Case Study: Cardiovascular Accident (Pathophysiology, Nursing Role, Priorities, and Shared Decision-Making)

Overview of the pathophysiological state

Hello, everyone. Today’s presentation will explore the topic of cerebrovascular accidents through the case study of Kevin. Cerebrovascular accidents (CVA), commonly known as strokes, encompass two main types: ischemic and hemorrhagic strokes, each characterised by distinct pathophysiological mechanisms and associated risk factors (Khaku & Tadi, 2023). Ischemic strokes occur when a clot or narrowing in a cerebral artery disrupts blood flow to the brain. Risk factors for ischemic strokes include hypertension, smoking, diabetes, and atrial fibrillation. On the other hand, hemorrhagic strokes involve bleeding into or around the brain, frequently triggered by hypertension-related vessel rupture or the bursting of aneurysms. Hypertension and aneurysms are significant risk factors for hemorrhagic strokes (Khaku & Tadi, 2023).

In 2018, Australia witnessed an alarming statistic: an estimated 387,000 Australians aged 15 and over, accounting for 1.6% of the population, had experienced a stroke at some point in their lives (Australian Institute of Health and Welfare, 2023). According to the most recent data available for Australia, slightly more than one-third of stroke survivors have a handicap that hurts their everyday activities. 88% of disabled stroke survivors receive care at home, compared to 12% in residential care. Limitations in movement, speech impairment, paralysis or weakness of either side of the body, grasping or holding objects, and delayed communication ability are the most common stroke-related difficulties (Better Health Channel, 2021). The following slide will discuss registered nurses' role in providing safe and effective care.

Role of the Registered Nurse

Registered Nurses (RNs) serve as representatives in promoting safe and effective nursing care, adhering to Australia's National Safety and Quality Health Service (NSQHS) standards, particularly regarding cerebrovascular accidents. Firstly, through nurse-led education (Standard 1:Clinical Governance), RNs empower patients with knowledge about cerebrovascular accident risk factors and prevention strategies. They equip patients and their families with the tools to recognise stroke symptoms early and make informed choices for healthier living (Australian Commission of Safety and Quality in Health Care [ACSQHC], 2021).

Secondly, RNs emphasise shared decision-making (Standard 2: Partnering with Consumers) when planning nursing care for stroke patients. Collaborating closely with patients and their families, RNs ensure that care plans align with individual preferences, values, and needs, fostering patient autonomy and participation. Finally, RNs' deep understanding of cerebrovascular accident pathophysiology (Standard 6: Communicating for Safety ) enables them to provide rapid, informed care while facilitating effective clinical handovers that improve patient safety. This multifaceted approach underscores the critical role of RNs in meeting NSQHS standards and ultimately enhancing patient outcomes in cerebrovascular accident care (ACSQHC, 2021).

Nursing management priorities

Let’s now discuss the nursing management priorities relevant to Kevin’s case. In the comprehensive care plan for Kevin, who has experienced a CVA, a holistic approach is crucial to align with best practices and the Acute Stroke Clinical Care Standard. Frequent neurological assessments using the NIH stroke scale and hourly checks will enable monitoring changes and gauging treatment effectiveness. A validated stroke screening tool, like the F.A.S.T. ( Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services) test, will ensure immediate assessment upon first contact, facilitating early stroke recognition and prompt intervention (ACSQHC, 2019). Controlling Kevin's elevated blood pressure through antihypertensive medications, such as a combination of aspirin and dipyridamole, will be crucial (Australian Prescriber, 2021). Dysphagia management, including consulting a speech therapist and administering prophylactic antibiotics, mitigates aspiration pneumonia and malnutrition risks (Tamburri et al., 2020).
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Early mobilisation and rehabilitation, in collaboration with therapists, address Kevin's right hemiparesis and ataxia, adhering to stroke unit care principles (ACSQHC, 2019). Effective communication support, including alternative methods and involving his family, is paramount for patient-centred care. Medication management ensures adherence to secondary stroke prevention with patient education. Smoking cessation counselling acknowledges a significant risk factor. Nutritional assessment and support, psychological counselling, and comprehensive education and discharge planning complete the patient-centric approach, ensuring Kevin's well-being during hospitalisation and post-discharge (InformMe, 2023).

Shared decision-making

Now, we will discuss promoting shared decision-making with Kevin, a person recovering from a Cerebrovascular Accident (CVA), This would involve a patient-centred approach that considers his individual needs and preferences. To begin, I would ask what matters most to the patient. This question allows Kevin to express his values and goals, providing insight into what he considers meaningful in his recovery journey, whether regaining independence or improving specific aspects of his life post-stroke. Furthermore, I would ask what symptoms the patient finds most difficult. This query helps identify the symptoms that impact Kevin's daily life the most, allowing me to prioritise interventions and therapies accordingly.

When discussing treatment options, I would explore which risks and benefits matter most to Kevin. By involving Kevin in the conversation about potential treatment outcomes, he can express his tolerance for risks and the benefits he values most. This input is essential in tailoring the care plan to align with his preferences. Lastly, I would ensure that Kevin can access adequate support and advice by asking if he has enough support and advice to make a decision. This question underscores the importance of patient education and collaboration, ensuring that Kevin and his family feel well-informed and supported throughout the decision-making process. Ultimately, these questions will serve as a foundation for a collaborative care approach, where Kevin's unique needs and priorities guide the development of a care plan that respects his values and enhances his engagement in his recovery.

References

Australian Commission on Safety and Quality in Health Care [ACSQHC]. (2019). Acute stroke clinical care standard. https://www.safetyandquality.gov.au/sites/default/files/2022-05/Acute-Stroke-Clinical-Care-Standard-2019.pdf

Australian Commission on Safety and Quality in Health Care [ACSQHC]. (2021). National Safety and Quality Health Service Standards (2nd ed). https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_updated_may_2021.pdf

Australian Institute of Health and Welfare [AIHW]. (2023). Heart, stroke and vascular disease: Australian facts. https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/all-heart-stroke-and-vascular-disease/stroke

Australian Prescriber. (2021). Drugs in secondary stroke prevention. https://australianprescriber.tg.org.au/articles/drugs-in-secondary-stroke-prevention.html

Better Health Channel. (2021). Effects of stroke. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/effects-of-stroke

InformMe. (2023). Living clinical guidelines for stroke management. https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management

Khaku, A.S., & Tadi, P. (2023). Cerebrovascular disease. In Stat Pearls [Internet]. Stat Pearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430927/

Tamburri, L. M., Hollender, K. D., & Orzano, D. (2020). Protecting patient safety and preventing modifiable complications after acute ischemic stroke. Critical Care Nurse, 40(1), 56-65. https://doi.org/10.4037/ccn2020859

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