Impact of Stroke Case Study

Impact of slam Case sightIntroductionJithra is now 68 years of age. Her family bes of husband, daughter, nephew and nephews wife. She has been living with left face hemiplegia begind by shooting since she was 64. As this interview went, Jithra was holding her daughters deliberate and slowly elaborated her word by word experience in tears. Before an episode of buffet damaged the right side of meat of her whizz and order her in bed for the rest of her carriage, Jithra was living a life of a healthy person. She stated that poverty and debt were the most important factors that propel her to wake up at 430 am on regular basis in order to prep be food and beverage for her respective customers who kindly supported her small restaurant. A strong flavor that she did non necessitate all health issue strengthened by the fact that an annual physical check-up was so expensive disguised Jithra from realising how necessity it was to strike her birth coerce and downslope gluco se level regularly monitored when she aged. As now that she spends her activities of daily living in bed, drag sore has set about the main concern for both Jithra and her family. Though Jithra does not complain of soreness, loss on scrape does indicate that some field of studys need attention. This essay depart provide an overview understanding of stroke and its negative effects posed on Jithra. Further more than, this essay will emphasise on the intervention and stay freshion of insistency ulcerationationation in depth.Understand lashAccording to World wellness Organization (2014), stroke occurs when there is an interruption of the dividing line supply to a part of the whiz. Stroke sight be divided into two major types. The first type is called haemorrhagic stroke. This type of stroke accounts for slightly 13 percent of all strokes (Brown Edward, 2012). It results from bleeding into the brain tissue. The bleeding ca utilize by a rupture of blood vessels results in the leakage of blood into the brain impairing the speech communication of type O and nutrients. Haemorrhagic stroke bum be caused by a number of disorders affecting the blood vessels. Some of which are long-standing gamy blood pressure and cerebral aneurysms, a thin or weak bit on a blood vessel wall. The weak spots that cause aneurysms are usually present at birth. The move upment of aneurysms happens over a number of years and dont usually cause perceptible problems until they break (Stroke Foundation, 2014). Jithras daughter stated that Jithra complained of headache and nausea round 48 hours, in particular during periods of activity, before an episode of stroke occurred. Headache peculiarly distinguishes haemorrhagic stroke from ischaemic stroke. Its other symptoms alike include nausea, vomiting, fall level of consciousness, neurological deficits and hypertension (Brown Edward, 2012).The second type is called ischaemic stroke. It accounts for approximately 85 percent of all strokes. According to Brown and Edward (2012), this type of stroke occurs as the result of partial or complete obstruction, caused by a blood clot, of a blood vessel that supplies blood to the brain. This leads to an insufficient of oxygen supply and glucose needed for cellular metabolism. A clot may be formed by means of embolism or thrombosis. Both types of clotting formations can be differentiated by their characteristics. The term embolism in relation to stroke is characterised by a condition where an embolus is created in ace part of the brain or the body, circulates in the bloodstream, and eventually blocks the flow of blood through a vessel in another part of the brain (Crosta, 2009). This is called embolic stroke. On the other hand, the term thrombosis is characterised by the formation of a clot resulted from fatty deposits or plaque blocking the passage of blood through the artery. This type of clot remains in one area of blood vessels without being carried through out the bloodstream. This is called thrombotic stroke (Brown Edward, 2012).Stroke encounter factors at that place are multiple find factors associating with stroke as according with (Brown Edward, 2012). The pretend factors can be classified into non-modifiable essay factors and modifiable risk factors. Non-modifiable risk factors include age, gender, race and heredity. Modifiable risk factors include diabetes mellitus, heart disease, atrial fibrillation, heavy alcohol consumption, hypercoagulability, hyperlipidaemia, hypertension, obesity, physical inactivity, sickle cell disease and smoking.Jithra, at 68, was diagnosed with hypertension or high blood pressure and diabetes mellitus. Age, hypertension and diabetes mellitus stir played a mainstay role in contribution to stroke. Stroke risk increases with age, doubling each decade after age 55 (Brown Edward, 2012, p. 1622). The rate of atherosclerotic development is usually increased by the essay of a constantly elevated blo od pressure. The term atherosclerosis is referred to as hardening of the arteries resulting from the formation of fatty deposits or