ACUTE ISCHAEMIC STROKE

Nursing care and management of a patient who received thrombolysis treatment for Acute Ischaemic Stroke



Nursing care and management of a patient who received thrombolysis treatment for Acute Ischaemic Stroke

Introduction

For our understanding, we will use 81 years old man suffering from Acute Ischaemic stroke. He arrived at the emergency department at 9:15 a.m. with speech difficulty and weakness on the right side. He had awakened that morning without symptoms. During breakfast at 8 a.m. his wife saw him slump over and fall from the chair to the floor. He was unable to speak and could not move his right arm or leg. She called 999, and he was transported to the emergency department. He made a few attempts to speak, but his speech was unintelligible. He could move his right arm and leg but could not lift either limb off the bed. Computed tomography (CT) of the brain showed no hemorrhage and no early ischemic changes. Blood pressure was 160/90 mm Hg. His platelet count, glucose level, and prothrombin time were all normal. After the patient returned from imaging at 10 a.m., a neurologist was consulted, who confirmed the presumptive diagnosis of acute ischemic stroke and recommended immediate initiation of intravenous thrombolytic therapy.

The Clinical Problem

Acute Ischaemic stroke is the leading cause of disability among adults in the United Kingdom (Davis, 2009, 2910). Despite advances in preventive strategies and initial therapy for acute ischaemic stroke, nearly 800,000 strokes occur per year in the United Kingdom, and 87% of all strokes worldwide are ischemic in origin (caused by in situ thrombosis, embolism, or systemic hypoperfusion).1 The risk of stroke is higher among men than among women, among blacks than among whites, and in older than in younger age groups.

In 2007, stroke accounted for 1 of every 18 deaths in the United States. According to one report, the 30-day mortality for ischemic stroke was 8 to 12% for people 45 to 64 years of age. In the Framingham Heart Study, among survivors of an ischemic stroke who were 65 years of age or older and were evaluated 6 months after the event, 50% had some evidence of hemiparesis, 30% were unable to walk without assistance, 19% had aphasia, and 26% were institutionalized. The estimated direct medical cost of stroke in the United Kingdom was $25 billion in 2007 (Furlan, 2009, 11).

Pathophysiology and Effect of Therapy

Acute ischaemic stroke results from vascular occlusion that reduces cerebral blood flow to the area of brain perfused by the occluded artery. In either thrombotic or embolic stroke, such occlusion is caused by obstruction of the artery by thrombus. If the reduction in blood flow is sufficiently severe, a series of events occurs at the cellular level that leads to infarction. The discharge of excitatory amino acid neurotransmitters, the arrival of calcium, the generation of oxygen free radicals, membrane depolarization, and eventually, the loss of membrane integrity are all thought to contribute to the detrimental effects of ischemia (Syfret, 2011, ...