Sample Nursing Research Paper on Ischemic stroke

Introduction

Stroke is among the leading causes of morbidity and mortality globally. Every year, approximately 900,000 persons are diagnosed with stroke in the United States with the ischemic type accounting for over 85% of these cases (Hinkle & Cheever, 2018). Ischemic stroke is characterized by neurologic deficits such as loss of speech, sensory and motor function following an interference to the brain’s blood supply. Besides, it affects the emotional and social being of affected patients and their families. Therefore, nurses are key players in terms of their contribution to the treatment and rehabilitation of stroke patients and caring for their families.

 

Patient description

Within a hospital system in Minneapolis, the internal medicine department was consulted to deliver services to a patient who had been admitted to the medical floor. The patient was a 65-year-old, Caucasian female patient who complained of left upper and lower limb weakness, associated with confusion, dizziness, changes in gait, and incoherent speech which had started five hours earlier. However, he denied any history of hearing loss, visual disturbances, chest pain, palpitations, difficulty in swallowing, bladder incontinence, or trauma (Hinkle & Cheever, 2018). Her past medical and surgical history was remarkable for hypertension and uncontrolled diabetes since the age of 55 and was on Metformin, Hydrochlorothiazide, and Losartan potassium regimen. This was the first episode and the rest of her history was insignificant.

Upon examination, her blood pressure and glucose levels were significantly elevated at 189/111 mm Hg and 13mmol/liter respectively. All other vital signs were within the normal ranges. Her neurological examination was remarkable for left-sided hemiplegia, dysarthria, and ataxia. Other examination findings were insignificant. Basic laboratory investigations were all within the normal laboratory ranges. An initial non-contrast CT scan reported no intracranial abnormalities and a head CT angiogram, and MRI were requested. A diagnosis of ischemic stroke was arrived at based on the patient’s history, physical examination, and imaging studies.

Patient Care

The patient was admitted to the intensive care unit where hemodynamic status, cardiac and neurologic functions were continuously monitored and her vital signs were stabilized within 16 hours. Thrombolytic therapy using a Recombinant tissue plasminogen activator was instituted together with aspirin for the antiplatelet function to reduce cerebral infarction (Hinkle & Cheever, 2018). The patient stayed in the ICU for one week and is currently undergoing continuous monitoring and treatment in the hospital’s internal medicine inpatient ward. Neurologic assessment is continuously been done in liaison with a neurosurgeon, physician, physiotherapist, and the nurse in charge to ensure restoration of the patient’s functional status. Current nursing interventions being instituted include correct positioning to prevent neuropathies and joint contractures, changing positions to prevent pressure ulcers, feeding using nasogastric tubes to reduce aspiration, and mobility aid for rehabilitation of limb functions. Additionally, due to her comorbid conditions, her regimens are being optimized to achieve normal blood pressure and adequate glycemic control.

Comparison of Patient Care with Evidence-Based Practice

According to evidence-based practice, the patient is a good candidate for thrombolytic therapy because she is within the 4.5-5 hours timeline, which is in line with the nursing interventions instituted on the patient. However, there was an omission of assessment using the NIH stroke scale to further qualify the eligibility criteria for alteplase administration even though other contradictions were absent (Theofanidis & Gibbon, 2016). Additionally, his blood pressure ought to have been managed to reach the goal of 185/110 mm Hg before initiation of alteplase therapy using pharmacologic agents such as Labetalol, Nicardipine, and Nifedipine. The nurse in charge did not perform this intervention with the reason that the patient was not in a state of hypertensive emergency despite the history of longstanding uncontrolled diabetes and hypertension. Furthermore, research suggests that hypertensive agents such as calcium channel blockers do not alter the outcome in ischemic stroke patients.

Evidence-based practice also recommends endovascular recanalization therapy in patients with ischemic stroke within or after 6 hours to aid in cerebral reperfusion. This intervention was not considered in this patient since the patient did not consent to this intervention (Ko et al, 2019). Since patients suffering from stroke are at risk of developing deep venous thrombosis and pulmonary embolism as a result of hemiplegia and hemiparesis, anticoagulation therapy ought to have been considered which was not the case for this patient(Ko et al, 2019). Nonetheless, the rest of the care the patient is receiving is similar to evidence-based practice recommendations in helping the patient regain functional status.

Conclusion

Ischemic stroke is a major cause of mortality and morbidity worldwide. Therefore, a multidisciplinary approach must be undertaken together with the implementation of evidence-based practice recommendations to achieve the best care for stroke patients. In this case scenario, the nursing interventions undertaken were in line with medical-surgical literature guidelines but differed slightly with evidence-based practice recommendations in achieving quality care for the patient.

Reflection

This case has taught me the importance of incorporating evidence-based practice recommendations in providing quality care for the patients I interact with. Additionally, I have also learnt to critic current medical practices and embrace new practices that are based on reliable evidence from research studies. For example, instituting medical interventions such as anticoagulation therapy and blood pressure monitoring before alteplase therapy in stroke patients with very high blood pressures, are important in preventing cerebral death and reducing the length of hospitalization. I feel that this new knowledge will complement that which I had already acquired earlier about the topic. The lessons learnt will be useful in my current and future practice as a professional nurse to act towards the best interest of patients.

 

 

References

Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing. Retrieved from https://www.academia.edu/40014727/Brunner_and_Suddarths_Textbook_of_Medical-Surgical_Nursing_14th_ed

Ko, S. B., Park, H. K., Kim, B. M., Heo, J. H., Rha, J. H., Kwon, S. U., … & Jeong, H. W. (2019). 2019 update of the Korean clinical practice guidelines of stroke for endovascular recanalization therapy in patients with acute ischemic stroke. Journal of Stroke21(2), 231. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549067/

Theofanidis, D., & Gibbon, B. (2016). Nursing interventions in stroke care delivery: an evidence-based clinical review. Journal of Vascular Nursing34(4), 144-151. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1062030316300735