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Nursing Care for Long Term Condition - Case Study Example

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Sample Case: Mrs. X lives most of her younger life in Brighton she moved to Kent 30 years ago near her son. She is 68 years old and used to work as bank clerk Mrs. X suffers from cerebral vascular accident (stroke) five years ago. She experiences some difficulty with her speech.
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Nursing Care for Long Term Condition
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Download file to see previous pages Definition of Stroke: Stroke is a focal neurological deficit lasting longer than 24 hours and is the result of a vascular lesion. A completed stroke is when neurological deficit has reached its maximum (usually within six hours). (Ballinger et al. 2000)
Epidemiology: It has been found that stroke is the third most common cause leading to death in the UK and the most common cause of physical disability among adults. (Ebrahim 1990) Immediate mortality is high and almost 20% of stroke patients die within 30 days. For those who survive, the recovery of neurological impairment takes place over a variable time span. About 30% of survivors will be fully independent within three weeks, rising to nearly 50% by six months. (Scottish Intercollegiate Guidelines Network 2001 - 2008) Mrs. X in this study had an attack when she was 63 years of age. Atrial fibrillation can be one of the causes leading to stroke. The prevalence of atrial fibrillation (AF) is highly age related and is a major cause of stroke and premature death and disability. The risk of stroke and systemic thromboembolism is highest in the elderly, particularly older women. (Ford et al. 2007) Stroke is also related to stress factors which may be induced by environment, loneliness, lifestyle changes, relationships and a number of other factors. Mrs. X had enjoyed a busy life working as a clerk in a bank. Her lifestyle changed considerably after her retirement. The loneliness brought about by a change in her environment could be one of the causes leading to her illness. Her lifestyle has changed in response to her changed environment and her financial needs and capabilities. (European Stroke Organization 2008)
Pathogenesis: The two major mechanisms which cause brain damage in stroke are ischemia and haemorrhage. Almost 80% of all strokes are ischemic strokes. In ischemic strokes, decreased or absent blood circulation deprives neurons of necessary substrates. The effect of this is fairly rapid since the brain does not store glucose which is the chief energy substrate and is incapable of anaerobic metabolism. (Merck Manuals 1995 - 2009) About 10% to 15% of strokes are caused by non-traumatic intracerebral haemorrhage. Intracerebral haemorrhage originates from deep penetrating vessels and causes injury to brain tissue by disrupting connecting pathways and causing localized pressure injury. In both kinds of stroke destructive biochemical substances, released from a variety of sources, play an important role in tissue destruction. (Foundation for Education and Research in Neurological Emergencies 2009)
The causes for a cerebral infarction may be:
Thrombosis at the site of an atheromatous plaque in a major cerebral vessel.
Emboli arising from atheromatous plaques in the carotid/vertebrobasilar arteries, or from cardiac mural thrombi or from the left atrium in atrial fibrillation
Rarely cerebral infarction is the result of severe hypotension. (Ballinger et al. 2000)
At the basic level, vascular compromise leading to stroke evolves over time. The progression and extent of ischemic injury is influenced by many factors such as:
Rate of onset and duration: The brain is able to better tolerate an ischemic attack of short duration or of slow onset.
Collateral circulation: A good collateral circulation in the impacted area often results is a better recovery. (American Heart Association 2009)
Health of systemic circulation: A constant cerebral perfusion pressure depends on ...Download file to see next pagesRead More
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