Stroke Assessment

Answer

Stroke Assessment

Question 1:  Identify and justify with evidence two risk factors that may have contributed to Mr Chong’s diagnosis of stroke? (3 marks)

According to Kariasa et al. (2019), stroke can happen to everyone but there are some factors that increase the risk of getting it. In the case of Mr. Chong, the first risk factor is coronary heart disease, which the patient had been diagnosed with. This disease increases the chances of stroke since it causes plaque buildup in arteries that block the flow of oxygen from reaching the brain. The second risk factor in this case is atrial fibrillation. According to Soto-Cámara et al. (2020), this is a type of irregular heart beat which may be abnormally first.  This may cause the heart not to empty itself of blood at every beat which may cause a clot to form as a result of the blood left behind. The clot may block arteries leading to the brain which could cause stroke.

Question 2:  Describe the signs and symptoms exhibited by Mr Chong that suggested he has dysphagia. Explain the pathophysiology behind why Mr Chong is at risk of aspiration and support your discussion using assessment data from Mr Chong’s medical record and case study; and evidence from peer-reviewed literature (4 marks)

Dysphagia is also known as difficulty in swallowing solid or liquid food.  It is associated with pain and is very common in patients who have been diagnosed with stroke. In this case, there are two symptoms that indicate Mr.Chong  is suffering from dysphagia . The first one is coughing or gaggling when swallowing. According to the case study, it is evidenced that when he was given water he had a cough that lasted for five minutes.  Krekeler et  al. (2018) state that coughing is a key symptom for this condition. He also coughs when he tries to speak.  Another symptom of dysphagia is hoarse voice. Notably, people who are suffering from the condition have their voices sound breathy, raspy, and strained, something that has been observed in this patient.  Aspiration occurs when foreign materials are inhaled into the lungs through the airways. In this case the pathophisiology of aspiration follows the fact that the muscles within the patient’s throat do not work properly and normally. Thus, instead of the foods following the right channel, they enter the trachea when the patient is swallowing.  According to Stevens et al.(2021), the entry of fluid into the bronchi and alveolar space triggers an anti-inflammatory reaction with the release of tumor necrosis factor-alpha, proinflammatory cytokines, and interleukins.

Question 3: Discuss and justify with evidence how the Registered Nurse assessed for the risk of aspiration and make recommendations for additional assessments relating to dysphagia and aspiration that should have been conducted (5 marks)

 There are several ways through which registered nurses assessed the risk of aspiration in Mr. Chong. The first one is level of consciousness. According to the study conducted by (), the primary risk of aspiration is decreased level of consciousness. As observed in this patient, his last Glasgow Coma Scale (GCS) is between 13- 14, and indicator that his consciousness is mild as demonstrated with his confusion and disorientation.  Another way through which the nurse assessed risk of aspiration is through coughing after swallowing food. Heijnen et al. (2020) asserts that impaired swallowing increases the risk for aspiration. There are additional recommendations of assessing aspiration and dysphagia that should have been conducted. For aspiration, the registered nurse should have assessed the pulmonary status for clinical evidence of aspiration.  This includes osculating breath sounds to notify about crackles and rhonchi since pulmonary infiltrates on chest x-ray films indicate some level of aspiration has already occurred. Additionally, the nurse should have tested sputum with glucose oxides reagent strips since a significant glucose in the sputum is a key indicator of high chances of aspiration. For dysphagia, the nurse should have assessed the strength of facial muscles. According to Heijnen et al. (2020), coordinated function of muscles innervated by these nerves is necessary to move a bolus of food from the mouth to the posterior pharynx for controlled swallowing. 

Question 4: Describe and justify using peer-reviewed evidence three nursing interventions that should be implemented to reduce the risk of Mr Chong aspirating (9 marks)

The first nursing intervention that should be implemented to reduce the risk of Mr. Chong aspiration is keeping suction machine available when feeding him. This is because when the aspiration does occur, the nurse should perform suction immediately.  It is important to note that a patient with aspiration or risks aspiration requires immediate suction and further life saving interventions such as intubation. A study conducted by Hollaar et al .(2017), reveals that prevention is more important in patients with aspiration and healthcare professionals should be alert when handling such problems particularly when they are feeding the patients since this is the time  that aspiration is more likely to occur.

The second nursing intervention that should be implemented to reduce the risk of Mr. Chong aspiration is keeping the head of bed elevated when feeding him for at least half an hour afterwards,. According to the study conducted by McKinney et al.(2017), maintaining a specific sitting position, especially the head after eating assists to decrease aspiration in patients.  The positioning also known an rescue positioning decreases the risk by promoting drainage of secretions out of the mouth instead of down the pharyns when there is high possibility of aspiration.

The last nursing intervention that should be implemented to reduce the risk of Mr. Chong aspiration is provision of food with consistency that the patient is able to swallow.  In such cases, the registered nurse should include thickening substances. It is important to note that thickened semisolid food like hot cereal and pudding are most easily swallowed and less likely to be aspirated.  Notably, thin and liquid foods are most difficult for patients with dysphagia to swallow.

Question 5:  Effective and accurate assessment skills are imperative for the Registered Nurse working with Mr Chong at all times. Identify and discuss two priority problems (NB: Risk of aspiration should not be one of the priority problems) for Mr Chong during his admission to the Stroke Unit. Justify the priority with peer-reviewed evidence (6 marks)

Stroke presents with several health issues; however, there are certain issues that become top priority for nurse’s interventions. The first nursing priority for Mr. Chong is improving mobility and preventing deformities.  Poor mobility results in other condition such pressure ulcers that further worsen the condition of the patient. In this case, nurses should position the patient appropriately to prevent contractures, use measures to relieve pain, help in maintaining good body alignment, and prevent compressive neurpathies. Additionally, healthcare providers should ensure that position is changed after every two hours and also places the patient in a prone position for 15 to 30 minutes several times in a day.

The second nursing priority is maintaining the normal blood pressure.  A study conducted by McKinney et al.(2017) reveals that patients with stroke are likely to develop high blood pressure.  This worsens health state of the patient since high blood pressure causes damage to the inner lining of the blood vessels. HBP puts more pressure on the blood vessels until they can no longer maintain the pressure and the blood vessel ruptures over time.