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The nurse educators play a crucial role in the development of new nursing staff. Apart from teaching theory, nurse educators must prepare the students to work in the clinical setting, think critically, and use the modern means of communication to obtain evidence-based data. In addition, nurse educators need to encourage passion and desire to work in the learners.
To teach the students properly, a nurse educator needs to have an in-depth knowledge of the pathophysiologic mechanisms of diseases (to explain to the students how a disease harms the organism), the associated physical assessments (to teach them how to identify/diagnose diseases), and the pharmacologic implications for care (so the students may prescribe the appropriate drugs).
In this paper, we will study the case of Charles Gibson, an imaginary patient who has suffered from an ischemic stroke, and offer recommendations concerning the prescription of medications to him. We will also take a closer look at the role of the nurse educator in the students’ professional development.
Charles Gibson’s Case
Mr. Gibson was diagnosed with an ischemic stroke when he arrived at the hospital. He was treated with the tissue plasmogen activator. Recently, he was moved from the emergency department to the rehabilitation unit. According to the post-stroke MRI, the patient had no worsening ischemia, and had reperfusion in the affected area of the brain.
The patient can consume nectar-thick foods; it is planned to move him to soft diet if swallow evaluation results are good enough. He also has difficulty speaking; the problems appear to have motor origins. Mr. Gibson identifies words when he is shown pictures with items for everyday use.
His current physical assessments are within the normal: the heart rate is 82 with normal sinus rhythm; the blood pressure is 130/80; the respiratory rate is 18, regular (the normal RR for people of Mr. Gibson’s age is 12-28 (Rodríguez-Molinero, Narvaiza, Ruiz, & Gálvez-Barrón, 2013)); the oxygen saturation is 96% on 2 L/min; the body temperature is 98.6 F.
On the whole, the patient’s condition seems to be favorable. He is apparently recuperating from his ischemic stroke.
There are a number of factors that have predisposed the patient to the ischemic stroke. First, the patient had hypertension before the stroke (and refused to take medications for it); the vessels that are constantly tense can lead to a lack of blood supply, which increases the chance of an ischemic stroke.
Second, diabetes is also a risk factor (Hewitt, Guerra, del Carmen Fernández-Moreno, & Sierra, 2012); high sugar in blood damages many organs, including the vessels: the tunica intima loses its smoothness, which increases the risk of blood clotting. Third, smoking is also a factor that greatly increases the likelihood of a stroke; among the most known mechanisms are hypercoagulability (thrombophilia) and atherosclerosis (fibrofatty plaques inside the vessels) (Edjoc, Reid, Sharma, & Fang, 2013).
Fourth, the patient had the habit of eating all kinds of food, including junk food; apart from being a factor that increases the risk of stroke directly, it also exacerbates the patient’s diabetes. Fifth, the patient is overweight (weight: 250 lbs, height: 6 feet), which also stimulates the formation of plaques in the arteries, thus increasing the likelihood of thrombi, and, consequently, a stroke.
To identify the specified pathophysiological problems that led to the stroke, it is essential to gather information about the patient’s habits, as well as to obtain some clinical data. To know about the patient’s hypertension, it is necessary to monitor his blood pressure regularly for a period of time – to identify the persistently high BP.
To find diabetes, it is important to control the level of sugar in the blood; the blood for the tests must be taken on an empty stomach, because the levels of sugar in blood increase after an intake of food. The rest of the named factors that increase the risk of a stroke are more apparent (because they are related to the lifestyle, such as eating junk food or smoking cigarettes, or because they are rather obvious, such as being overweight).
To identify the pathophysiological problems caused by the ischemic stroke (the lack of blood supply to the brain), it is possible to look at the consequences of the stroke. The LoC (level of consciousness) test can be used not only to identify the severity of stroke; it includes a number of symptoms typical of a stroke, many of which are a loss of a certain function.
