NURSING CARE MANAGEMENT 103 RELATED LEARNING EXPERIENCE HEALTH TEACHING

Prepared by: Group III-A3 Submitted to: Mr. Joel Fabros R.N

Reference:

http://www.umm.edu/patiented/articles/who_gets_pneumonia_000064_5.htm http://emedicine.medscape.com/article/234240-overview http://meded.ucsd.edu/isp/1999/CAP/durat.html

General objectives:
This study aims to provide the nurses, future researchers, readers and general audiences to understand, learn and gain more knowledge regarding the case of our patient; that is CAP-MR.

Specific objectives:
To establish rapport with the client and her family in order to develop therapeutic working relationship and gain trust for obtaining significant information; To discuss the etiology and symptomatology of the disease process; To present the diagnostic examinations and their implications; To present the drug studies of all the prescribed medications with the corresponding nursing responsibilities; To develop appropriate nursing care

The brain controls how our body functions, how we think, how we see, how we talk, and how we move. The signals to and from the brain are transmitted through the spinal cord to the rest of the body.

The right side of the brain controls the left side of the body, and the left side of the brain controls the right side of the body. This includes movement and sensation. Speech centers usually are located in the Broca's area on the left side of the brain. Vision is controlled by the back of the brain in the occipital lobes. The carotid arteries provide the majority of the blood supply to these parts of the brain (known as the anterior circulation). Balance and coordination are controlled by the cerebellum, or the base of the brain, and its blood supply comes from the vertebral arteries located in the bony canals in the back of the vertebral column (referred to as the posterior circulation).

When the brain loses blood supply, it tries to restore blood flow. If blood supply is restored, function may return to the affected brain cells, permitting return of function to the affected body part. This is what happens with a TIA (transient ischemic attack). Some may consider this a mini-stroke, however, in reality, it is a stroke that has resolved or has improved functionality in the affected body part. TIAs are often warning signs of a future stroke. The risk of a stroke increases dramatically in the days after a transient ischemic attack, and the TIA may offer an opportunity to find a cause or minimize the risk to prevent the permanent neurologic damage that results because of a stroke.

Transient ischemic attack (TIA, Mini-Stroke) : Transient ischemic attack is a neurological event with the signs and symptoms of a stroke but which go away within a short period of time. Also called a mini-stroke, a TIA is due to a temporary lack of adequate blood and oxygen (ischemia) to the brain. This is often caused by the narrowing (or, less often, ulceration) of the carotid arteries (the major arteries in the neck that supply blood to the brain). TIAs typically last 2 to 30 minutes and can produce problems with vision, dizziness, weakness or trouble speaking. If not treated, there is a high risk of having a major stroke in the near future. People who have a TIA have a 25% greater risk of having a stroke or other serious complication within 90 days.

Stroke is the 3rd leading cause of death on America and no.1 cause of adult disability. 80% of stroke is preventable. In Philippines, stroke affects 486 out of 100,000 Filipinos or roughly half a million Filipinos, according to Dr. Navarro in his study in the Philippine journal neurology. Transient Ischemic Attack Half of the people who experience a TIA are unaware of the event. Up to a 25% people who suffer a TIA die within one year. Up to 17% of all TIAs are followed by a stroke; most of them within 30 days of their occurrence. Approximately 15% of all strokes are preceded by a TIA.

Symptoms of an embolic stroke usually come on quite suddenly and are at their most intense right from the start, while symptoms of a thrombotic stroke come on more gradually. Symptoms may include:

blurring or decreased vision in one or both eyes severe headache often described as "the worst headache of my life" weakness, numbness, or paralysis of the face, arm, or leg, usually confined to one side of the body dizziness, loss of balance or coordination, especially when combined with other symptoms

The most common is coronary heart disease (also called coronary artery disease). Coronary heart disease is the number one cause of death in the United States. If the arteries that supply the heart with blood, called the coronary arteries, are affected by coronary artery disease, you may have symptoms that include:

Chest pain or chest discomfort (angina) Pain in one or both arms, the left shoulder, neck, jaw, or back Shortness of breath Dizziness Faster heartbeats Nausea (feeling sick to your stomach) Abnormal heartbeats Feeling very tired.

Symptoms of a stroke or a transient ischemic attack (also referred to as a TIA or "mini-stroke").

Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body Sudden confusion or trouble speaking or understanding speech Sudden trouble seeing in one or both eyes Sudden dizziness, difficulty walking, or loss of balance or coordination Sudden severe headache with no known cause.

. DIAGNOSTIC EXAMS *If a TIA is suspected, the doctor may want to do tests, such as a: - CT scan of the head, to check for bleeding in the brain when symptoms of a TIA are occurring and to check for evidence of a stroke or other disease, such as a tumor. - MRI scan, to check for damage to the brain from a stroke. ~Further tests are often done to identify the cause of the TIA: *If blockage of the carotid arteries is suspected, you may have tests such as: -A Doppler ultrasound. -A magnetic resonance angiogram (MRA). -An angiogram of your head and neck. TIA symptoms may be due to blood clots caused by a heart problem.

