Stroke: Nursing process (ADPIE)

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Russell King is a 70-year-old male client who experienced an embolic stroke in his left middle cerebral artery. His wife says she found Russell slumped in his recliner, unable to get up. She noticed that his face looked like it was drooping on one side, and his speech was slurred. She called an ambulance, and he was brought to the emergency department, or ED, and was quickly diagnosed with a stroke and treated with thrombolytic therapy. After Russell recovered in the stroke unit, he was transferred to an inpatient rehabilitation facility where he will undergo rehabilitation therapy.

A stroke is when there’s a sudden neurological deficit because part of the brain loses its blood supply. There are factors that may put an individual at risk for stroke. Unfortunately, many of them are non-modifiable, including older age; male sex; history of prior stroke; and family history of stroke. On the other hand, modifiable risk factors include uncontrolled hypertension, dyslipidemia, diabetes, heart disease like atrial fibrillation, as well as obesity, lack of physical activity, diet high in saturated fats, and smoking or using drugs like cocaine or amphetamines.

Okay, now there are two main types of stroke: an ischemic stroke, in which a blocked artery reduces blood flow to the brain, and a hemorrhagic stroke, in which an artery in the brain breaks and creates a pool of blood that damages the brain. In this video, we are going to focus on ischemic strokes, which are much more common. Now, most ischemic strokes are caused by thrombosis, meaning that a clot forms over an atherosclerotic plaque. This is when a buildup of fat and cholesterol forms within a cerebral artery and starts to obstruct its blood flow. Another mechanism for ischemic stroke is an embolism. This happens when an embolus, which is a piece of blood clot or fatty deposit, breaks off from an atherosclerotic plaque from an artery outside the brain, most often from the heart or neck. The embolus then travels to the brain, where it gets lodged in a cerebral artery. Now, sometimes a small clot can block a cerebral artery for a short period of time, usually within minutes up to 24 hours, before dissolving and restoring normal blood flow. This is called a transient ischemic attack, or TIA for short. Although TIAs don’t cause permanent brain damage, they can be a warning sign for future strokes.