Stroke Can Occur at Any Age Discussion Post

I am submitting three discussion post and I need you to respond to them INDIVIDUALLY and provide constructive and insightful comments that go beyond that of agree or disagree. 1)The first post is from Brook: Can the nurse use the information from this video to educate the public to promote stroke awareness and early treatment? Yes, the nurse can use this video to educate the public about stroke in the younger population and the differences between the kinds of stroke as in TIA or hemorrhagic. I think that most people have the assumption that stroke can only happen to an older population and might overlook the signs and symptoms of a stroke in a younger individual. The video depicts a very young woman who had the frightening experience of a stroke and how her family has also had a life changing experience since. Education to the public will increase awareness indefinitely and shorten response times to treatment. -What teaching would the RN incorporate into a plan of care that focuses on coping and adaptation? The R.N. would incorporate that the patient, family, or significant others are educated about stroke, why it happens and ask about any questions or concerns that they might have? The family will be educated about realistic outcomes and offer resources as in counseling to cope. It's important that the family is reassured that they will need to give their love and understanding to help with recovery. It might be of concern to the patient that the occurrence can happen again or during sexual activity, the R.N. would need to perform a history about sexual activity before and after the stroke and implement interventions as in education, counseling, means of sexual expression. The nurse will need to continually reassess and adjust the care plan accordingly seeing that not all families or patients will cope in a healthy manner -What cues would the nurse use to determine the patient is ready for teaching? The nurse will be able to tell that the patient is ready to learn by actively listening to what the patient is saying, and how the patients reacts when speaking about the stroke. If the patient seems angry, upset or in denial it is not a good time to start teaching. The nurse needs to listen first then address any concerns moving towards the direction of education, if the patient still appears to distraught to talk about education it must be done at another time when the patient is open and asking questions. -How are patient goals determined? Patient goals are implemented the day the patient has the stroke and is increased during a stage called convalescence, this requires a collaborative team approach. It's imperative that the assessment of the patient includes how the patient functioned before the incident ie. ADLs. Stroke predictors can be utilized as in age, NIHSS score, and LOC at time of admission to provide realistic goals. -What referrals would be appropriate? Nursing, occupational therapy, physical therapy, physiotherapy, speech language pathology, social Work, clinical nutrition, and counseling. -How can the RN assist the patient in developing the coping skills to address the challenges a younger person will experience over a lifetime as a result of the stroke?The R.N. can talk to the patient about expectations that the patient might have about goals and evaluate if they are realistic? If not the R.N. can formulate a plan with the patient that is more acceptable with the patients current health status including resources for achieving the goals. Again, the R.N. will need to re-evaluate over time to see how the patient is copeing and will need to encourage and positively reinforce any goals or achievements that are big or small the have been met. The R.N. will also need to make referrals to the appropriate resources to implement the proper care for the patient over a lifetime. 2) the second post is from Joseph:Can the nurse use the information from this video to educate the public to promote stroke awareness and early treatment? Yes, the nurse can use this video to educate the public about stroke in the younger population and the differences between the kinds of stroke as in TIA or hemorrhagic. I think that most people have the assumption that stroke can only happen to an older population and might overlook the signs and symptoms of a stroke in a younger individual. The video depicts a very young woman who had the frightening experience of a stroke and how her family has also had a life changing experience since. Education to the public will increase awareness indefinitely and shorten response times to treatment. -What teaching would the RN incorporate into a plan of care that focuses on coping and adaptation? The R.N. would incorporate that the patient, family, or significant others are educated about stroke, why it happens and ask about any questions or concerns that they might have? The family will be educated about realistic outcomes and offer resources as in counseling to cope. It's important that the family is reassured that they will need to give their love and understanding to help with recovery. It might be of concern to the patient that the occurrence can happen again or during sexual activity, the R.N. would need to perform a history about sexual activity before and after the stroke and implement interventions as in education, counseling, means of sexual expression. The nurse will need to continually reassess and adjust the care plan accordingly seeing that not all families or patients will cope in a healthy manner -What cues would the nurse use to determine the patient is ready for teaching? The nurse will be able to tell that the patient is ready to learn by actively listening to what the patient is saying, and how the patients reacts when speaking about the stroke. If the patient seems angry, upset or in denial it is not a good time to start teaching. The nurse needs to listen first then address any concerns moving towards the direction of education, if the patient still appears to distraught to talk about education it must be done at another time when the patient is open and asking questions. -How are patient goals determined? Patient goals are implemented the day the patient has the stroke and is increased during a stage called convalescence, this requires a collaborative team approach. It's imperative that the assessment of the patient includes how the patient functioned before the incident ie. ADLs. Stroke predictors can be utilized as in age, NIHSS score, and LOC at time of admission to provide realistic goals. -What referrals would be appropriate? Nursing, occupational therapy, physical therapy, physiotherapy, speech language pathology, social Work, clinical nutrition, and counseling. -How can the RN assist the patient in developing the coping skills to address the challenges a younger person will experience over a lifetime as a result of the stroke?The R.N. can talk to the patient about expectations that the patient might have about goals and evaluate if they are realistic? If not the R.N. can formulate a plan with the patient that is more acceptable with the patients current health status including resources for achieving the goals. Again, the R.N. will need to re-evaluate over time to see how the patient is copeing and will need to encourage and positively reinforce any goals or achievements that are big or small the have been met. The R.N. will also need to make referrals to the appropriate resources to implement the proper care for the patient over a lifetime. 