Ticket To Enter Adult Health 2 Stroke Is Essential To The S

Ticket To Enteradult Health 2 Strokeit Is Essential To The Success Of

Ticket to Enter Adult Health 2: Stroke It is essential to the success of your simulation experience that everyone is prepared. You will discuss your answers to the following questions during pre-briefing. This is an individual assignment to be submitted in your course on Brightspace and must be printed or available via phone/tablet as your “ticket” to enter the simulation center. You must have this completed assignment with you to participate in simulation.

Paper For Above instruction

The effectiveness of patient care during a cerebrovascular accident (CVA), commonly known as a stroke, heavily depends on thorough understanding and prompt response by healthcare professionals. As part of preparing for simulation, students are required to investigate several key aspects related to stroke, including its pathophysiology, risk factors, assessment tools, treatment medications, and interdisciplinary care. This comprehensive knowledge ensures that students can demonstrate confidence and competence during the simulation exercise, ultimately improving real-world patient outcomes.

1. Pathophysiology of Cerebrovascular Accident (CVA) and Associated Signs and Symptoms

A cerebrovascular accident occurs when there is an interruption of blood flow to the brain, leading to neuronal injury and functional impairment. The primary mechanisms include ischemia, due to blockage of cerebral blood vessels typically by thrombi or emboli, and hemorrhage from ruptured vessels. Ischemic strokes, accounting for approximately 87% of cases, result from arterial occlusion which deprives brain tissue of oxygen and nutrients (Mohr et al., 2011). Hemorrhagic strokes involve bleeding into or around brain tissue, often caused by hypertension or vascular malformations. Symptoms vary depending on the affected brain region but commonly include sudden weakness or numbness, difficulty speaking or understanding speech, visual disturbances, loss of coordination, and severe headache (Benjamin et al., 2019). Recognizing these signs promptly is critical for timely intervention.

2. Risk Factors for Stroke

Multiple risk factors predispose individuals to stroke. Non-modifiable factors include age, gender, race, and genetic predisposition. Modifiable factors encompass hypertension, smoking, diabetes mellitus, dyslipidemia, atrial fibrillation, physical inactivity, obesity, excessive alcohol intake, and poor diet (Benjamin et al., 2019). Hypertension remains the single most significant modifiable risk factor, with elevated blood pressure causing damage to cerebral vessels and increasing the likelihood of both ischemic and hemorrhagic strokes. Managing these factors through lifestyle modification and medical therapy significantly reduces stroke risk (NHS England, 2019).

3. The National Institutes of Health Stroke Scale (NIHSS)

The NIH Stroke Scale is a standardized tool used to objectively quantify neurological deficits and assess stroke severity. It evaluates several domains including consciousness, vision, motor strength, sensation, language, and neglect. Each item is scored, culminating in a total score ranging from 0 (no stroke symptoms) to 42 (most severe stroke). The NIHSS assists clinicians in determining prognosis, guiding treatment decisions, and monitoring patient progress over time (Lyden et al., 2017). Accurate assessment with this scale is fundamental for effective stroke management.

4. Medications for Acute Stroke and Contraindications for Thrombolytic Therapy

In acute ischemic stroke, thrombolytic agents such as recombinant tissue plasminogen activator (tPA) are administered to dissolve clots, ideally within 4.5 hours of symptom onset (Emberson et al., 2014). Other medications include antiplatelet agents like aspirin, which are used for secondary prevention. Contraindications for tPA include active bleeding, recent surgery or trauma, history of hemorrhagic stroke, intracranial neoplasm, uncontrolled hypertension (>185/110 mm Hg), and bleeding disorders. Proper patient selection is critical to avoid adverse outcomes (Powers et al., 2018).

5. Permissive Hypertension

Permissive hypertension refers to the clinical strategy of allowing higher blood pressure levels temporarily after a stroke to maintain cerebral perfusion, especially in ischemic stroke patients not receiving thrombolytics. The rationale is to prevent ischemic penumbra from progressing to infarction. Typically, blood pressure is tolerated up to 220/120 mm Hg unless there are contraindications such as suspicion of hemorrhagic stroke or the need for antihypertensive therapy (Qureshi et al., 2018). Careful monitoring ensures that blood pressure remains sufficiently elevated to sustain brain tissue viability without increasing hemorrhagic risk.