*If heart problems are suspected, you may have tests such as a: - Chest X-ray to assess the size and shape of your heart. - Electrocardiogram (ECG, EKG) or Holter monitoring or ambulatory EKG to assess heart rhythm. - Echocardiogram (echo) to examine the shape of the heart chambers and blood flow through them. -Cholesterol and triglycerides tests to check the level of these blood fats that can increase your risk for blood clots and hardening of the arteries.

*You may have other blood tests, such as a: - complete blood count (CBC) - chemistry screen - prothrombin time based on your age and medical history. Your doctor will use these tests to look for other causes of the TIA.

It is important to get to the hospital as soon as possible if you suspect a stroke. Many large hospitals are now treating strokes caused by blood clots with clot-dissolving medicines. These medicines can cause the symptoms to stop very quickly. They can prevent long-term disability or death. This treatment works only if the medicines are given within the first 3 to 6 hours after the stroke began.

All strokes require careful observation, especially in the first 24 hours. In addition to bed rest, you will probably need an IV and oxygen. Underlying medical problems that may have caused the stroke, such as high blood pressure or heart rhythm problems, will be treated.

Depending on the severity of your symptoms and how soon you are alert and able to start exercises, in the bed or out of the bed, you will begin your rehabilitation (rehab) program. Most stroke rehab programs last several weeks to several months after you leave the hospital. The program consists of physical therapy, occupational therapy and, if needed, speech therapy.

Physical therapy helps you regain muscle strength and teaches you ways to move safely with weak or paralyzed muscles. Occupational therapy helps you relearn ways of eating, dressing, and grooming. Speech therapy may help you if you have problems with swallowing, speaking or understanding words.

The patient who has experienced TIA is at risk for altered cerebral tissue perfusion. Important nursing interventions include performing baseline and subsequent serial assessments of neurological status for any further signs and symptoms of altered cerebral tissue perfusion that may indicate a recurrence of TIA or a developing stroke. The nurse must also educate the patient and family about the laboratory and diagnostic tests being performed during the initial evaluation Most patients with TIA and their families also have a knowledge deficit related to risk factors for TIA and stroke. A nationwide survey of 11,400 adults reported that 8.2% of those surveyed were able to identify the definition of TIA and only 8.6% were able to recognize at least one common symptom. In another study of 215 hospitalized women, all respondents named stress as the number one risk factor for stroke Patient and family education should proceed according to a baseline assessment of knowledge deficit related to risk factors and secondary prevention. The degree of readiness to change must also be assessed. Assessment needs to be directed first toward the recognition of non-modifiable risk factors including advancing age, male gender, Hispanic or African American race, and heredity. Individuals in these groups need to be more vigilant about controlling modifiable risk factors. Recommendations for prevention of modifiable TIA risks include

Hypertension should be treated aggressively to maintain systolic blood pressure (BP) below 140 mm Hg and diastolic BP below 90 mm Hg Diabetes mellitus, if present, must be controlled Cigarette smoking must be eliminated Coronary artery disease, cardiac arrhythmias, congestive heart failure, and valvular heart disease should be treated Excessive alcohol use or any illicit drug use should be eliminated Use of oral contraceptive should be discontinued, or at minimum a low-estrogen version should be used Cholesterol levels need to be monitored and hyperlipidemia should be treated for reduction of coronary artery disease Physical inactivity must be corrected and the benefits of an exercise program as well as a healthy diet leading to weight loss in overweight individuals should be explained Hormone replacement therapy in postmenopausal women is not recommended for prevention of stroke

Hospital Discharge Planning: Following a stroke, the patient is rushed to the hospital and stabilized, and the blood flow to the brain is restored. In the days following a stroke, doctors will seek to prevent any future strokes and to limit the complications associated with the original stroke; A patient usually is discharged from the hospital several days after the stroke, after a doctor gives the "all clear." patients will be typically sent to a rehabilitation center, usually associated with their hospital, and the more quickly the treatment begins the greater the likelihood of regaining lost capabilities.

Rehabilitation Process Rehabilitation time varies, depending on the severity of the stroke and the damage to the brain. The three most common effects from a stroke are speech impediments, decreased motor skill coordination and depression. Many patients need to learn to speak again, to walk again, to use their hands, and to complete daily tasks. Due to the intense nature of the treatment, some people develop depression, which needs to be addressed to ensure continued dedication to rehabilitation. After several weeks of rehabilitation, the patient usually will be sent home or to an assisted-living facility to continue the recovery process, but at a more gradual pace. Long-Term Implications If the effects of the stroke remain severe, physical therapy will be necessary. For minor stroke sufferers, the initial rehab might be enough for them to be able to live on their own and resume their usual activities. The rehabilitation process will last for as long as the patient continues to show side effects from the stroke. Physical therapy can go on for months or years before patients regain some or all of their previous abilities. The recovery time will depend on the severity of the stroke coupled with the effort put into rehabilitation.