Acute Ischaemic Stroke Case Study

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On Bills admission to the unit after suffering an acute ischaemic stroke, a comprehensive care plan was devised using the Nursing Process to accommodate his various issues associated with the stroke. This framework, involving the assessment, diagnosis, planning, implementation and evaluation of nursing interventions guided practice on the two issues focused on in this essay.
Issue 1 - Thrombolysis
A stroke, is the “rapidly developing signs of focal (or global) disturbance of cerebral function with symptoms lasting 24 hours or longer” (World Health Organisation,1998). In the event of a stroke blood supply to the brain is occluded by a thrombus or an embolus from the heart (Fitzpatrick and Birns,2004). A treatment option for those who have suffered an ischaemic stroke is thrombolysis. As 85% of strokes are ischaemic this is a treatment option for many (Fitzpatrick and Birns,2004).The goal of thrombolysis is to disintegrate the thrombus/embolus occluding the vessel and reduce the scale of tissue damage (Fitzpatrick and Birns,2004).It is important to note that thrombolysis using ateplase should only be used to treat acute ischaemic stroke once intracranial bleeding has been ruled out by diagnostic imaging, and within 4.5hours of onset by
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Before Bill was given medication, food, or fluids he was assessed for ineffective swallow by the nurse. If the screening shows swallow impairment the patient must be referred to SALT within 24hours (NICE,2008). The screen used in this hospital was the “Stroke dysphagia screen” (Lepine,2009 cited in Barnard,2011). This involves giving an alert patient (absent of facial droop and with a gag reflux) a sip of water, if they can swallow without coughing/choking they are allowed more and observed for coughing/choking (Barnard, 2011). If facial droop present, as in this case, the test is not done and the protocol requires immediate referral to SALT.A nursing diagnosis of “ineffective swallowing” was

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