6. Pharmacology of Intravenous Labetalol and Its Use in Acute Stroke

Labetalol is a combined alpha- and beta-adrenergic blocker used intravenously to rapidly lower elevated blood pressure in hypertensive emergencies, including acute stroke scenarios. It works by decreasing systemic vascular resistance (via alpha-blockade) and heart rate (via beta-blockade). The typical indication involves reducing blood pressure to safer levels without compromising cerebral perfusion. The medication is particularly useful when hypertension threatens to worsen stroke outcomes or complicates thrombolytic therapy, with target reductions usually around 15-25% within the first minutes to hours (Roth et al., 2020).

7. Nursing Diagnoses and Interventions for Stroke Patients

Three common nursing diagnoses include Impaired Physical Mobility related to hemiparesis, Risk for Aspiration related to impaired swallowing, and Risk for Ineffective Cerebral Tissue Perfusion related to ongoing cerebrovascular compromise. Corresponding interventions involve implementing passive and active range-of-motion exercises, assessing swallowing ability with swallow studies, elevating the head of bed, and monitoring neurological status continuously (Levack et al., 2017). Each diagnosis targets essential aspects of functional recovery and complication prevention.

8. Signs of Difficulty Swallowing and Risk for Aspiration & Assessment of Swallowing Ability

Indicators such as coughing during swallowing, drooling, pooling saliva, delayed swallowing, and changes in voice quality suggest dysphagia. Nurses should routinely assess swallowing ability in all stroke patients to identify those at risk of aspiration pneumonia. Early assessment using standardized tools like the water swallow test enables timely dietary modifications and precautions (Martino et al., 2017). Systematic evaluation minimizes aspiration risk and improves nutritional status.

9. Interdisciplinary Team Members in Stroke Care

The management of stroke patients requires a multidisciplinary team including neurologists, nurses, speech-language pathologists, physical and occupational therapists, dietitians, and social workers. Neurologists oversee diagnosis and acute treatment; nurses provide ongoing monitoring and care; speech therapists evaluate and treat swallowing and communication disorders; physical and occupational therapists focus on mobility and functional independence; dietitians ensure nutritional needs are met; social workers assist with discharge planning and psychosocial support (Salter et al., 2020). Collaboration across these disciplines optimizes patient recovery and long-term outcomes.

References

• Benjamin, E. J., Muntner, P., Alonso, A., et al. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528.
• Emberson, J., Lees, K. R., Lyden, P., et al. (2014). Effect of treatment with alteplase within 4.5 hours of acute ischemic stroke: A meta-analysis of individual patient data from randomized trials. The Lancet, 384(9958), 1835–1843.
• Levack, W., Dean, S. G., & McPherson, K. M. (2017). Principles and practice of stroke rehabilitation. Oxford University Press.
• Lyden, P., Marler, J. R., Tilley, B. C., et al. (2017). The National Institutes of Health Stroke Scale: A validation study. Stroke, 24(11), 1542-1547.
• Mohr, J. P., Caplan, L. R., & Hier, D. B. (2011). Stroke: Pathophysiology, diagnosis, and management. Elsevier.
• NHS England. (2019). Stroke prevention and management. NHS England guidelines.
• Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2018). Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46–e110.
• Qureshi, A. I., Memon, A., & Kassem, K. (2018). Permissive hypertension in ischemic stroke: A review of current evidence. Journal of Stroke & Cerebrovascular Diseases, 27(2), 357–364.
• Roth, T., Cummings, E., & Johnson, E. (2020). Pharmacology of antihypertensive agents in stroke management. Clinical Pharmacology & Therapeutics, 107(1), 73–82.
• Salter, K., Teasell, R., & Bhogal, S. (2020). Interdisciplinary management of stroke: Strategies and collaboration. Rehabilitation Nursing, 45(2), 69–77.