Rehabilitation Care - Essay Example

The aim of the paper is to discuss various aspects of the rehabilitation care for the patients with diagnosed ischemic stroke. It is suggested, that correctly designed rehabilitation care is the instrument of the better outcomes for the patients with the ischemic stroke, and thus it is essential to have closer look at the nursing, as well as cultural, social and medical aspects of rehabilitation from the viewpoint of the experienced practitioner. Case study integrating biological, social, cultural, nursing and other aspects of care for the client needing rehabilitation Ischemic stroke has become one of the most widely spread reasons causing deaths among people of all ages. For this reason, and for the reason of the better outcomes for the patients having experienced ischemic stroke, it is essential to concentrate on the nursing aspects of the rehabilitation care and to discuss it from the various viewpoints. Diagnosis and etiology From the medical viewpoint, ischemia itself is the result of thrombi or emboli. 'Emboli may lodge anywhere in the cerebral arterial tree. Embolic sources include especially in atrial fibrillation, in rheumatic heart disease (usually mitral stenosis) vegetations on heart valves in bacterial or marantic endocarditis or atheromas in neck arteries'. (Ebrahim, 1990) Thus, it is clear, that to predict the development of the disease is always easier than to cure it then, but we here have to discuss the process of rehabilitation, which may play crucial role in the positive outcomes for the higher percentage of patients. Case study Mr L appeared in the hospital in June 2006 with the suggested ischemic stroke. The principal symptoms and complaints were headache, losing consciousness. There were no signs of vomiting, but the left side of the body was almost paralyzed. The diagnosis was checked in clinics, he was tested for the blood glucose level to exclude hemorrhage; diagnosing also included ultrasonography, ECG and PT/PTT blood tests. On the basis of the acquired results, it was forecast that the patient would be eventually able to walk, but there would not be full neurobiological recovery on the basis of the severity of the symptoms and the age of the patient (he was 69). The treatment prescribed included chlopidogrel 75 mg once a day, dipyridamole 200 mg and with warfarin in short-term period. Rehabilitation care The principal aim of any rehabilitation care no matter what diagnosis is accounted, is to provide the patient with the highest quality of life possible, bearing in mind the short and long-term consequences of the disease, which may occur. It is stated, that though rehabilitation itself does not cure the stroke, and the process which take place in the human brain are often irreversible, it is still possible to achieve the long-term positive outcome with the majority of patients, if the care plan is designed correctly and accounts all factors. A thorough research has been conducted in relation to the different means of rehabilitation care for the patients after ischemic stroke. The results have shown, that 'the patients, receiving organized in-patient stroke unit care were more likely to survive, regain independence and return home than those receiving less organized service'. (Karla & Eade, 1995) Thus, nursery rehabilitation care is essential for the fatality statistics of the ischemic strokes, and should be started as soon as it is possible depending on the severity of symptoms with the patient. Post-stroke rehabilitation in general is the effective instrument for the patients after strokes to regain and restore the skills, which they may lose as a result of the brain damage. In our case, the patient was diagnosed for the problems with movements, especially in the right side of the body; it is not frequent with the patients suffering from ischemic strokes, while the left side of the body appears to be the most vulnerable to paralysis; but it also depends on what part of brain is damaged. If the patient is not able to restore certain skills, the aim of the nursery rehabilitation care is to teach the patient other means of performing certain tasks, which will ultimately compensate the lost abilities. 'There is a strong consensus among rehabilitation experts that the most important element in any rehabilitation program is carefully directed, well-focused, repetitive practice'. (Peacock et al, 1972) Rehabilitative therapy should begin already in the hospital, as soon as the medical state of the patient is stabilized. Such stabilization usually occurs through the first 48 hours after the stroke, but may take longer period depending on the severity. With the case of Mr L, the rehabilitation care nurse attended him on the fourth day after he appeared in the hospital and was diagnosed for the ischemic stroke. His right side was almost paralyzed; he had problems with speech and was emotionally broken. Thus, from the nursery care viewpoint, he needed rehabilitation of those lost skills, and especially his moral state. Accounting cultural aspect, people with disabilities usually take inferior place in the society, and thus to make the person independent, and to give him the quality of life of full value, the rehabilitation process had to be thoroughly organized and account all the disabilities which could be cured or fixed. It is essential that the levels of staff in the in-patient care unit correspond to the size of this stroke unit and the dependency of patients. (Strand et al, 1985) It is stated, that the minimum nursing level of 10 whole time equivalents per 10 beds is recommended. In case with Mr L, it has been founded that only 9 whole equivalents were present for each 10 beds, which was ultimately the reason for the delay with the rehabilitation process' start, as well as the longer period of stay. 