Other tests may be used to identify the lost or damaged functions. Finally, a CT or MRI scan can be used to identify the area where the stroke occurred (Ünlüer et al., 2012); this information can be utilized to understand which functions are likely to have been impaired.
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The only psychological problem mentioned in the description of Mr. Gibson’s case after he has been moved to the rehabilitation unit is that he “expresses remorse about not ‘being able to do what he did before’”; however, he stays motivated. Therefore, he apparently does not suffer from serious psychological disorders. However, such disorders still may be present. A psychologist’s examination might be useful.
The patient has suffered from an ischemic stroke. Pathophysiologically, it affects the function of blood circulation by creating an obstacle for the blood (an occluded vessel in the brain) and preventing it from reaching certain tissues in the brain. The brain tissues deprived of the blood supply stop performing their functions and start dying.
The person may lose their ability to do different actions, and may achieve a disability; the types of abilities lost depend on which part of the brain has suffered from the ischemia.
The disability may be permanent (and a stroke can also be lethal, of course); however, if the stroke was not too severe, and the blood supply was restored rapidly, the damage might not be so critical, and some of the living neurons may gradually adopt the function of the tissues that died, restoring the patient’s ability to perform certain actions, but this often may require additional training.
Mr. Gibson has difficulty speaking, and the problem seems to have motor origins. This means that he is capable of understanding words and formulating his thoughts using words in his mind, but he is unable to properly pronounce the words due to the damage to the parts of the brain that are responsible for moving speech muscles. It is possible that his ability to speak will be eventually restored, but a certain amount of time, and, quite possibly, special training (speech therapy) may be required.
Psychologically, Mr. Gibson might start suffering from e.g. depression due to his inability to perform certain activities (especially if it turns out that he is incapable of performing everyday activities). However, as it was mentioned, currently the patient stays motivated. It is important to support him via e.g. occupational therapy, and, of course, various types of encouragement and motivation (Carey, 2011); the OT might also allow him to restore some of his lost abilities, if he has lost any.
Pharmacologic Treatment Plan for Charles Gibson
The offered medications are as follows:
- Metformin 1000 mg PO every 12 hours – an anti-diabetic drug that is often used for overweight people. We would recommend using this medication, but monitoring the levels of sugar in blood. The patient had bad dietary habits, and now his diet has completely changed; it is necessary to check whether the dose is adequate. The levels of sugar should be checked until the patient starts having a (relatively) stable diet (currently, it is being considered whether to move him from nectar-thick foods to soft diet).
- Enteric coated aspirin 81 mg PO every day – lowers the chances of blood clot formation. Use, but monitor the possibility of hemorrhagic stroke, for it may increase due to aspirin (Doutremepuich, Aguejouf, Desplat, & Eizayaga, 2012). Also, ensure that the patient is not aspirin-resistant (Topçuoglu, Arsava, & Ay, 2011); if he is, the aspirin may be replaced by e.g. warfarin.
- Persantine (dipyridamole) 75 mg PO every day – also lowers the chance of blood clot formation. Administering it with aspirin means that if one of the medications is ineffective, the other will have an impact. However, perhaps it would be reasonable to start giving them gradually, not on the same day, to see whether they produce an effect. It also should be noted that if aspirin is ineffective, dipyridamole can be combined with warfarin.
- Losartan 75 mg PO every day – used for hypertension. The patient needs some hypertension medications, and Losartan is an appropriate choice.
- Amiodarone 200 mg PO every day – an anti-arrhythmic drug. The patient had atrial fibrillation when he arrived at hospital, but currently he has a normal sinus rhythm, and it is uncertain whether this condition will relapse again. On the other hand, atrial fibrillation, if it was persistent, may have damaged the tissues of the heart, making a relapse more likely (Kowey, Mohmand-Borkowski, & Burke, 2011, pp. 33-39), which is especially dangerous after a stroke, because strokes also often relapse (Ostwald, Godwin, Ye, & Cron, 2013). So perhaps it is justified to give him Amiodarone, especially when the dose is not high – 200 mg daily.