plaques. The narrowing of the blood vessels is its consequence. The carotid artery in the neck is a common site where these plaques develop and tend to break away and lodge in the vessels of the brain (Sander, 2013). Likewise, diabetes mellitus increases list towards the dysfunction of the inner linings of the blood vessel walls leading to an increase in the tendency towards the development of plaques. In addition, high cholesterol and triglyceride levels are transcendly likely among people with diabetes mellitus (Brown Edward, 2012, p. 863).Impact of StrokeAccording to Brown and Edward (2012), stroke is a leading cause of serious, long-term disability. Jithra has been living with left side paralysis since she was 64 as a consequence of stroke. Immobility and the helplessness in Jithras right arm and leg are the key limitations. She relies greatly on her family members when move in bed is attempted and a combination of self- shell out abilities and activities of daily living, such as eating or drinking, are performed. Dysarthria, a disturbance in the muscular control of speech, is also experienced. worsening may involve pronunciation, articulation and phonation. This helps explaining why Jithra feels uncomfortable communicating with strangers. As the interview went, a sudden change in emotion was spotted. Persons who have had a stroke may have difficulty controlling their emotions. worked up responses may be exaggerated or unpredictable (Brown Edward, 2012, p. 1628).The daughter say that Jithra sometimes cried without any reason. The interchanging between laughing and crying took only proceedings to do so. Besides pressure, shearing force, friction and excessive moisture apply to pressure ulcer formation (Maklebust Sieggreen, 2001). As mentioned above that Jithra is bed-bound and greatly relies on her family members wh en re siting is attempted, manual handling is used in order to bringing up and move her around the bed. However, the in crystallise techniques feature with non-supportive equipment, such as slew sheet, have put the maintenance of Jithras contend integrity becomes much(prenominal) more difficult. squash UlcerAccording to Sydney South western hemisphere (2008, p. 4), pressure ulcers are defined as any lesion caused by unrelieved pressure when soft tissue is compressed between a bony intumescency and an external surface for a prolonged period. Factors that influence the development of pressure ulcers include the intensity of the pressure the length of time the pressure is exerted on the skin and the ability of the tissue to tolerate the externally applied pressure. innate factors that put Jithra at risk in developing pressure ulcers consist of advanced age, malnutrition and diabetes mellitus. Extrinsic factors include pressure, shear and moisture Sydney South West (2008).Interve ntionAlthough the skin remains intact, the appearance of persistent redness, particularly in sacrum, followed by itchy sensation indicates that stage one pressure ulcer has already developed. Stage one pressure ulcer can be intervened as referred to pressure ulcer intervention guidelines (Jones, 2013) by strictly maintaining the skin integrity. This can be pip by relieving the externally applied pressure, protect fragile skin and bony prominence, preventing friction and shearing and defend skin from moisture.In relieving the externally applied pressure, a regime of shift combined with the use of pressure relieving devices has already been utilised by Jithras daughter. However, it king not be enough in terms of the frequency. The frequency of repositioning depends on the ability of the tissue to tolerate the externally applied pressure. In this case, Jithra should move or be repositioned frequently enough in allowing colour area of affected skin to recover from the effects of p ressure. A work clock may be a helpful reminder of correct body positions and appropriate routine times. Additionally, a 30- stagecoach side fictionalization position may well be utilised for Jithra as it diverts pressure from the sacrum. Maintaining a 30-degree side lying position can simply be done by use pillow or foam positioning wedges. However, lying on the side may increase pressure on extremities, especially knees and ankles. Placing pillows between the legs helps preventing opposing knees and ankles from exerting pressure on one another (Maklebust Sieggreen, 2001).In protecting fragile skin and bony prominence, an appropriate support surfaces shall be used and yet its cost has to be taken into consideration. Poverty and debt make it very difficult for Jithra to afford buying or renting them. Charges can range from $24 to purchase a foam overlay to a daily rental fee of $125 for a highly good therapy bed (Maklebust Sieggreen, 2001, p. 75). Regardless of the variations in price, There is no scientific show up that one support surface consistently works better than any others. Nevertheless, pressure points require protection whether at risk persons are in a bed or on a chair. Using pillows to straddle vulnerable areas, again