'A major challenge in stroke rehabilitation practice is how best to customize available rehabilitation resources to meet the needs of patients to optimize outcomes. Failure to optimize rehabilitation interventions and therapies may result in too little or too much care relative to a patient's needs and preferred outcomes.' (Ronning & Guldvog, 1998) It is essential, that from the viewpoint of nursery care for the post-stroke patients, the care of nurse as a whole should be highly qualified, skilled and to deliver the necessary therapeutic effect to the patient. Nurses are integral parts of the so-called multidisciplinary teams, which carry out the post-stroke rehabilitation for the patient. In rehabilitation of the post-stroke patients the principal elements of the nursery care may be as follows: multidisciplinary team participation; removing the competition for nursing time; knowledge, interest and enthusiasm; nursing assessment of the care needs of the patient, including the formal scoring of pressure sore risk and swallow screening; nursing management of the patient's care needs; active contact from nursing staff. (Moloney et al, 1999) 'Optimal timing of rehabilitation after stroke remains controversial. It is an important question to answer. Several studies provide evidence for the benefit of early rehabilitation compared with later intervention in patients with stroke. However, interpretation of these studies is limited. Early rehabilitation may mean starting anywhere from 3 to 30 days after stroke. On the other hand, rehabilitation in the very early stages after stroke theoretically may harm vulnerable cells via oxidative and metabolic stress in concert with reperfusion injury'. (Strand et al, 1985) Thus, we have the issue of the timeline with the rehabilitation intervention for each patient, and this issue involves all aspects of after-stroke therapy, because it ultimately defines the outcomes of the rehabilitation therapy and the quality of patient's life, which in its turn scopes all other related aspects. Standards of the nursery care state, and it is a direct responsibility of the nursery practitioner, that each patient should be cared for by the multidisciplinary team, in which nurses are the integral participants, who closely cooperate with all other medical specialists; their role is in amending the general care course in correspondence with the medical specialists' requirements. The nurse providing care should pay particular attention to the exact problems the patient has. In our case these are the problems of walking for Mr L, whose right side is partially paralyzed and thus needs implementation of the special therapy. In this relation the nurse's role in the multidisciplinary team appears to be as of the intermediary between the patient and the medical specialist developing the therapy. On the one hand, the nurse is to provide all the elements of the therapy provided by the physician; on the other hand, the nurse is to provide the physician with the response of the patient, as well as with the possible negative reactions to the medicines prescribed and procedures performed. The nurse has to actively involve the patient into the rehabilitation processes; not only should the nurse clearly know and understand the goals of the rehabilitation for each specific patient, but should be able to deliver those goals to the patient himself. Mr L was not aware of the timelines through which his rehabilitation had to be started; though his nursery carer was qualified, but he has not informed the patient as for the expected course of rehabilitation, as well as the actions which should be taken to reduce the risk of further strokes. The nurse and the care the nurse provides often appears to be impacted by the interior and exterior factors; among the inner factors influencing the nurse's activity may be the knowledge which the nurse tries to implement into the care delivered to the patient, which means that no amendments to the therapy prescribed should be implemented without the physician's agreement. Of the external factors there should be noted first of all, the possible changes in the standards of care, of which the nurse should be aware and which the nurse should follow; moreover, as far as the nurse is a part of the multidisciplinary team, the changes in the therapy provided by other medical specialists will ultimately influence the strategy of the care management. The core of the care management in terms of post-stroke patients is in establishing the exact team of the specialists who will work with the specific patient and deal with the health problems in each specific case. Conclusion The issue of the after-stroke rehabilitation in general has become a subject of active discussion over the recent times; the reasons for this discussion becoming so active is in better understanding of how many factors make the ground of the better rehabilitation of the patients with ischemic strokes, as well as for the reasons of ischemic strokes being the main causes of deaths among all age groups of population. Rehabilitation for the patients after ischemic strokes is important to be looked at from the viewpoints of social, cultural, medical and biological aspects. The principal issue, which was discussed in this work was the period of time, which might pass between the stabilization of the patient's state and the rehabilitation care start (that is, whether it is relevant to start the rehabilitation care plan as soon as possible, or can it harm the patient's health). In its turn, the question of the rehabilitation care start involves not only social and cultural problems of the patient's quality of life and the outcomes of this therapy, but also the costs, as the start of the rehabilitation care will ultimately define the length of patient's stay in the stroke care unit. Thus, in designing the rehabilitation plan for any after-stroke patient it is essential to understand the importance of the individual approach. There cannot be given general recommendations; only the guidelines which should be applied to any separate case. In case with Mr L, we have notices certain delays in the rehabilitation course start, though it is yet under question, whether the longer stay of Mr L in the stroke care unit was caused by this delay, as the information for the further research is insufficient. References Abissi C.J., Sepe E., Patiak C., and Davis JN. (1995) Cerebral infarction: Comparison of a care with case-management to traditional care. Neurology 45: A240. 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