Mary Young is a 71-year-old Aboriginal Australian female. She has present with a number of different health issues, including osteoporosis, hypercholesterolaemia, atherosclerosis, atrial fibrillation and Type 2 diabetes. She has been feeling fatigued for the past several months, and her current admission was on account of increasing dizziness, blurred vision and persistent headache. She was found to have suffered an ischaemic stroke, of moderate to severe status. This paper will outline the primary admission diagnosis, the nursing problems, nursing management strategies and discharge planning for Mary.
Primary Admission Diagnosis
Mary was admitted to the ED with left-sided hemiparesis, aphasia, and hypertension. She had an irregular pulse rate. An ECG revealed atrial fibrillation. A thrombotic ischaemic stroke was suspected and confirmed on CT. She has now been stabilized, and has been admitted to the medical ward for clinical management and rehabilitation.
Thrombotic ischaemic strokes are caused by a number of factors. Among them, Mary has Type 2 diabetes, hypertension and atrial fibrillation. Thus, Mary possesses several risk factors that not only could have caused this stroke but may cause future strokes as well, if these factors are not addressed. Hinkle (2007) notes that this type of stroke involves blood flow to the brain being constricted. There are several potential outcomes that can affect care after the patient has been stabilized. The patient’s airway can be constricted, and they should have a swallow screen applied when receiving anything by mouth, including water and medications (Hinkle, 2007). The patient’s ability to communicate can be affected by the stroke, and should be monitored. Mary worked for the SA Police Dept so she should be able to communicate in English, but does not appear to be able to do so at this point in time, so this is something that should be addressed prior to discharge (Hinkle, 2007).
There are a number of nursing diagnoses that can be made at this point for Mary. She has impaired physical mobility/impaired walking because she cannot bear her own weight. She has fatigue, and was facing this prior to the stroke. She has impaired verbal communication. She is at risk for powerlessness, because of her deteriorating physical condition. Mary wants to continue with her job, and making contributions to her community, and may struggle emotionally and mentally with being unable to continue in these functions during her recovery. She is also at risk for social isolation. This is going to occur especially as her mobility is compromised, and if she does not recover her ability to communicate in English. The Aboriginal languages that she speaks have very few if any fluent speakers, and in any case there has not been an assessment as to how well she speaks them in her present state. There is risk that she will become socially isolated if she cannot move or communicate verbally.
The first problem to examine is Mary’s fatigue. Mary was experiencing fatigue prior to her stroke, and as the result of her stroke she is expected to continue to experience fatigue. One of the problems with post-stroke fatigue is that there is not much evidence to guide practice. There is a sizeable body of work on chemotherapy-related fatigue but not on stroke-related fatigue. Collo (2007) notes that fatigue is common in stroke survivors and is linked to reduced independence, both of which are nursing issues. Some of the research that has been done is inconclusive in nature (Michael, et al., 2006), but fatigue has been shown to be related to balance, and to falls, which themselves a significant health risk in older individuals such as Mary. Strokes have been linked to falls, especially where there is fatigue (Schmid et al., 2010).
However, with little knowledge about how to combat this type of fatigue, only generalized assistance can be given. First, the patient needs to be made aware of the risks of fatigue, and her daughter does, too. This includes the risks of falling, so that perhaps her home can be adequately equipped to minimize the risk of falling. Dietary factors need to be taken into consideration. Furthermore, there needs to be some physiotherapy or rehabilitation done so that Mary can regain as much of her mobility as possible. The more she can regain, the better she will be with respect to fatigue. That said, at her age, it may come down to finding the right coping strategies, such as her daughter helping her around the house more, organizing some sort of home care, or other alternatives to minimize the negative impact of fatigue on Mary.
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