3)The third post is from Kellie: Time lost is brain lost. The information in the video emphasized the importance of early diagnosis and treatment. Understanding that early treatment is key to successful rehabilitation, the most important thing in education is teaching people to identify the symptoms of stroke. With possible stroke minutes matter, so the ability to recognize the cardinal signs of impending stroke: -Weakness in either arm or leg. -Sudden vision changes -Trouble speaking -Confusion understanding simple statements -Problems with balance and walking -Severe headache Additional education would focus on understanding modifiable risk factors, leading a healthy lifestyle and managing chronic conditions. Incorporating the Health Belief Model into teaching could also prove to be useful. This model is based upon the individual's perception of 4 areas: the severity of a potential illness, the person's susceptibility to that illness, the benefits of taking preventive action, and the barriers to taking that action. Having each person complete their own personal risk assessment using the American Heart Association's Stroke Risk Scorecard might also be a valuable tool. Modifiable risk factors include: -Manage hypertension, hyperlipidemia & hyperglycemia -Limit alcohol -Stop smoking -Teach the DASH diet -Control weight and keep it within recommended healthy limits -Work with healthcare providers to identify and treat various heart related issues such as atrial fibrillation, carotid stenosis, and valvular heart disease Patient education is a continuous journey using all available resources to develop a plan that meets each patient's unique needs. Assessment is ongoing and should take into consideration patient safety, functional readiness and limitations. Patient goals are based upon the level of damage caused by the stroke as well as understanding of the patient's prior level of function, and the patient's dedication to the recuperative process. It is important to have an understanding of the patient's NIHSS (National Institutes of Health Stroke Score) score in order to set realistic goals and outcomes. When the patient exhibits a readiness to learn, he or she will begin showing an interest by asking questions and demonstrating a desire to participate in their own care. Self-efficacy, the belief in one's own ability to effectively perform tasks, will be an important characteristic for the nurse to identify. The Registered Nurses' Association of Ontario had some excellent questions which could be integrated into the ongoing assessment. -What questions do you have regarding your/your family member's stroke? -What concerns you most about your/your family member's stroke? -What would you like to learn about this condition? -When you consider the future and your/your family member's stroke, what do you imagine? -What about your/your family member's stroke do you find frustrating? -What about your/your family member's stroke frightens you? Post stroke care requires an interdisciplinary team approach involving many specialists. In the acute phase collaborative efforts will involve acute care physicians, radiologists, neurologists, and neurosurgeons. Once the patient is stabilized, the rehabilitative phase begins. This team consists of physical and occupational therapists, nursing staff, speech/language pathologists, dieticians, counselors and/or psychiatrists, home care specialist, and community based stroke support programs. In addition to daily care, the nurse's role will be predominantly one of support for the patient and family, coordinating care from other clinicians, and addressing educational needs. Coping and adaptation largely depends upon the amount of brain damage, the patient's personal experience, and the familial support system. A post stroke patient might also suffer from fear of recurrence, and self-esteem and confidence issues related to their impairments. From a psychosocial point of view, stroke affects a person's individual value, identity, and perception of their ability to contribute to the family and society at large. All of this combined serves to create a sense of vulnerability and loss which could lead to depression and psychological problems. Additional disabilities from stroke can be related to motor, sensory and communication losses, perceptual disturbances, cognitive impairments and psychological problems. The extent of the patient's limitations would dictate physical and environmental adaptations and could include assistive devices and modification of the environment. Long-term post-stroke complications can include: -Weight loss. -Seizures. -Pressure sores, and/or blood clots within deep veins if the person sits or lies in one position for a long period of time. -Shoulder pain. -Tight muscles and muscle spasms in the affected arm or leg which can lead to contractures. -Depression. -Infection While every individual is unique and has different needs, learning styles, limitations, and preferences, the younger patient needs to understand their specific type of stroke, ischemic or hemorrhagic, and the possible etiology so that steps can be taken to avoid reoccurrence. They also need to have a thorough knowledge of modifiable risk factors, so they can effectively incorporate these as lifestyle changes into their personal life. This requires a significant personal commitment to the pursuit of a healthy lifestyle. Once again, the extent of damage is an important consideration, as is ongoing family and community support. The younger patient who experiences preoccupation with fear of recurrence may need therapeutic counseling to instill confidence in their ability to manage their illness.