Introduction
The stroke
occurs when the flow of blood towards the part of the brain is blocked
or cut off. With no oxygen in the blood, the cells in the brain start
to die within minutes (Cherry and Jacob, 2016). To assist in stroke prevention
and better post-stroke management and rehabilitation, it is necessary to learn
better about the causes of stroke, it’s presenting features/ symptoms, and the
anatomical and functional changes it makes in the body. Stroke rehabilitation
also plays a greater role. It is defined as the process with which people
having disabling strokes take up treatment for better return to the normal life
like as much as plausible through relearning and regaining skills of daily
living (Cherry and Jacob, 2016). Rehabilitation also aims at assisting the
survivor to acknowledge and adapt to complexities, avoid secondary
complications and have better education for the family members to play the
supporting role (Winstein, Stein, Arena, Bates, Cherney, Cramer, Deruyter, Eng,
Fisher, Harvey and Lang, 2016). The essay is addressing the causes, presenting
features, and physiological relevance of stroke condition for defining the
implications of such functional changes for the rehabilitation nursing
practice.
The
rehabilitation nurses need to be aware of the causes of stroke to help in
avoiding relapse or stroke recurrence. The conditions which increase the risk
of stroke can be avoided with better rehabilitation process (Cherry and Jacob, 2016).
High blood pressure or hypertension is the biggest reason for strokes globally.
Stroke patients need blood pressure maintenance below 140/90 through
medications and other treatments possible. Further chewing tobacco or smoking
also increases the stroke odd. It is because nicotine increases the blood
pressure. The cigarette smoke results in building up fatty element in the key
neck artery and thickens blood to make clots (Kernan, Ovbiagele, Black,
Bravata, Chimowitz, Ezekowitz, Fang, Fisher, Furie, Heck and Johnston, 2014).
The rehabilitation nurses can support the survivors or risky patients to have
control on their blood pressure and smoking (if holds the smoking habit). The
defective heart valves and atrial fibrillation and even irregular heartbeat can
result in quarter of all the reported strokes in elderly people (Cherry and
Jacob, 2016). Even the clogged
arteries from the deposits of fats can result in stroke problem. Another major
cause of stroke is diabetes. This health condition is also found with
hypertension and obesity that
together enhances the stroke likelihoood (Winstein et al., 2016). Diabetes results in blood vessel
damage that makes likely that the stroke occurs. If stroke has occurred, the blood
sugar levels are usually high and even the injury to the brain is higher. The
rehabilitation staff needs to know these causes to keep them as far as possible
from the patient (Kernan et al., 2014).
It is
not just about the awareness about the causes of stroke, but to have good
presence of mind and good observational skills in terms of presenting features
of stroke. It is to be aware of its symptoms. It is to pay attention to when symptoms
start (Dreyer, Angel, Langhorn, Pedersen and Aadal, 2016). The length of
symptom’s time can impact the treatment and rehabilitation options. If the
person has trouble with understanding and speaking, like confusion, slurring of
words, and complexity in understanding speech, it is the direct symptom
(Meschia, Bushnell, Boden-Albala, Braun, Bravata, Chaturvedi, Creager, Eckel,
Elkind, Fornage and Goldstein, 2014). The person may develop weakness, numbness
or paralysis in arms, legs or face suddenly, but at only one side of the body,
stroke is potential. It could be like falling of one arm when you raise the
hands, or dropping of one side of the mouth while smiling (Cherry and Jacob, 2016).
Another symptom is trouble seeing in both or one eye. If the person experiences
blurry or blackened vision or doubled vision, stroke is happening. Moreover,
severe and sudden headache accompanied by dizziness, vomiting, or altered
consciousness, and trouble while walking (loss of coordination or balance) are also the alerting signals of stroke
(Meschia et al., 2014).
