Reflection Account: Patients with Ischaemic Stroke - Essay Example

REFLECTION ACCOUNT: PATIENTS WITH ISCHAEMIC STROKE Affiliation Reflection Account: Patients with Ischaemic Stroke Introduction Basically, a stroke can be defined as a brain attack that occurs when the blood supply to the brain is cut. Since blood caries vital nutrients to the brain, a blood cut leads to dead or damaged cells. More than 85% of strokes are a result of a blockage (blood clots) which cuts off the blood supply to the brain. This leads to an ischaemic stroke. As a result, ischaemic stroke affects approximately nine of every ten patients suffering from stroke. Normally, these clots form in parts where arteries have been blocked or have narrowed over time due to fatty deposits which are often termed as plaques. Globally, Ischaemic stroke affects more people than other forms of strokes. The stroke can happen or occur in two ways; arterial thrombosis or cerebral embolism. Arterial thrombosis is when a blockage forms in the artery that supplies blood to the brain. As a consequence, blood supply to the brain is blocked (Baker, 2008). On the other hand, cerebral embolism occurs when a blood clot forms in a different part of the body (usually a large artery or the heart) and subsequently travels to the brain and blocks the blood supply. The disease is most prevalent in older adults (people over 65 years of age). In light of this, the paper will employ Gibbs’ reflective cycle model. The model is preferable since it is fairly straight forward. Additionally, the model advocates for a succinct description of the scenario, evaluation of the feelings and experience, conclusion, and a reflection based on experience of what I would do if a similar situation came up again. Description of the event during the placement for the patient The condition that I am dealing with is called the ischaemic stroke. It is the clotting of the blood in the blood arteries. In his book, a Schmer (1973) stated that the brain is deprived off food and the oxygen when clotting occurs in the arteries. As a result, the brain cells die. Although some blood cells may die immediately at the onset of the stroke, some may survive longer. If the blood supply is regained, the surviving cells may live or die. The condition may occur very fast, within seconds, or the patient may experience symptoms for some hours. The patient needed to be checked for the symptoms of an ischaemic stroke. At times, the underlying problems might not be the stroke but something different (Wilbur 1997). A patient suffering from ischaemic stroke shows numbness or some weaknesses of one side of the body. This is called contractual hemiplegia. On the other hand, some may show defects of the face such as dropping eyelids, and aptosis. Still, others get visual defects or writing problems, a problem called aphasia. Some patients do have difficulties in understanding, a condition known as receptive aphasia. A good number of the patients do have difficulties in seeing, a condition better known as homonymous hemianopsia. There are patients that suffer from a severe headache that has no real cause. Finally, some patients may suffer from gait deviations (Feigin 2006). There are important questions that helped me establish the cause, the type of stroke, and the treatment to offer (Feigin 2006). For example, I obtained the patient’s medical history such as past strokes, hypertension, diabetes, bleeding disorders, recent surgeries, liver diseases, atherosclerosis, and the peripheral artery disease. I took into account the current medication of the patient. It involved finding out if the patient was on insulin, anti-hypertensive, aspirin, anticoagulants, anti platelet agents, cocaine, amphetamine, other street drugs, and alcohol intake. I sought to know when the symptoms first appeared and when they disappeared. In addition, I tried to find out if the patient had an injury, and especially the head trauma. Either embolic or thrombotic stroke is identified via the symptoms. However, a doctor has to perform other tests to determine the type of stroke. In case of the embolic stroke, the blood clot forms anywhere in the body, then travel through the bloodstream to the brain and to a vessel that is too small (Baker 2008). The vessel is blocked, and the brain denied the nutrients and oxygen. The second type of the ischaemic stroke is called the thrombotic clot. It occurs when the blood leaves behind plagues of cholesterol as it travels through the arteries (Pan, X. et al 2015). The plagues increase in size and block the arteries in the neck. The brain is denied the nutrients, and hence the brain cells die. Consequently, the patient loses the ability to perform the task. My patient had an embolic stroke. Student nurses often perform baseline activities while doctors perform the relevant tests. I am focusing on basic activities that are primarily aimed at monitoring the patient’s psychological and physical state. As such, I observe the patient’s eating and drinking habits, speech patterns, and facial expressions. Patients with ischaemic stroke display slurred speech and an odd face. Additionally, they may not be able to raise and hold their arms. My feelings while attending to the patient Throughout the process, I imagined what my patient was undergoing. It is tough to accept the loss of the functionality of vital body organs. Stein (2009) states that it is hard to accept that you can no longer do what you used to do before. For example, for persons that loved swimming, it is hard for them to imagine that they can no longer swim if they lose the functionality of their legs. The same applies to persons that can no longer talk if they lose the functionality of their mouths. It is worse to imagine the possibility of the death emanating from slow or inadequate medical care. I would regret to lose a patient out of negligent. The family of the patients would not forgive me (Stein 2004). The medical professional would also hold me liable for my actions (Gladstone, Johnson, & Institute for the Study of Civil Society 2000). I cared most about the comfort, the respect, and the hope of my patient. I encouraged him to fight stronger. I showed my support and understanding of the condition throughout. In addition, I felt it was my duty to be there and attend to his medical needs when called upon. Evaluation of the care process Stroke is a severe disease. If not attended in time, the patients may never regain functionality of various organs in the body. Alternatively, the patient may lose his or her life. My prior knowledge helped me save the life of the patient. I knew the information to ask for and the symptoms to look