We could also recommend using:
- d-amphetamine, 10 mg once every four days for 10 sessions, in conjunction with physical therapy. It is stated that some experiments have shown positive results in patients with motor impairments and aphasia after a stroke (Stein, Harvey, Winstein, Zorowitz, & Wittenberg, 2015, ch. 12). This treatment may be offered to Mr. Gibson as experimental.
Nurse Educator’s Role in Developing Students
The nurse educator plays an important role in developing student’s professionalism. Apart from advancing their knowledge by providing theoretic information, the nurse educator has to develop the student’s practical skills of caring for the patients, and develop their abilities so they may use them effectively in the clinical setting. In other words, the nurse educator has to link the medical and nursing theory with the clinical practice, develop the learners’ natural abilities, and boost their passion for caring for patients.
Critical thinking in nursing comprises the use of logic and intellect in combination with the analysis of the data from the current research to provide patients with the care and medical assistance of the highest quality. The nurse has to be clear and precise in their judgments to eliminate possible mistakes or irrelevant information when caring for their patients.
To develop critical thinking, clinical judgment, and innovative communication in their students, nurse educators may use two following strategies:
- Give the students tasks which require self-reliant research and analysis. For instance, it is possible to give the students case studies with imaginary patients who have diseases that the learners have not studied before (but, clearly, they must have enough background knowledge to figure it out).
The students will learn to act in a situation when they have to gather information about a disease unknown to them (using the innovative means of communication, for instance, by searching medical databases), combine it with their current knowledge (develop critical thinking), and prescribe the treatment for the patient (use clinical judgment).
- Another option is to create a “role game” where a nurse has to deal with a patient (who has a disease that requires the nurse to look for new data to treat it properly), as well as with other individuals involved in the process of treating and caring: relatives, multiple physicians, other nurses.
This situation contains the benefits of the previous approach, developing the critical thinking, clinical judgment, and innovative communications skills in the same way, but it also adds additional practice of clinical judgment, for the nurse has to take into account the wishes, attitudes, and opinions of the other parties. To realize this method in practice, it is possible to use the virtual reality.
To sum up, we have studied the case of Charles Gibson, evaluated his physical assessments, described the pathophysiological mechanisms of his disease, and provided pharmacological options for his treatment. We have also explained the role of a nurse educator in the nurse teaching process. It is important to stress that understanding patients on an in-depth levels helps the nurse educator develop their students’ skills by e.g. showing how important the information and attitudes of the patients are for their treatment.
Carey, L. M. (Ed.). (2011). Stroke rehabilitation: Insights from neuroscience and imaging. New York, NY: Oxford University Press.
Doutremepuich, C., Aguejouf, O., Desplat, V., & Eizayaga, F. X. (2012). Paradoxical effect of aspirin. Thrombosis, 2012, 1-4. doi:10.1155/2012/676237.
Edjoc, R. K., Reid, R. D., Sharma, M., Fang, J. (2013). The prognostic effect of cigarette smoking on stroke severity, disability, length of stay in hospital, and mortality in a cohort with cerebrovascular disease. Journal of Stroke and Cerebrovascular Diseases, 22(8), e446-e454. Web.
Hewitt, J., Guerra, L. C., del Carmen Fernández-Moreno, M., & Sierra, C. (2012). Diabetes and stroke prevention: A review. Stroke Research and Treatment, 2012(12), 1-6. doi:10.1155/2012/673187.
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Ünlüer, E. E., Yaka, E., Akhan, G., Limon, Ö., Kara, P. H., Yavaşi, Ö.,…Kutluk, K. (2012). Ability of emergency physicians to detect early ischemic changes of acute ischemic stroke on cranial computed tomography. Medical Principles and Practice, 21(6), 534-537. Web.