror as their involved side doing those movements that are hidden from view.

Primary prevention activities could decrease the incidence of stroke includes the proper management of modifiable risk factors that include:

* Hypertension: Stroke risk can be reduced by up to 50% with appropriate treatment of hypertension

*Heart disease (Valvular abnormalities)

*Diabetes Mellitus: Diabetes mellitus is a significant risk factor for stroke. The risk for stroke in people with diabetes mellitus is five times higher than in the general population

*Smoking: Cessation of smoking

*Excessive alcohol consumption: limitation on alcohol consumption

*Obesity: weight control,

*Sleep apnea

*Metabolic syndrome

*Lack of physical exercise: Promotes regular exercise

*Poor diet: Healthy diet with routine health assessments.

*Patients with known risk factors such as diabetes mellitus, hypertension, obesity, high serum lipids, or cardiac dysfunction require close management thus reduce the incidence of the stroke and the impairments.