out. In addition, I was aware of the tests to administer to determine the cause and the type of the stroke. I had the prior knowledge of the drugs to administer. They are the drugs for breaking down the clots, prevention of recurrence of the clots, and the drugs for clots originating from the heart (Pan, X. et al 2015). Equally important, I knew how to reassure the family of the patient that all will be well, everything is normal, and that the patients will recover. Lastly, I knew how to connect with the patient, make him feel comfortable, at ease and relaxed enough to share his concern. There is always phobia in treating a condition that you have never treated before. It was my first time to deal with an ischaemic condition. The patient had cognitive problems, depression, communication difficulties, and emotional problems (Okkema & Rehabilitation Institute of Chicago 1993). I am used to having a conversation with my clients. I am also in the habit of touching the various body parts. For example, I may feel the head and ask which particular part of the head is the pain originating. My current patient was different. He could not communicate verbally. I had to rely on sign languages. Due to death of the nerves, some body parts were stiff and hence the sign language was not very useful. It is also easier to calm down and comfort someone who can communicate back their feelings and concern. However, since my patient was not in a position to communicate easily, I had to put in a little bit more effort in consoling him. However, in the end I managed the patient. Analysis of options available at the time of the care Data from the secondary sources showed that my patient might have been suffering from other conditions apart from the Ischaemic seizures. For instance, hypoglycemia is a metabolic disorder that produces neurologic symptoms like that of Ischaemic stroke. Intracranial masses such as tumour though gradual in development, do at times mimic stroke. Other examples are Transient global amnesia that results in sudden memory disturbances. In the complex types of seizures, the patient may suffer postictal paralysis, postictal confusion, confusion, and speech arrest, sensory and, visual disorders. Most of the symptoms exhibited by my patient showed that he was suffering from Ischaemic stroke. However, I had limited knowledge to rule out the other ailments. Davidoff (2002) argues that headaches are common symptoms of Ischaemic stroke and migraine. In the future, I would conduct a complete analysis of the patient’s symptoms and obtain concrete grounds for ruling out some conditions and treating the others. Conclusion I have not changed my opinion about the care I provided. Therefore, I support my actions fully since students are not required to administer any tests or medicines on the client. Proper analysis and evaluation of the physical symptoms is very significant and vital. If the disease or symptoms are not identified earlier, the patient might lose his/her life. Also, I used a patient centred approach which relied greatly on the patient’s feedback. Thus, I relied on the answers from the client about diabetes, the cholesterol level, and the efficiency of the kidney (LaValle 2013). That was significant since communication is a vital aspect in the health care sector. Action plan Faced with the same situation, the first thing that I would do is to conduct a historical examination of the client (Warlow 2007). The primary factors would be confirmation of the status of the vision of the patient, ataxia, aphasia, and weakness. Furthermore, I would consider the presence of altered sensation, headache, and sudden onset of symptoms hx TIA, gaze paresis, diplopia, sensory loss, dysarthria, and arrhythmias. The symptoms would give me an idea of what the patient is suffering from and the kind of tests needed (Elling & Elling 2003). Secondly, I would allow the doctor to carry out tests to determine the exact condition of the patient. In this step, I would be just observing. An example of the tests to conduct are the CT head, MRI brain, serum glucose, serum electrolyte, serum urea and creatinine, Cardiac enzymes, EGG, FBC, PT and PPT tests (Salvolini & Scarabino 2006). The tests would confirm or rule out the presence of intracranial haemorrhage, hypoglycaemia, concomitant MI, anaemia, coagulopathy and show the area of the ischaemic infarct (Mizukami 1983).The tests would shed some more light onto what the patient is suffering from. I would be in a position to know if the patient reacts to some types of medication. In addition, I would plan on how to handle the delicate patient. The third step would be differentiating the symptoms to identify the exact underlying ailment. For example, intracerebral haemorrhage is associated with low consciousness and increased intracranial pressure (Kase & Caplan 1994). Such signs are milder in the ischaemic stroke. Likewise, hypoglycaemia is associated with the history of diabetes and reduced consciousness. According to Burks (1994), complicated migraine has a repetitive history as opposed to ischaemic stroke. Wernickes encephalopathy is exhibited by irritability, delirium, and confusion. Patients who are suffering from it tend to have a history of the use of alcohol. With the brain tumour, the symptoms might have persisted for quite some time. Such ailments would be ruled out to determine if the patient is suffering from the ischaemic stroke. The fourth step is treating the disease. This would be performed by the doctor. It involves administering the tissue plasminogen activator within a period of 3 to four hours after the manifestation of the symptoms by the patient (Kjaeldgaard 1991). I would later administer aspirin after 24 hours of the doctor issuing the Alteplase. I would ensure that the patient receives treatment from the stroke unit for minimal disturbance and quick recovery. Moreover, I would conduct swallowing assessment. As a result, I would ensure that a patient with swallowing difficulties is hydrated with isotonic fluids (Torranin 1975). Finally, I would conduct a follow-up on how my patients are recuperating (Mead Van & Langhorne 2012). Conclusion The occurrence of an ischaemic stroke is attributed to the blockage of arteries which supply the brain with blood. People over the age of 65 are more susceptible to stroke. The paper utilised Gibbs’s cycle reflection model. The model is vital in improving health care of the patient since it outlines the relevant steps to be followed. As such, a nursing student has the chance to visualize in advance the problems likely to arise in the course of the treatment/ care. 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