Caregiving Strategy and Pathways in Stroke and Hypertension Patients - Essay Example

Study of Care Giving Strategy And Pathways in Stroke and Hypertension Patients Explain the nature of the two d physiological disorders (stroke) and (hypertension) (P1) Physiological conditions that affect body metabolism and affect friends and family of the diseased are subject to intensive study and research. Two prominent physiological disorders that we are going to study in this paper are stroke and hypertension. Stroke has been identified as an attack on the brain which can happen in either of the three following ways. Ischemic stroke occurs when blood flow gets cut off to a part of the brain, leading to immediate closure of activities in body parts controlled by the affected brain region. Hemorrhagic stroke occurs when blood vessels in the brain rupture and lead to clotting and interrupted blood flow thereby effecting neurons and brain activity. TIA or transient ischemic attacks are strokes that are similar to ischemic strokes but occur due to temporary blockage. In all three types of stroke, the patient collapses and experiences physiological failure due to death of brain cells at the point of effect, and needs to be immediately rushed to the hospital. Hindered blood flow leads to consequent physiological disorders like low pulse, reduced blood flow, blue skin, choked breathing, and dilated eyes. Stroke is generally caused by irregular lifestyle involving physiologically affecting habits like smoking, drinking, and too much fat in diet. Other causes of a stroke include excessive exercise, shock or stress. Hypertension is the phenomenon of increased blood pressure in the arteries, which in turn increases tension in respective organs and can have very drastic impact on the brain. Many cases of blood vessel damage result from hypertension, some of which happen in the brain causing a stroke. Common causes of hypertension are blockages in blood vessels, excessive fat intake, high cholesterol, stress, lifestyle, medication, unregulated food habits, and excessive exercise. People suffer in from hypertension experience short breaths, organ swelling, fluid accumulation, and muscle dystrophy. Such patients are prone to heart attacks and need to be kept under regular medication till the condition subsides. Treatment for both the physiological disorders involves the use of anti-coagulants to increase blood flow. Physiological changes observed during treatment include reduction (normalization) in blood pressure, smoother flow of blood in the brain, greater healing in blocked areas. However, serious cases of blockage cannot be treated through medication and may require surgical removal of the blockage. When treatment is applied on a patient suffering from hypertension, he experiences calming of senses, lighter body weight, reduced giddiness and exhibits clear speech. When administered the right treatment, a patient suffering from a stroke regains consciousness, shows reduced eye dilation, clear speech, ability to move limbs, ability to walk steadily and normal skin and lip color. Factors that influence stroke are: Factors that influence hypertension are: (P2) Signs and Symptoms of Stroke and Hypertension Patients suffering from stroke tend to show signs like slurring of speech, tongue moving to one end of the mouth, partial paralysis, asphyxiation, fainting, vomittings, uncontrollable dysentery and eye dilation. Most of these signs are related to the loss of brain activity in the region of the brain that controls these parts of the body. The patient experiences severe giddiness before losing consciousness, which is caused by the irregular blood flow in the brain (Vissers & Beech, 2005, 3). Hypertension is more subtle in its signs and the patient experiences sweating, breathlessness, giddiness, nausea, a bloated feeling and heaviness in daily activities. The most common sign of hypertension is that the patient tends to snap at small problems and over-react at simple day-to-day events. The cause of the condition is physiologically observed to be the high blood pressure in brain and other organs of the body, which causes extra fluid accumulation in parts of the body and exerts pressure on surrounding vessels and tissues. (M1) Often it becomes difficult for paramedics to ascertain the exact physiological disorder by merely studying signs and symptoms. Giddiness and nausea are usually associated as symptoms of many disorders like stomach infections, weakness, pregnancy, and many other physiological or metabolic disorders. For example, strokes often arrive and leave unannounced while the patient is unable to feel any pain or loss of activity especially during incidents like a sudden fall or a temporary period of giddiness, after which the patient recovers immediately. In such cases, the doctors and nurses at the service center adopt a systematic approach towards detecting irregular brain function or hindered blood flow in the brain. The case with hypertension is, on the contrary, not so hard to deduce the disorder as a cause of the signs and symptoms, since it is easy to determine the blood pressure of the patient when he or she walks into the clinic. Judging the extent of the disorder and its chronic possibilities is accomplished by deeper understanding of the case, through systematic tests. However, in both the physiological disorders, problems of a different nature crop up at the last moment, making it difficult for the staff at the care or nursing center to arrive at the right conclusion about the disorder. These problems include lack of co-operation from patient, family unwillingness to let the patient undergo prescribed tests, allergic reaction in patients, uncontrollable nausea or unconsciousness. Further on, lack of identity papers or proper documents to define the situation of the patient, hinders progress of diagnosis. This is the reason why patients’ families are expected to carry all documents related to medical history and identity of the person when admitting them to the hospital. There were several cases reported of secondary infections like eczema, skin diseases, previous medication and post-surgical