Question 1

It may be possible that Robert probably sustained an ischemic stroke, as demonstrated in the examination. A cerebrovascular accident (CVA) tends to be very prevalent. There are two different forms of ischemic stroke: embolic in addition to thrombotic. The embolic stroke looks more feasible throughout this setting, based on the physiological alterations, underlying medical conditions, as well as Robert’s description. As an outcome, atherosclerosis arises in inner arteries throughout the body; consequently, this debris could become unfastened and go upward into the brain’s major circulation routes (Sun et al., 2018). As a response to the blockage, blood flow to the neurological system is postponed, and therefore the cortical area obtains lesser oxygen-rich blood and nutrients. Because of insufficient oxygenation as well as improper nutrition availability, the cerebral hemisphere tends to be unable to operate correctly. The deficiencies of oxygen cause cell injury and induce apoptosis that exacerbates the ischemia inside the nervous system. Compression of the middle cerebral arteries looks to be the most prevalent trigger for ischemia. M1 to M4 are thought to be the four components of a hemisphere, which supply circulation to the basal ganglia as well as the internal capsule. Its M1 component, also known as the horizontal component, seems to be in charge of supplying circulation toward the basal ganglia. Basal ganglia are in charge of physical movement, mood alteration, as well as other physiological feedback management. The inferolateral frontal lobe, cerebral insula, superior temporal, as well as temporal lobes are all served by the sylvian section of every M2. If plasma flow in this area is limited, and ischemic stroke ensues. Clots are frequently released from the heart and land inside a cerebral vein. Secondly, whenever the right MCA gets blocked, the left portion of the lobes is affected, as well as the basal ganglia may be impaired (Au 2018). Musculoskeletal failure could develop as a result of such a degenerative condition. The right MCA gets obstructed, and as a result of this pathophysiology, Robert has formed a left-sided dysfunction.

A cerebrovascular infarction can result in a face collapse, one-sided immobility, and difficulties in swallowing (dysphagia). Due to a serious cerebrovascular accident (CVA), high percentages of patients endure paralysis (Herpich & Rincon 2020). Furthermore, because the right MCA gives regulates the left side and the left MCA regulates the right, hence, the body’s performance might be affected in opposite ways.

Regardless of the kind of CVA, tissue plasminogen activator (tPA) has been routinely utilised to clear a channel. This appears to be the clot-busting medicine that aids in the restoration of tissue perfusion (Huang et al., 2019).  Assessment And Management Of Stroke Suspect Example Paper

Question 2

The objectives of the neurological examination should be to diagnose the placement of the stroke, the type of Cerebrovascular injury, the care urgency, and the risk of transient ischemic attack (TIA). A cognitive assessment is however essential to dismiss the possibility of further degenerative diseases (Ritarwan et al., 2018). This test assesses cranial efficiency, transportation, limb extension and elasticity, communication skills, reaction to position, language, and illumination, along with cerebellar efficiency, sensitivity, movement, vision, and muscle strength. All of these facts might be adequate for the expert to understand the suspect’s neurologic situation. The National Institutes of Health Stroke Scale (NIHSS) has been used throughout neurological examinations (Sylaja et al., 2018). For examining the essential aspects, this seems to be the most accurate scale.

Such investigations may disclose further information about Robert’s illness. This could also aid in excluding the possibility of a transient ischemic attack (TIA). This assessment, on the other hand, can aid professionals in better identifying the type of stroke Robert has faced in the instance. Due to the actual moment of this CVA being unknown, an investigation like this might aid in the discovery of essential information regarding the incident (Furlanis et al., 2018). As a result, this examination may be useful in determining the true neurological origin of this issue. This would give crucial information regarding the client’s brain function. As a result, this evaluation is required to offer Robert enough ambulatory assistance. Furthermore, this method is incredibly easy to apply and involves very little effort.

The customer’s radials, jugular, along with posterior tibial pulses, in addition to femoral responses, are all measured during a peripheral vascular evaluation. Both heart rate and plasma flow within the circulatory systems of both limbs are measured during this physical evaluation. It’s critical to keep a lookout for other unusual activities in this area (Pedragosa et al., 2018). Leg stiffness and discomfort are frequent signs of this condition. This examination is also necessary in order to determine the person’s cardiovascular health.

