All Stroke Units Case Study

Module 7 Discussion Board Assignment ________________________________________ Instructions: Answer the discussion board question below. Your post must be well thought out and supported using research, outcome data, concepts of physiology and/or pathophysiology. You will need to use APA citations and provide references in APA format at the end of each of your posts. All posts should be related to course content and science based. Review the etiology, risk factors, clinical manifestations and the pathophysiology of acute stroke and choose one key point which you believe is significant to your practice as a nurse practitioner and answer the following question.

Stroke is seen as a major health concern and this is due to the fact that every year, as many as 110,000 individuals suffers from strokes making it a key issue. (NHS 2014)

The health issue that this artifact discusses is the significance of knowing and recognizing the warning signs of a stroke. The American Heart Association has made it their mission to provide unlimited health information and research in the hopes of eliminating cardiovascular diseases as well as helping society in maintaining a healthy lifestyle. “Stroke is the number 5 cause of death and a leading cause of

Led by our chairs Samantha Sangabi and Julia Roh, our Power to End Stroke initiative has worked to break the barrier that lies between the community and the signs of stroke. With the help of the B.E.F.A.S.T method we have been able to reach out to the community and provide patients with the tools to detect and take preventative measures against stroke.

Strokes are commonly associated with old age, symptoms and awareness are often unnoticed in young adults due to ambiguity about strokes.

Delirium tremens is a serious condition and can be life threatening. Most people need treatment in a hospital or a detox unit.

In professional experience working at a comprehensive stroke center, early intervention in crucial in decreasing the amount of deficits stroke victims acquire. As I further my education and professional status in the field of Nurse Practitioner, I will be able to participate in in-depth research related to cerebrovascular accidents and quality patient outcomes.

The medical cases of delirium have been rising of late among patients. However, in comparison to other medical sections, there exist a higher prevalence rates in intensive care unit. According to the medical statistics in the United States, the prevalence rates of delirium range between 11% to 42% with the highest rate in the Intensive Care Unit (ICU) standing at 87% (Rivosecchi, Smithburger, Svec, Campbell, & Kane-Gill, 2015). In terms of the population affected, delirium affects 20% to 50% of non-mechanical patients and 60% to 80% of patients admitted to the ICU (Gregory, 2016). Furthermore, the financial impact of ICU delirium per year in the United States so far has been $4 to16 billion dollars (Arumugam, El-Menyar, Al-Hassani, Strandvik,

-Accompanied UCLA Brain Attack Team during code strokes to identify potential stroke patients at Ronald Reagan Hospital’s ER

In almost all cases of dementia, stroke is the main pre-cause towards this disease. The first thing to prevent this disease will be to understand what a stroke is and how to prevent it from occurring, although some cases in which a stroke surfaced, the subject was not at risk of any symptoms for a stroke, so it can be a guessing game. Seizures, hypotension and urinary incontinence are the three strongest predictive signs of post stroke dementia. Scientists use a new predictive theory to lay down a concrete analysis on whether or not a patient is at risk for post-stroke dementia. In summary, a stroke is associated with an increased risk of dementia. “About 1-in-10 patients are demented prior to first stroke, 1-in-10 develop new dementia soon after first stroke, and over 1-in-3 are demented after a recurrent stroke.” The number one pre-stroke dementia care factor is optimal acute stroke care and prevention of recurrent stroke are likely to be effective in slowing the pain of post-stroke

Yuma Regional Medical Center (YRMC) does not currently have a standardized delirium prevention protocol or policy

Mariam background is 60 year old lady admitted with left sided weakness and facial droop. Once confirmed stroke using the Recognition of Stroke in the Emergency Room (ROSIER) scale. Catangui (2015) states ROSIER scale is used to distinguish whether the patient is having a stroke or stroke mimics e.g. seizures or brain tumours. Computed tomography CT brain showed ischemic stroke. Ischaemic stroke is lack of sufficient blood supply to perfuse the brain/ cerebral tissue due to narrowing or blocked arteries in the brain (Morrison, 2014). According to Stroke Association (2015) statics shows that 1520000 strokes occur in the United Kingdom.

The National Library of Medicine notes that seniors with delirium have an increased risk of blood clots, pneumonia, and a significantly greater chance of near-term death.

Delirium is an acute change in brain function that can be accompanied by inattention and either a change in cognition or perceptual disturbances (Allen and Alexander, 2012). Delirium in critical care patients is very common, it actually occurs in 2 out of 3 intensive care patients who are on a ventilator, but often goes undetected because delirium monitoring is considered too time consuming or unreliable (Reade and Finfer, 2014).  Intensive care unit (ICU) patients that have delirium spend more days on a ventilator, remain on sedation longer, have increased chance for infections, have longer hospital stays, and higher mortality rates during their hospital admission and in the 6 months after.

The stroke is a condition with an abrupt onset of a neurological deficit that attributable to a focal vascular cause. (1) It is the third leading cause of death worldwide. (2) Lower-income countries have shown a higher relative stroke burden compared to industrialized ones. (3) Despite the significant achievement in management of acute stroke, it remains also a third cause of death in industrialized countries.(4) Over a third of stroke deaths occur in developing countries(5) In the United States,700000 stroke cases responsible for 165000 deaths each year (6). The number of people having a stroke each year in Iraq is around 24000. (7) Determining predictor of mortality at period of hospitalization could aid a clinical care by providing valuable prognostic information to patients and their family members and identify those at high risk for poor outcomes who may require more intensive recourses. Various clinical variables have been implicated in the etiology of in hospital mortality of stroke. This study is an attempt to evaluate the effect of a number of these variables and whether they could predict in hospital mortality or not. These predictors included important co- morbidities like diabetes mellitus ( DM), ischemic heart diseases(IHD) hypertension( HTN) , and role of diastolic blood pressure (DBP) in first few hours after attack , history of old stroke and medications that expected to change the outcome of