The stroke sometimes causes permanent or temporary
disabilities, relying over how long the brain is lacking blood flow and which
brain part is being affected. The most important and most basic complication of
stroke is paralysis or loss of motor control (Dreyer
et al., 2016). This disability occurs
often on one side of the body which occurs in the opposite side of the brain
which is damaged by stroke. The paralysis can impact the arm, leg or face or
even the whole side of the body (Meschia et al., 2014). The defined one-sided paralysis is termed
as hemiplegia (this is the one-sided weakness known as hemiparesis).
Even the stroke patients having hemiplegia or hemiparesis might hold complexity
with daily activities like grasping objects or walking (Dreyer et al.,
2016). Certain stroke patients might
suffer from swallowing issues known as dysphagia because of damage
to brain part which controls the swallowing muscles. Even the damage occurs in
the lower brain part that is the cerebellum; it can result in the body’s
capability to coordinate movements which is known as ataxia. This
leads to issues with balance, walk and body posture (Meschia et al., 2014).
Rehabilitation will not work until and unless the
nursing staff is not aware of survivor’s problem level with understanding or
using language also known as aphasia. Over
1/4th stroke survivors experience the language impairments (Lohse,
Lang and Boyd, 2014). If the stroke-induced
injury has occurred in the language-control center of the brain, it can
severely cause verbal communication impairment. Brain’s left side has dominant language
centers for right-handed individuals and several left-handers (Winstein
et al., 2016). This is the Broca's area
and it causes expressive aphasia where survivor is not able to convey their
thoughts via writing or words. They develop incoherent speech and make grammatically
incorrect sentences. The damage to the language center in the rear brain portion
is termed as Wernicke's area which leads to receptive aphasia (Dreyer
et al., 2016). These people suffer from
complexity in understanding written or spoken language and usually experience incoherent
speech. The sentences made are grammatically correct, but the utterances devoid
meaning. Global aphasia is the most
severe type of aphasia which occurs due to extensive damage to various brain
parts involved in the language function (Dreyer et al., 2016). This aphasia makes the survivor lose almost
all the linguistic capabilities as they cannot use language to convey their
thoughts or understand language. The rehabilitation need to focus on innovative
and lesser stressful strategies of enhancing patient’s language skills (Cherry
and Jacob, 2016).
Rehabilitation
nursing practice is also based on analysing the degree of damage to survivor’s
thinking and memory functions. Stroke also damages certain brain parts
responsible for awareness, learning, and memory. The survivor might suffer from
dramatically shortened span of attention or deficits in the short-term memory
(Lohse et al., 2014). People might lose planning ability, comprehension skills,
ability to learn new tasks, or involvement in complex mental tasks. Thus,
rehabilitation nursing practice needs to work on improving patient’s memory and
thinking. Further, two common deficits due to stroke are neglect (inability to make response to stimuli or objects situated
on stroke-impaired side), and anosognosia (inability in acknowledging physical impairments due to stroke)
(Meschia et al., 2014). The rehabilitation system also examines patient’s apraxia development
which causes inability to carry out the purposeful movement learning and
inability to do work in sequence. They cannot follow set of instructions. This
occurs due to disruption in person’s subtle connections existing between one’s thoughts
and actions (Cherry and Jacob, 2016).
Another
major consideration during rehabilitation process is to analyse and define ways
to control person’s emotional skills and disturbances. It is because 25% of
stroke survivors feel fear, anger, anxiety, a sense of grief, frustration, and
sadness for their mental and physical losses (Winstein et al., 2016). Such
feelings are highly probable as their natural response towards experienced psychological
trauma. Even the brain damage causes certain personality and emotional changes.
The clinical depression has been reported as a key complication in several
people post-stroke that leads to sense of hopelessness (Wade, 2016). Person
might experience symptoms like sleep disturbances, lethargy, radical alteration
in eating patterns causing sudden weight gain or loss, irritability, social
withdrawal, suicidal thoughts, fatigue, and self-loathing. Rehabilitation
nursing practice should pay attention to emotional stability of the stroke
survivors to maintain their mental balance and more involvement in societal
activities (Lohse et al., 2014).