Robert looks to have a cardiac condition, as well as leg pain inside the lower part, as per his medical documents. As a result, research like this is critical in excluding the potential of peripheral artery disease (PAD). Ischemia, particularly transient ischemic episodes, is common in people having PAD. It has been linked to an enhanced danger of atrial fibrillation as well as hypertension in the past. Robert suffers from both of these ailments, as well as a myocardial infarction (Sharrard et al., 2020). As a result, the diagnostic evaluation is essential to rule out the possibility of PAD as well as other cardiac issues. Furthermore, Robert’s age of 78 years increases his risk of PAD.

Question 3

Robert began to spasm all of a once. It might be an indication of a blockage within the cerebral blood flow. As a consequence, the availability of oxygenated blood in the brain gets reduced. Convulsions may cause a drop in blood oxygen levels that could damage cognitive functions and other bodily functions. As a result, it’s critical to begin oxygen treatment as soon as possible in order to increase blood oxygen status and enhance oxygen-rich serum transportation to the brain. With time, this would boost Robert’s blood oxygen level, allowing more oxygenation to reach the brain. It’s possible that such care may be completed swiftly. The Hudson masks would be used in this situation. Such a mask could deliver 35-45 per cent oxygenation to the entire body (Duprez, 2020). It is, nevertheless, inexorably linked to the unique situation of the client. As a result, high-flow therapy may be necessary if the patient’s condition escalates. The goal should be to increase and keep a blood oxygen concentration of 96 per cent throughout the environment.

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This posture is frequently used in a medical environment to assist the sufferer with respiration. The sufferer’s breathing, as well as airway clearance, might be improved by correctly situating the sufferer. As a result, a caregiver may maintain Robert in a semi-fowler stance throughout this circumstance. The diaphragm stays low in this position, allowing for appropriate lung expansion on both ends. As a result, respiration would be much more fluid. This also aids in the expansion and dilation of the lungs. As a result, it aids in the gaseous exchange within the lung, particularly inside the alveolus. The attendant must raise the client’s bed by 30-45 degrees to create this posture (Firdaus et al., 2019).

To optimize Robert’s respiration, airway management, in combination with supplemental oxygenation, plus therapeutic posture, seems to be essential. Both tracheostomy canals, as well as endotracheal thread, are required for airway restriction. It is necessary to correctly inflate the cuff for appropriate ventilation, which also necessitates monitoring the TV as well as blood oxygen concentration. A provider should maintain the therapeutic protocol throughout this circumstance which includes analysing the inflation pressure with the lowest leakage process and the lowest occlusive capacity. These actions are critical in preventing tracheal tissue damage (Edelman et al., 2019). Nevertheless, in this scenario, the assistance of a pulmonary professional is required to appropriately administer these treatments. It’s also crucial to double-check the parameters to prevent the occurrence of a disastrous event.

Neurological Assessment

Lorazepam affects the nervous system by associating with the benzodiazepine subunit of GABA-A ligand-gated chloride circuit neurones. GABA’s antagonistic function is increased by lorazepam, enabling greater chloride ions to flow via the nerve cells. As a result of the shift in chloride penetration, the cellular membranes get hyperpolarized and eventually stagnate. Furthermore, this medicine inhibits the activity of the amygdala inside the brain which has been connected to the occurrence of depression, whilst inhibiting the activity of the cerebral cortex has been associated with convulsions (Ghiasi et al., 2021). As a result, Robert was given a Lorazepam medication to help him cope with his anxiety and convulsions.

The primary goal of administering this medication is to reduce anxiety. Stress can increase the risk of an acute stroke, therefore it’s vital to keep the client’s condition under control if he or she wishes to avoid a stroke (Ghiasi et al., 2021). Also,  Lorazepam may be used to prevent seizures in individuals.

This medication can be taken orally. It can also be administered intramuscularly (IM) or intravenously (IV). When taken intravenously, lorazepam took 1-3 minutes to show action. When taken intramuscularly, it took 15-30 minutes to have a full impact. However, the dosage of Lorazepam must be altered based on the seriousness of the clinical condition (Ghiasi et al., 2021).