simple, is an effective way to eliminate pressure. A regime of repositioning, together with the use of pillows has proved to be highly effective in protecting fragile skin and bony prominence.In preventing Jithra from friction and shearing, a family education on how friction and shearing occur and correct impost of manual handling techniques and appropriate equipment shall be provided. Shear is greatest when a caregiver drags an at risk person along the surface of the sheets during repositioning or allows the person to slide from high-fowlers position. In order to understate shearing force, the head of the bed shall not be raised exceeding a 30 degree angle, unless the patient is eating. Furthermore, friction, a precursor o f shear, is ordinarily caused by pulling a patient across the bed linen. rubbing the protective layer of skin away increases the potential for deeper tissue damage. profligate moisture may be the result of sweating, wound drainage, soaking during clean and faecal and urinary incontinence. Moist skin is five times as likely to become ulcerated as dry skin. The intervention guidelines suggested that protecting skin from moisture can be done by using continence concern systems, using barrier skin cream to prevent skin maceration and keeping the site clean and dry. Living in a hot and humid country like Thailand may put Jithra at a higher risk of developing pressure ulcer due to sweating. Thailand normally has its temperature sitting at around 30 degree Celsius. Two fans, together with the application of baby powder are used in maintaining the dryness of Jithras skin.RecommendationAccording to Jones (2013), it is highly recommended that risk assessments must be done on Jithra by usin g the Waterlow scale. In doing so, her body mass index is required. The scale will give a score which helps identifying if Jithra is at risk, high risk or very high risk in developing pressure ulcers. Therefore, repositioning regime can be precisely arranged in order to ensure optimal pressure redistribution. Manual handling, together with the use of equipment such as hoists or slide sheets, effectively helps avoiding shear and friction. Education on the use of the mentioned equipment shall also be provided. A dietician shall be involved in discussing intimacy of healthy diet and considering the need for food fortification and nutritional supplements. amaze sure that Jithra consumes adequate fibre and well hydrated as she is more prone to constipation due to immobility.ConclusionThis can be conclude that the maintenance of skin integrity plays a key role in avoiding the development of pressure ulcers. Being rich or poor expertness not be the factors in treating and preventing p ressure ulcers. This essay has shown how beneficial it is to have carers or family members who strictly put pressure ulcer intervention and barroom guidelines into practice to look after Jithra. The mattress that Jithra lays her body on might not be the best that the family can afford but frequently turning and maintaining dry skin have proved in lowering the risk of developing pressure ulcers. Only stage one pressure ulcer developed though, Jithra has been suffering from disability for 4 years.ReferencesBrown, D., Edwards, H. (Eds.). (2012). Lewiss medical-surgical nursing assessment and management of clinical problems. NSW, Australia Elsevier Australia.Crosta, P. (2009). What Is Embolism? What Are The Different Types Of Embolism?. Medical intelligence operation Today. Retrieved from http//www.medicalnewstoday.com/articles/153704.phpJones, D. (2013). Pressure ulcer prevention in the community setting. Nursing Standard, 28 (3) 47-55. Retrieved from http//web.a.ebscohost.com.ezpro xy.holmesglen.vic.edu.au/ehost/pdfviewer/pdfviewer?vid=3sid=87c6951d-c6be-44c5-8985-c35d1918eb04%40sessionmgr4004hid=4207Maklebust, J., Sieggreen, M. (2001). Pressure Ulcers Guidelines for Prevention and Management (3rd ed.). Pennsylvania, USA Springhouse Corporation.ONeill, P. A. (2002). Caring for the Older prominent A Health Promotion Perspective. Pennsylvania, USA W.B. Saunders Company.Sander, R. (2013). Prevention and treatment of chills and fever ischaemic stroke. Nursing Older People, 25(8), 34-39.Scott, K., Webb, M., Sorrentino, S., Gorek, B. (Eds.). (2006). Long-term care assisting Aged care and disability. NSW, Australia Elsevier Australia.Stroke Foundation. (2014). Types of Stroke. Retrieve from http//strokefoundation.com.au/what-is-a-stroke/types-of-stroke/Sydney South West Area Health Service. (2007). Pressure Ulcer Prevention and Management. Retrieved fromhttp//www.sswahs.nsw.gov.au/pdf/policy/pd2008008.pdfWatkins, C., Leathley, M. (2010). Setting the scene. In Wil liams, J., Perry, L., Watkins C. (Eds.), Acute Stroke Nursing (pp.1-16). Retrieved fromhttp//0-onlinelibrary.wiley.com.alpha2.latrobe.edu.au/store/10.1002/9781444318838.ch1/asset/ch1.pdf?v=1t=ht43cw4ls=1791526b00be208b196d718b1c2189904267ad40World Health Organization. (2014). Stroke, cerebrovascular Accident. Retrieved from http//www.who.int/topics/cerebrovascular_accident/en/