RNSG 2432 Enhanced Concepts of Adult Health

Module 9:  Nursing Care of the Individual with Stroke

 

Module Objectives:  

Utilizing critical thinking and the nursing process, the student is expected to:

  1. Compare and contrast risk factors associated with Stroke (Cerebral Vascular Accident/Brain Attack)
  1. Analyze the etiology and pathophysiology of stroke:
  • Cerebral Vascular Accident/Brain Attack:
    • Disease process- ischemic (occlusive) and hemorrhagic
    • Time between lack of blood and brain dysfunction (TIA/CVA)
    • Artery involved
  1. Analyze the signs and symptoms and complications stroke:
  • Stroke:
    • Manifestations: disease process (occlusive/hemorrhagic), blood vessel affected, hemisphere involved, and length of time. the brain is without blood supply Motor deficits (one sided), elimination disorders, sensory-perceptual deficits, language disorders, cognitive and behavioral changes, and changes in other body systems.
    • Complications: increased intracrainal pressure; aneurysms- rebleeding, vasospasm, hydrocephalus.
  1. Integrate the diagnostic tests with the etiology, pathophysiology, and signs and symptoms for the individual experiencing a stroke.
  • Computer tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Angiography
  • Transcranial ultrasound doppler
  • Positron emission tomography (PET)
  • EEG
  • Other
     
  1. Formulate relevant prioritized nursing diagnoses that address physical, psychosocial, and learning needs:
  • Stroke:
    • Ineffective cerebral tissue perfusion
    • Impaired physical mobility
    • Self care deficit
    • Impaired verbal communication
    • Impaired urinary elimination and risk for constipation
    • Impaired swallowing
    • Other
  1. Formulate client and family centered goals that assist toward health promotion, maintenance, and/or restoration.
  1. Prioritize and evaluate nursing interventions related to:
  • Drug therapy:
    • Occlusive stroke: tPA; antithrombolytics; anticoagulants; anticonvulsants
    • Hemorrhagic stroke: antihypertensives, Aminocaproic acid (amicar), calcium channel blockers (Nimodipine), anticonvulsants, stool softners, analgesics, other
    • Brain tumors: corticosteriods, chemotherapy
  • Diet therapy
  • Surgical/Medical interventions:
    • Burr holes/craniotomy/crainectomy/crainoplasty
    • Occlusive stroke: endarterectomy, bypass, other
    • Hemorrhagic stroke: clipping of aneurysm, coils, other
    • Gamma knife/Laser knife - reduce size of AVM (arteriovenous malformation) or brain tumor
  • Patient teaching; therapeutic communication
  • Consider human and material resources, including delegation
  • Referrals
  • Other
  1. Evaluate and revise goals and modify the nursing care plan specific to individual experiencing stroke.
  1. Integrate associated issues and trends into nursing practice.
  • Legal
  • Ethical considerations

Learning Activities:

1. Review module objectives.

2. Learning Resources:

Required: 

  • Lewis: 8th edition p. 1459-1484 (7th p. 1502-1525)
  • Notes- Neurosensory Disorders: Stroke
  • Learning Guide- Neurosensory Disorders: Stroke
  • Powerpoint- Neurosensory Disorders: Stroke
  • View video- Jill Taylor
  • NIH Stroke Scale   (if do not understand how to perform, then view free NIH videos- refer to Supp Learning below)
  • PDS Software: Case study: Critical Care: Mrs Thorne 48 yr SAH
  • PDS Software: Case Study: Adult Health: Mrs Stevens 65 yr Stroke
  • Lewis p. 1483: Case Study/Critical Thinking Exercise.
  • NCLEX questions Lewis p. 1483

3. Complete Critical Thinking Exercises:

 

4. Supplemental Learning:

5. Review module objectives and check for knowledge gaps.


6. Complete module quiz