Owing to dose-dependent effects, lorazepam might affect the possibility of respiratory discomfort and CNS issues. Therefore, the higher the dosage, the more probable the adverse effects would be. Delirium, memory lapses, agitation, hypotension, hypoventilation, respiratory problems, as well as a skin disease at the puncture site are some of the other negative effects (Ghiasi et al., 2021). Adverse effects such as stiffness, disorientation, and sedation problems are all conceivable.

This medicine might have serious adverse effects, increasing the risk of a bad result. Therefore, the caregiver must follow the NSQHS protocol when giving this drug and assess the client’s health status. In addition, if Robert’s health deteriorates, the caretaker needs to immediately inform the physician (Ghiasi et al., 2021).

Robert’s tremors would be less pronounced when he swallows lorazepam. Robert will recover from his seizures as a result of this (Amore et al., 2021). A cognitive test may be used to verify it. Robert does have a GCS rating of 12. This indicates that he had mild to moderate traumatic brain damage. As a result, it’s likely that following the drug, Robert’s GCS score shall be 15, indicating that he’ll be capable of effectively concentrating on illumination, sensation, and speech stimuli (Kamdar et al., 2020). Therefore, a GCS exam is required to accurately diagnose the neurological problem.

Vascular Assessment

Although seizures and epilepsy sometimes tend to be the same, actually are not. Epilepsy patients could be viewed as long-term happenings, whilst seizures are one-time occurrences. Epileptics have seizures that last longer than five minutes. The sufferer would fail to readjust to normal cognition at this point. Therefore, it is thought that administering lorazepam may reduce the chances of having epilepsy (Maguire et al., 2018).

It is expected that using lorazepam drugs would help with anxiety reduction. Therefore, after taking the prescription, Robert’s anxiety level would be lower. Stress over time may raise the risk of hypertension that could lead to a stroke (DeLaune et al., 2019). As a result, in measuring overall improvement, the caregiver would require to assess Robert’s mental abilities along with his hypertension.

If a significant person’s situation deteriorates, it will have an influence on the health of family members. Agnes’ emotional state will be affected by Robert’s illness. Hence, offering family-centred care (FCC) is critical for reducing emotional distress. To enhance the odds of a favourable outcome, FCC recommends that a caregiver incorporate Agnes’ choices into Robert’s therapy plan. As a result, it’s critical to engage within the therapeutic discourse and obtain consensus on decisions.  To build a potential care plan, a caregiver must talk with Agnes. It’s critical to get the user’s informed permission (Banerjee et al., 2018).

Reference

Au, A. (2018). Metabolomics and lipidomics of ischemic stroke. Advances in clinical chemistry, 85, 31-69. https://doi.org/10.1016/bs.acc.2018.02.002

Banerjee, J., Aloysius, A., Platonos, K., &Deierl, A. (2018). Family-centred care and family delivered care–What are we talking about?. Journal of Neonatal Nursing, 24(1), 8-12. https://doi.org/10.1016/j.jnn.2017.11.004

DeLaune, S. C., McTier, L., Tollefson, J., Lawrence, J., & Ladner, P. K. (2019). Fundamentals of Nursing: Australia & NZ Edition 2e. Cengage AU. https://books.google.co.in/books?hl=en&lr=&id=RFnYDwAAQBAJ&oi=fnd&pg=PR1&dq=medical+surgical+nursing+australia&ots=QS-scfO9-a&sig=Y2u1AJZIpvEfT86h-tjKnw3Y3wI&redir_esc=y#v=onepage&q=medical%20surgical%20nursing%20australia&f=false

Duprez, F. (2020). Oxygen therapy in hypoxaemic failure. https://dial.uclouvain.be/pr/boreal/object/boreal%3A235367/datastream/PDF_01/view

Edelman, D. A., Perkins, E. J., & Brewster, D. J. (2019). Difficult airway management algorithms: a directed review. Anaesthesia, 74(9), 1175-1185.  Assessment And Management Of Stroke Suspect Example Paper