complications which led to difficulties in diagnosing cases of stroke or hypertension, wherein the entire attention of the attending staff was towards restricting the advance of known diseases. In such cases, from symptoms to disease diagnosis, the journey involves repetition of signs and symptoms in spite of medication being administered to address a separate disease. (P3) Main Investigations Carried Out To Diagnose Stroke and Hypertension Blood flow and pressure are important investigating parameters in diagnosis of both stroke and hypertension. Other factors important for diagnosis of stroke include brain function, organ failure and response to stimulus. For hypertension, the investigations include response to medication, in addition to the simple step of blood pressure check. Measures and Investigations suitable for stroke Patients are usually expected to arrive at the clinic with self-referral, professional referral or referral by a third party. However, since stroke patients are serious and usually need emergency services, professional referrals are usually found in most admissions. Investigative measures are taken on basis of signs and symptoms and for patients doubted with a stroke, immediate tests and scans around the brain area are conducted. None of the investigations can be carried out by the individual and all of the steps must be conducted at the local clinic or health practice center or a General Practitioner’s clinic. Equipment for stroke detection are only available in local hospitals or at specialist centers and therefore, the patient needs to be rushed to a well equipped nursing home or hospital or a specialist center for the investigative procedures. The medical records of the patient that includes family history and lifestyle basics form part of preliminary study of the patient. Other investigative procedures include blood tests, urine tests, radiological investigations like X-rays, scans like the MRI or Citiscan, organ function tests including kidney function are recommended to diagnose stroke. Important measurements to be studied include weight, height, body mass index, blood pressure, and peak flow. Measures and Investigations Required for Hypertension In cases of hypertension, patients are either brought in at a critical stage or are diagnosed at an early stage. General records of the patient like medical history that includes family history and lifestyle inputs are taken into record. The blood pressure of the patient is noted at regular intervals for the prescribed number of hours. The individual cannot check his own blood pressure and need to visit a doctor to get his blood pressure count recorded accurately. Self referrals are enough to get these investigations under process. Further tests may include a few blood tests to determine sugar and hormone concentrations in the blood and a few organ function tests. Radiological investigations and scans are not required unless organ failure or reduced organ function is reported in the organ function tests. General measurements like height, weight, body mass index, peak flow and response to stimulus are noted down. Urine tests are often prescribed to check hormone levels in the blood. Task 4 (P4) Two planned care pathways for both stroke and hypertension are as follows. It must be noted that the flowchart uses a broad description of all factors important for the care pathway and does not discuss details. Care pathway for stroke: In the care pathway for stroke, there are three distinct phases. These are primary phase, secondary phase and tertiary phase. These phases have not been demarcated in the above flowchart. The primary phase begins when the patient is admitted to the hospital/clinic. The nursing and paramedic staff immediately undertake primary care in the form of emergency blood transfusion, anti-coagulant injection administer, medical investigations and measurements of the patient. Medicines administered during primary care for stroke include aspirin, statin and anti-hypertensives to add support to the action of anticoagulants or surgical processes that the patient undergoes (Sulch, 2000, p.1933). The aspect of treatment that involves regular medical attention from nursing care providers like blood pressure monitoring, organ response monitoring, medication administering, routine blood and health check up, blood glucose control, falls under primary care conducted jointly by doctors, surgeons, and nurses. Secondary care is provided by several therapists like physiotherapists, speech therapists, occupational therapists and sleep therapist, and dieticians who check dietetics and check levels of nutrition and hydration in the patient. Tertiary care consists of care provided by family and friends, personal care and home care agencies and the individual himself, which ultimately helps the patient recover. Care Pathway for Hypertension: In the care pathway for hypertension, diagnosis is actually easy since the major symptoms lead directly to a simple blood pressure check-up which indicates a high blood pressure condition. Primary care begins soon after as medical investigations and medicines are used by the experienced nursing staff and doctors in these clinics to bring the blood pressure down to normal and avoid all chances of artery blockage and stroke. Organ failure due to lack of or obstructed blood flow is also checked during the investigations. Secondary investigations involve dietician care which ensures administer of fat-free diet to patients. Tertiary care involves family or home care agencies and personal care by individuals. Tertiary care also calls for services of occupational therapists who ensure that the patient is able to rejoin work in full spirits and in a good shape similar to his profile before the illness. (M2) In both physiological disorders being studied in this paper, health practitioners and agencies play a major role in creating complete care plans for the patient’s recovery. Interviews of individuals who have suffered from strokes and hypertensive sessions indicated that secondary care when administered over long periods of time, lead to the stabilization of their condition and actually