CNA504 REHABILITATION NURSING 2

Assessment Task 1

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 1/4^th 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.

References

Cherry, B. and Jacob, S.R., 2016. Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Dreyer, P., Angel, S., Langhorn, L., Pedersen, B.B. and Aadal, L., 2016. Nursing roles and functions in the acute and subacute rehabilitation of patients with stroke: going all in for the patient. Journal of Neuroscience Nursing, 48(2), pp.108-115.

Gillen, G., 2015. Stroke rehabilitation: a function-based approach. Elsevier Health Sciences.

Kernan, W.N., Ovbiagele, B., Black, H.R., Bravata, D.M., Chimowitz, M.I., Ezekowitz, M.D., Fang, M.C., Fisher, M., Furie, K.L., Heck, D.V. and Johnston, S.C.C., 2014. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, pp.STR-0000000000000024.

Lohse, K.R., Lang, C.E. and Boyd, L.A., 2014. Is more better? Using metadata to explore dose–response relationships in stroke rehabilitation. Stroke, 45(7), pp.2053-2058.

Meschia, J.F., Bushnell, C., Boden-Albala, B., Braun, L.T., Bravata, D.M., Chaturvedi, S., Creager, M.A., Eckel, R.H., Elkind, M.S., Fornage, M. and Goldstein, L.B., 2014. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(12), pp.3754-3832.

Östlund, U., Bäckström, B., Saveman, B.I., Lindh, V. and Sundin, K., 2016. A family systems nursing approach for families following a stroke: Family health conversations. Journal of family nursing, 22(2), pp.148-171.

Wade, D., 2016. Rehabilitation–a new approach. Part four: a new paradigm, and its implications.

Winstein, C.J., Stein, J., Arena, R., Bates, B., Cherney, L.R., Cramer, S.C., Deruyter, F., Eng, J.J., Fisher, B., Harvey, R.L. and Lang, C.E., 2016. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), pp.e98-e169.