Introduction
Cerebral vascular accident, also known as CVA or a stroke, is one of the most critical health conditions. It can last several minutes and up to several hours, but its consequences remain dangerous for human health (Centers for Disease Control and Prevention, 2022). It is hard for an ordinary person to recognize its first signs, but its treatment has to be as fast as possible to predict the brain damage provoked by a blocked blood supply. Thus, patient and nurse education about the clinical presentation of CVA plays an important role, including its pathophysiology, diagnosis, and treatment, to enhance patient safety and the effective use of information.
Clinical Case Presentation: Pathophysiology
Understanding the pathophysiology of CVA is based on the basics of neurovascular anatomy and its clinical manifestations. An abrupt neurological outburst provokes impaired perfusion of blood vessels in the brain (Kuriakose & Xiao, 2020). In a short period, blood vessels narrow, limiting the supply of oxygen and blood to the brain (ischemic stroke) or start bleeding or leaking, provoking brain damage, disability, or death (hemorrhagic stroke) (Kuriakose & Xiao, 2020). There are five main signs of CVA: numbness (face, arms, or legs on one side of the body), confusion (trouble speaking), problematic vision, trouble walking (balance loss or dizziness), and headache (Centers for Disease Control and Prevention, 2022). The severity of symptoms mostly depends on the patient’s age (older than 55 years), harmful habits, and medical conditions like hypertension or hyperlipidemia.
Diagnostic Testing
There are several diagnostic tests to be made to prove the diagnosis of a stroke. First, it is important to act FAST, meaning check the person’s Face (ask to smile), Arms (ask to raise both hands), Speech (ask to repeat a simple sentence), and Time (call an emergency) (Centers for Disease Control and Prevention, 2022). Then, a physical examination and blood tests are necessary to check the blood pressure, heart rate, and sugar level that might affect the nervous system (Chugh, 2019). Finally, computerized tomography (CT) or magnetic resonance imaging (MRI) is used to get a clear brain image, reveal bleeding areas, and assess damage (Chugh, 2019). Some steps can be skipped if the patient is critical to provide the necessary operative help.
Treatment Modalities
One of the most important steps in treating CVA is using tissue plasminogen activators. This injection is a gold standard for stroke management during the first three hours of the symptoms to destroy blood clots and improve the blood flow to the brain (Chugh, 2019). Endovascular therapy is required for patients who experience stroke symptoms for more than 4.5 hours. It may include the MERCI device, the PENUMBRA system, or other stent retrievers to open the blocked artery after a thrombectomy was used to remove the clot (Chugh, 2019). If the patient’s condition is not stable, blood transfusion, aneurysm clipping, and coil embolization are additional treatment modalities.
The Case and the Master’s Prepared Nurse Practice
The material offered in this case significantly informs the practice of a master’s prepared nurse. Not all stroke signs are easily recognized, and people miss the moment when the first health changes occur, but time is a critical factor for treatment choices. Besides, the nurse should understand that not all diagnostic tests should be followed, and the patient’s condition can be changed within a short period.
Patient Education
The master’s prepared nurse should use the information to improve patient education and cover several important aspects. First, there are five main symptoms of CVA, and people can identify them if they know them. Second, it is necessary to note the time when CVA signs first appear for further treatment. Finally, even if the symptoms go away quickly, people should visit a hospital for physical examination and lab tests.
Importance
Although it has already been repeated several times, the most important information presented in this clinical case remains the same. The worth of time cannot be ignored because intravenous thrombolytics are effective during the first three hours, and endovascular interventions help patients after four hours (Chugh, 2019; Kuriakose & Xiao, 2020). The treatment of CVA highly depends on the duration of the symptoms, which must be underlined in any education process.
Challenges
In this case presentation, the most confusing information is related to stroke diagnostic features. On the one hand, there is a clear idea that a stroke occurs when its five characteristics are revealed and urgent help is required. On the other hand, CT and MRI are necessary to check the damage to the brain. Thus, it is hard to understand the order of interventions not to harm the patient.
Patient Safety
The risk of infection is one of the crucial patient safety issues in the CVA case. All nurses and educated patients are aware that every minute is vital during a stroke, and fast treatment is required to predict complications and death. However, when fast decisions are made, and interventions are offered, healthcare providers and patients may forget simple hygiene rules and protections, leading to infection progress. Thus, patient safety in terms of infection control should never be neglected in nursing practice.
Conclusion
In general, evaluating CVA pathophysiology, diagnostic features, and treatment modalities contribute to master’s prepared nurse practice in many ways. It is not enough to know and identify the signs and symptoms of a stroke but also to react quickly and not lose a minute for effective treatment. There are several approaches to help people survive a stroke, and most decisions depend on the duration of the patient’s condition.
References
Centers for Disease Control and Prevention. (2022). Stroke signs and symptoms. CDC. Web.
Chugh, C. (2019). Acute ischemic stroke: management approach. Indian Journal of Critical Care Medicine, 23(2), 140-146. Web.
Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. International Journal of Molecular Sciences, 21(20). Web.