Nursing Care Plan For Increased Weakness And Slurred Speech

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Nursing care plan for : CC: Increased weakness and slurred speech HPI: The patient is a 61-year-old man with a history of cerebrovascular accident (CVA) in September 2005, hypertension, hyperlipidemia, type 2 diabetes mellitus, seizure disorder, and cocaine abuse. He presents with increased global weakness, slurred speech, and altered mental status. Around 4:00 AM, the patient was found by his wife sitting on the couch, unable to stand or respond appropriately, with slurred speech. The room was disorganized, suggesting a possible fall, and there was evidence of urinary incontinence with a wet area on the couch. Upon presentation to the emergency department, the patient exhibited weakness in the right upper and lower extremities, slurred speech, and disorientation. The patient could not explain most of the night’s events but reported falling on his buttocks. He believed he was speaking strangely despite understanding what he wanted to say. His residual right-sided weakness from the previous stroke necessitated the use of a cane, but his recent episode was notably worse, especially regarding lower extremity strength and walking ability. The patient admits to ongoing cocaine use and non-compliance with medication since May 2006. When evaluated in the ED at 11:30 AM, his baseline condition was noted to be unchanged according to his wife. The patient denied head trauma, headache, vision changes, nausea, vomiting, dizziness, shortness of breath, chest pain, or palpitations. He also denied urinary incontinence despite evidence to the contrary.

Paper For Above instruction

The case of a 61-year-old man presenting with sudden worsening of neurological deficits, including increased weakness, slurred speech, and altered mental status, highlights the critical need for an effective nursing care plan aimed at prompt stabilization, accurate assessment, management of underlying causes, and prevention of future complications. This paper discusses the development of a comprehensive nursing care plan tailored to his current presentation, considering his past medical history, substance use, and current symptoms, emphasizing evidence-based interventions, continuous monitoring, patient education, and interdisciplinary collaboration.

Introduction

Stroke remains a leading cause of adult disability and mortality worldwide. Patients with prior cerebrovascular events are at increased risk for recurrent strokes and other complications, particularly when compounded by uncontrolled hypertension, hyperlipidemia, diabetes, and substance abuse. The sudden onset of neurological deficits such as weakness and speech difficulties necessitates rapid assessment and intervention. Nursing care plays a pivotal role in the early management of stroke, ensuring optimal recovery and minimizing risks associated with recurrent cerebrovascular insults.

Assessment and Data Collection

Initial assessment involves establishing a focused neurological evaluation utilizing tools such as the National Institutes of Health Stroke Scale (NIHSS). Key neurological parameters—level of consciousness, motor strength, speech, cranial nerve function, and reflexes—must be documented meticulously. Blood pressure and vital signs are crucial, given the patient’s hypertensive background. Additional assessments include evaluating blood glucose levels, renal function, and screening for coagulation abnormalities, considering his history of cocaine use which predisposes to vasospasm and increased stroke risk. A complete medication review is necessary to evaluate compliance and potential drug interactions, especially considering his history of non-adherence.

Immediate Interventions

Time-sensitive management is essential to reduce ischemic damage or address hemorrhagic causes. The primary objectives include maintaining airway patency, ensuring adequate oxygenation, establishing intravenous access, and performing neuroimaging (non-contrast CT scan) to differentiate between ischemic and hemorrhagic strokes. Given the presentation within the therapeutic window, if a thrombotic stroke is suspected, administration of tissue plasminogen activator (tPA) may be considered following strict inclusion/exclusion criteria. The nurse must monitor for signs of bleeding or neurological deterioration continuously.

Monitoring and Ongoing Care

Continuous vital sign monitoring, neurological status assessments, and evaluation of respiratory and cardiovascular stability are fundamental. The nurse should observe for any worsening deficits, changes in consciousness, or new symptoms such as visual disturbances or seizures. Proper positioning to prevent aspiration and promote cerebral perfusion involves maintaining the head of the bed elevated and preventing pressure ulcers. Managing blood glucose levels is vital, as hyperglycemia can worsen stroke outcomes. Ensuring medication adherence, including antihypertensives, antiplatelets, or anticoagulants, is essential once stabilized.

Addressing Underlying Factors

Addressing hermodifiable risk factors is critical for secondary prevention. This includes counseling on lifestyle modifications such as smoking cessation and avoidance of illicit substances, particularly cocaine. The nurse should collaborate with the healthcare team to optimize management of hypertension, hyperlipidemia, and diabetes mellitus through medication adjustment and dietary counseling. It is vital to educate the patient on medication adherence and the dangers of substance abuse, including cocaine, which acts as a potent vasoconstrictor, increasing stroke risk.

Patient Education and Support

Effective education empowers patients to participate actively in their recovery and prevention. The nurse should inform the patient and his family about stroke warning signs, the importance of medication compliance, and lifestyle changes to reduce further risk. Reinforcing the significance of follow-up appointments, lifestyle modifications, and rehabilitation services contributes to improved long-term outcomes.

Interdisciplinary Collaboration and Discharge Planning

Collaboration with neurologists, primary care providers, physical and occupational therapists, and social workers is necessary to formulate a comprehensive discharge plan. Rehabilitation may focus on mobility aids, speech therapy, and cognitive training as indicated. Arranging community resources and support groups aids in patient adaptation and compliance. During discharge, clear communication regarding medication regimens, warning signs of recurrent stroke, and follow-up care are fundamental.

Conclusion

The development of a tailored nursing care plan for an acute stroke patient involves swift assessment, prompt intervention, thorough monitoring, and effective patient education. Considering the patient's complex medical history and substance use, interventions need to be comprehensive and multidisciplinary. Proper implementation of evidence-based practices can significantly influence the patient's recovery trajectory, reduce the risk of recurrence, and enhance quality of life.

References

• Adamson, J., et al. (2010). Stroke secondary prevention: role of nursing in minimizing recurrent events. Journal of Stroke Nursing, 15(4), 173-182.
• Johnston, S. C., et al. (2016). Stroke prevention: an update on recent advances. The New England Journal of Medicine, 374(21), 2051-2060.
• Lees, K. R., et al. (2017). Management of acute ischemic stroke: a review of current guidelines. The Lancet, 389(10087), 1239-1249.
• Li, L., & Almazan, C. (2019). Substance abuse and cerebrovascular events: implications for nursing. Journal of Addictions Nursing, 30(3), 132-139.
• Mohr, J. P., et al. (2018). Therapeutic approaches to stroke management: an evidence-based perspective. Stroke, 49(8), 1905-1914.
• National Institutes of Health Stroke Scale (NIHSS). (2021). NIH Stroke Scale guide. NIH.
• O'Connell, M., et al. (2017). Comprehensive stroke management protocols in emergency nursing. Journal of Emergency Nursing, 43(5), 448-455.
• Semple, D., et al. (2015). Principles of neurological assessment in stroke. British Journal of Neuroscience Nursing, 11(3), 113-119.
• Wang, L., et al. (2020). Strategies for secondary stroke prevention: focus on modifiable risk factors. Stroke Research and Treatment, 2020, 1-8.
• Zhao, L., & Zhou, Q. (2021). Patient education and stroke recovery: effective approaches for nurses. Journal of Cardiovascular Nursing, 36(2), 124-132.