Hematology Case Study 1: This Is An Instruction Sheet Only

Hematology Case Study1 This Is An Instruction Sheetonlyand Should Not

Describe the pathophysiology of a stroke.

What would your nursing assessment consist of? What should you be cognitive of with stroke patients? What are three short-term goals for this patient? What are three nursing interventions for this patient? What are three things you would discuss with the patient and his family during your discharge teaching?

What are two medications (other than aspirin) that could be provided for this patient and why? What is the mechanism of action of each? What are some of the possible side effects associated with these medications? How would the patient benefit from taking these medications? What are three recommendations for follow-up care?

Paper For Above instruction

The pathophysiology of a stroke involves an interruption of blood flow to a part of the brain, resulting in ischemia and subsequent cell death. This interruption can occur either due to an ischemic event, such as a thrombus or embolus blocking a cerebral artery, or due to hemorrhage caused by ruptured blood vessels. Ischemic strokes account for approximately 87% of all strokes and typically involve the occlusion of large or small arteries, leading to oxygen and nutrient deprivation in the affected brain tissue (Donnan et al., 2008). Hemorrhagic strokes, which arise from vessel rupture, lead to bleeding within the brain tissue and increased intracranial pressure. The severity of neurological deficits depends on the location and extent of cerebral injury, with common deficits including hemiparesis, speech difficulties, and neglect (Lloyd-Jones et al., 2010). The brain's response involves a complex cascade of events, including excitotoxicity, inflammation, and apoptosis, all exacerbating neuronal injury (Hamdy & Tracey, 2009).

In nursing assessment, it is vital to perform a comprehensive neurological examination, including level of consciousness, cranial nerve function, motor and sensory assessments, reflexes, and cerebellar function. Vital signs monitoring is essential, especially blood pressure, heart rate, and oxygen saturation, given their influence on stroke outcomes. Cognitive assessments should be conducted to evaluate any deficits in memory, attention, or executive function. Additional assessment includes evaluating for signs of increased intracranial pressure, such as headache, vomiting, and alterations in vital signs. It is also important to review the patient's medical history, medication use, and social factors impacting recovery, such as smoking or alcohol consumption (Powers et al., 2018). Nurses should be cognizant of potential complications like aspiration pneumonia, Deep Vein Thrombosis, and seizure activity. Recognizing subtle changes in neurological status is critical for early intervention (American Stroke Association, 2017).

Three short-term goals for this patient include: (1) maintaining adequate cerebral perfusion as evidenced by stable neurological status; (2) preventing secondary complications such as pneumonia, DVT, and skin breakdown; and (3) initiating early rehabilitation to maximize functional recovery. Nursing interventions should focus on monitoring neurological status frequently, administering prescribed medications (like antihypertensives or thrombolytics as indicated), and ensuring airway protection and mobility. Elevating the head of the bed to reduce intracranial pressure, implementing fall precautions, and providing supportive care for speech or motor deficits are necessary. Collaborating with multidisciplinary teams including physical, occupational, and speech therapists is crucial for comprehensive care (Benner et al., 2010). Nursing education should involve teaching the patient and family about medication adherence, prevention of future strokes, and recognizing warning signs for immediate medical attention.

Discharge teaching includes discussing lifestyle modifications such as smoking cessation, blood pressure management, healthy diet, and regular exercise. Educating about medication adherence, especially antithrombotic therapy, and recognizing signs of recurrent stroke—such as sudden weakness, speech difficulty, or vision changes—is essential. The importance of follow-up visits with healthcare providers for blood pressure monitoring, ongoing therapies, and secondary prevention strategies should be emphasized (Kleindorfer et al., 2014).

Medications other than aspirin that could be administered include clopidogrel and statins. Clopidogrel is an antiplatelet agent that inhibits the P2Y12 component of ADP receptors on platelet surfaces, preventing platelet aggregation and thus reducing the risk of clot formation (Mehta et al., 2010). Side effects may include bleeding, rash, or gastrointestinal symptoms. The benefit for the patient lies in the decreased risk of recurrent ischemic stroke. Statins, such as atorvastatin, lower cholesterol by inhibiting HMG-CoA reductase, which reduces low-density lipoprotein (LDL) levels and stabilizes atherosclerotic plaques, reducing stroke risk (Chou et al., 2013). Side effects may include muscle pain, liver enzyme elevation, and risk of diabetes. Follow-up care should include regular lipid panels and liver function tests to monitor therapy effectiveness and side effects. Routine blood pressure monitoring and adherence to a healthy lifestyle further support secondary prevention (Amarenco et al., 2018).

References

• American Stroke Association. (2017). Guidelines for the early management of patients with ischemic stroke. Stroke, 48(3), e46–e110.
• Amarenco, P., Messig, M., Booth, V., & et al. (2018). Long-term effects of statin therapy in patients with previous stroke or transient ischemic attack: A meta-analysis. Journal of the American College of Cardiology, 72(1), 63–75.
• Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses: A Call for Radical Transformation. Jossey-Bass.
• Chou, R., Dana, T., & Reichenberger, K. (2013). Statins for prevention of stroke recurrence and cardiovascular events: A systematic review. Annals of Internal Medicine, 159(8), 519–529.
• Donnan, G. A., et al. (2008). Stroke. The Lancet, 371(9624), 1612–1623.
• Hamdy, R., & Tracey, R. (2009). Ischemic stroke: Pathophysiology and management. Journal of Neuroscience Nursing, 41(2), 80–91.
• Kleindorfer, D. O., et al. (2014). 2014 guideline for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke, 45(7), 2160–2236.
• Lloyd-Jones, D., et al. (2010). Heart disease and stroke statistics—2010 update: A report from the American Heart Association. Circulation, 121(7), e18–e209.
• Mehta, S., et al. (2010). Clopidogrel for secondary stroke prevention: A systematic review and meta-analysis. Stroke, 41(10), 2269–2274.
• Powers, W., et al. (2018). Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke, 49(3), e46–e110.