Rehabilitation
nursing implication is also related to person’s loss of capability to feel pain,
touch, position, or temperature, or to say sensory disturbance level. These
deficits result in severe loss of one’s ability to recognize the limb (Dreyer
et al., 2016). The experience of numbness, pain or odd tingling sensations or
prickling in weakened or paralyzed limbs is termed as paresthesias. Due to combination of motor and sensory
deficits, it can also result in urinary incontinence. They lose control
over the bladder muscles. It could be temporary but needs better rehabilitation
procedures (Lohse et al., 2014). Neuropathic pain is quite common in stroke
survivors. It also occurs because the pathways for sensation gets damaged that
result in the transmission of false signals of pain. The "thalamic pain
syndrome" is most common when thalamus is damaged (Gillen, 2015). The
rehabilitation nurses need to know if the patient is suffering from neuropathic
pain or pain due to mechanical problems radiating up and down. Rehabilitation
procedures must focus on better joint movements of patient as immobilization
for longer period results in pain in joints due to fixed ligaments and tendons also
known as "frozen" joint
(Östlund, Bäckström, Saveman, Lindh and Sundin, 2016).
It has
been found that the rehabilitation services that are available at the nursing
facilities are quite variable as compared to the inpatient and outpatient
units. With the skilled nursing facilities, there is a greater emphasis over
the rehabilitation nursing process (Gillen, 2015). Rehabilitation assists the
stroke survivors relearn skills which gets lost due to damage in brain’s part,
for instance, skills in coordinating leg movement for step and walking in the
complex activity. The rehabilitation helps the survivors to learn new methods
of task performance to compensate or circumvent for any type of residual
disability (Kernan et al., 2014). The stroke survivors need to learn the ways to
dress and bathe using just one hand or ways to communicate efficaciously when
language gets compromised. The research reveals that rehabilitation nursing
must focus on a directed, repetitive and well-focused practice to help stroke
patients to relearn their lost skills like a child once again with patient and
support (Östlund et al., 2016). It is essential for the rehabilitation nursing
practice to understand the physiological and anatomical changes that occur in
stroke to plan accurate care and rehabilitation services. It is also because
the rehabilitative therapy starts within the acute-care hospital just after the
patient has stabilized, usually within 24 to 48 hours post-stroke (Wade, 2016).
The very first step in rehabilitation is to assess patient’s movement ability
which is most hampered. The independent movement needs the very first priority
as several individuals after stroke suffer from paralysis or gets seriously
weakened. This assessment is also necessary to define the right process of
engaging the person in active or passive range of motion exercises for
strengthening his/her stroke-impaired limbs (Gillen, 2015). The rehabilitation
nurses as well as therapists assist the patients to learn to perform highly
demanding and complex tasks like dressing, bathing, and toilet using and to use
stroke-impaired limbs as possible. The details about person’s strengths and
weaknesses are necessary in physiological sense to ascertain the ways to help
the survivor to return to their independence (Östlund et al., 2016).
Conclusion
Stroke rehabilitation is a necessity because the
stroke survivors experience extreme changes and complexities in their daily
living. The sudden change in behaviour, self-care abilities, movements,
orientation, mental abilities, and communication make their life congested and
complicated. These negative changes and effects results in social withdrawal
and even make them impulsive due to disabilities. Thus, the nurses
specialized in rehabilitation assists the stroke survivors to relearn the way
to carry out the most basic ADLs and activities of daily living. They can
educate the survivors regarding the routine health care like how to have better
medication schedule follow up, ways to care for the skin, ways to move out of
the bed and within the wheelchair, and providing services to the special needs
for people who also have diabetes, only when the rehabilitation nurse know how
stroke has and will impact the patient’s anatomy and physiology. This knowledge
supports the nurses to decrease the risk factors which can result in second
stroke or recurrence to provide better caregiver training at the same time. As
the nurses are quite closely involved to support the stroke survivors in the
management of the personal care issues, they need to have detailed knowledge
about the core health status of the patient. The rehabilitation strategies can
be promoted only when the nurse knows what and how to tackle the patient needs.
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