prevented further onset or repetition of a stroke or a hypertension event. This primary research guided us in tracking activities of professionals and practitioners in the care giving agencies and we found the following observations. According to a leading care practitioner in New York City, the best care pathways are those which consider agencies and professional care from providers outside just the hospital. Care givers in different kinds of therapy, like physiotherapy, speech and cognition therapy, communication skills, occupational therapy and such secondary care giving practices, are hired by individuals and hospitals to add to the existing primary care pathway of the patients suffering from these two types of physiological disorders. Stroke patients need a lot of secondary care attention and that is accomplished by these professionals. In addition to speeding up recovery, the job of these care givers is also to ensure that the person suffering the stroke makes serious corrections in his lifestyle and removes factors that can cause repeat of strokes in the system. The performance of the patient after recovery is also monitored by these care giving professionals. In cases of hypertension, care givers ensure proper guidance is provided to patients as to how they should lead their lives after the medication is reduced and brought to normal levels. The patients have to maintain stress-free lifestyle, low fat diet, minimal exercise and proper sleeping routines to ensure good health and resumption of normal blood pressure. In fact, 90 percent of the cases reported in the practitioner’s clinic were found to be completely curable and show zero repetition of the factor. Task 6 (D1) The effectiveness of health and social care practitioners working hand in hand with primary care providers like nurses and paramedics and doctors is seen in the reduction in number of cases in stroke and hypertension in a society. For example, in any society, when two or more agencies are opened, the care giving services accompanying medical aide creates more awareness and discipline in patients and their friends and families (NLIAH & AGAAOI, 2005, p.12). As a result, it becomes very easy for the patient to incorporate lifestyle changes and control diet to live a healthy life, since everybody around works towards achieving the same. For example, in case of stroke, a major amount of recovery depends on the normalization of speech, cognition and mobility in the patients, all of which are accomplished by care givers like therapists. Nutrition and exercise are important in recovery and dieticians and physiotherapists fill that void to optimize upon the treatment that is being administered by doctors. In many cases, the patient is unable to resume work due to the change in lifestyle and needs therapy to cope up with pressure at work. As a result, patient is not required to take high doses of medicine and recovery is accomplished even with minimal medication. This approach cuts down costs and reduces the harmful effects of medication on the patient’s body. • Care strategies that can be used to support individuals with stroke and hypertension (P5) Care strategies that are being used to support people suffering from a stroke include primary, secondary and tertiary care combined together to give the patient ultimate benefit of the treatment and complete recovery. Planning for the right care giving pathway includes observation, investigations and diagnosis of the exact cause of disease condition. Primary strategy includes appropriate medication and stroke reversal, wherein the doctor may use oral, intravenous or surgical modes of medication and correction and ensure that adequate medical care is taken to improve the patient’s condition. Care strategies used to support people suffering from hypertension are of a longer duration and include primary and secondary care pathways while the role played by tertiary pathways is of lower importance than the others. Secondary pathways include therapy for speech and mobility, and occupational return. • Care strategies that can be used to support individuals with each of the physiological disorders.(M3) Care strategies that can be used for stroke could be sleep cycle monitoring and training to patients, training lifestyle analysis to patients and diet chart development training to patients. These help in the long run and help avoid return of a stroke condition. For hypertension, people are not encouraged to take up too much exercise. Training people in control of exercise and mental stress, incorporation of lifestyle activities like meditation, deep breathing and relaxation therapies, and routine check-ups is important to ensure that hypertension does not take a toll on the patient’s daily life. • Evaluation of care strategies that can be used to support an individual with stroke (D2) Daily life activities often cause stress in our body systems, which we tend to miss out. The use of regular monitoring even on an individual or personal basis will help us stay healthy. For patients who have suffered from stroke at least once, it becomes very important to self-evaluate diet and lifestyle parameters to be able to gain the perfect balance. When a care strategy has shown them the value of healthy diet and cost-effectiveness of care driven treatment, it becomes easy for them to follow the directives. Therefore, when a person controls his diet, undertakes minimal exercise to keep himself fit, uses regular monitoring to prevent hypertension or stress, he or she stays fit and avoids a stroke for a second time easily. References: NLIAH & AGAAOI (2005). Integrated Care Pathways: A guide to good practice. National Leadership and Innovation Agency for Healthcare and AGAAOI. Crown Publishers: London. Sulch, D., Perez, I., Melbourn, A. & Kalra, L. (2000) Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation. American Heart Association, Inc. p. 1929 – 1934. Accessed on 24th March, 2015 from: http://www.cebp.nl/media/m638.pdf Vissers, J. & Beech, R. (2005) Health operations management: patient flow statistics in health care. New York: Routledge, Taylor & Francis Group Publishers; p. 3 Read More