Stroke as Healthcare Issue and Management

Management Issues and Stroke as Healthcare 

What is Stroke,Stroke Warning Signs,Stroke as an Health Issue,Medical and Surgical Procedure for Stroke,Disabilities after Stroke as a Health Challenge,Nursing Care for Stroke Survivors,Family Care for Stroke Patient.

What is Stroke

    Stroke, also known as cerebrovascular accident or apoplexy, is a sudden loss of consciousness due to either a loss of blood flow to the brain or a sudden rupture of a blood vessel in or near the brain. There are two main types of strokes. 

    An ischemic stroke is caused by thrombus formation due to narrowing of the arteries from arteriosclerosis, an embolus that has dislodged and traveled to the brain, or a lack of blood flow to the brain due to circulatory failure (American Heart Association, 2004). 

    A hemorrhagic stroke results from the rupture of a blood vessel either in the space between the brain and the skull (subarachnoid hemorrhage) or deep within the brain tissue (intracerebral hemorrhage) (American Heart Association). A transient ischemic attack (TIA) is a brief disruption of blood flow to the brain causing warning signs to occur.

Stroke Warning Signs

Such warning signs of stroke include:

(a) sudden numbness or weakness of the face, arm, or leg

(b) sudden confusion, trouble speaking or understanding

(c) sudden trouble seeing in one or both eyes

(d) sudden trouble walking, dizziness, loss of balance or coordination

(e) a sudden severe headache (American Heart Association)

    Common disabilities from stroke include hemiparesis (50%), inability to walk without assistance (30%), activities of daily living dependency (26%), aphasia (19%), depressive symptoms (35%), and institutionalization in a nursing home (26%) (American Heart Association, 2003).

Stroke as an Health Issue

    Stroke is the third leading cause of death in the United States and about a quarter of first-time stroke survivors die within 1 year of having a stroke (American Heart Association, 2003). Approximately 500,000 people each year experience a stroke for the first time, and another 200,000 suffer a recurrent stroke (American Heart Association). 

    Stroke is also the number one cause of serious, long-term disability in the US (American Heart Association). There are currently about 4,800,000 stroke survivors alive today in the US, 1,100,000 of whom report functional limitations or deficits in activities of daily living (American Heart Association). 

    In 2004, stroke was estimated to cost $53.6 billion, with a mean lifetime cost for ischemic stroke estimated at $140,048 per person including inpatient care, rehabilitation, and follow-up care (American Heart Association).

 Medical and Surgical Procedure for Stroke

    Carotid endarterectomy is the most common surgical procedure and anticoagulants and antiplatelet agents are the most common medications used to prevent stroke (American Heart Association, 2003, 2004). It has only been within the past 10 years that an effective treatment for acute ischemic stroke has been made available to the public. 

    Tissue type plasminogen activator (tPA) is a drug that must be given intravenously to patients with ischemic stroke within 3 hours of the first warning sign to prevent disability from stroke. Unfortunately, few stroke survivors are able to make it to a physician who can administer tPA within the 3-hour time window. 

    This dilemma has prompted the development of primary stroke centers (Alberts et al., 2000). Recommendations for primary stroke centers include an integrated emergency response system, acute stroke team, in patient stroke unit, and written care protocols. 

    The acute stroke team must include a physician and a nurse who are available 24 hours a day for rapid evaluation of patients experiencing the warning signs of stroke (Alberts et al.). 

    Once stroke survivors are stabilized, they enter the rehabilitation phase of treatment where they learn how to live with their disabilities from stroke. Multidisciplinary rehabilitation teams consist of physicians, physiatrists, nurses, psychologists or psychiatrists, counselors, and physical, occupational, recreational, and speech therapists (American Heart Association, 2004).

Disabilities after Stroke as a Health Challenge

    Learning how to live with disabilities resulting from stroke is challenging for not only stroke survivors, but also for their family caregivers. Poststroke depression is a major complication of stroke and can greatly impede recovery (American Heart Association, 2004). 

    Other quality-of-life issues for stroke survivors include disruption of personality and moods, diminished self-care, changes in social and family roles, loss of work or productivity, among others (Williams, LS Weinberger, Harris, Clark, & Biller, 1999). 

    Family caregivers often experience negative changes in social functioning, subjective well being, and perceived health as a result of providing care (Bakas & Champion, 1999). 

    Caregiver tasks perceived as most difficult include managing behaviors and emotions of the stroke survivor, as well as providing household tasks and managing finances after stroke (Bakas, Austin, Jessup. Williams, & Oberst, 2004).

Nursing Care for Stroke Survivors

    Nurses are involved with the care of stroke survivors throughout the continuum of care. ET Miller and Spilker (2003) found that their educational intervention was effective in reducing stroke risk factors and increasing stroke knowledge in a local family practice. 

    Judith Spilker and colleagues (1997) integrated the use of the National Institutes of Health Stroke Scale into current nursing practice as a clinical stroke assessment tool. It is now widely used in stroke centers across the nation. Nursing research is greatly needed in the area of demonstrating best practices in the care of stroke survivors, particularly as new protocols are written and evaluated. 

    There are few published nursing research articles in the area of stroke survivor quality of life. Perhaps the development of outcome measures, such as the Stroke-Specific Quality of Life Scale (Williams, LS, et al., 1999), will stimulate more research in this area. 

    A recent search of the Computer Retrieval of Information on Scientific Projects (CRISP) a database of biomedical research funded by the National Institutes of Health (nd) revealed two studies of interest funded by the National Institute for Nursing Research (NINR).     

    Pamela Mitchell has been funded to evaluate a nurse-delivered psychosocial/ behavioral intervention for poststroke depression. Sharon Ostwald has been funded to evaluate her intervention for stroke survivors and spousal caregivers. It is hopeful that these intervention programs will provide promise for the future care of stroke survivors.

Family Care for Stroke Patient 

    Published nursing research focusing on family caregivers of stroke survivors is growing. Brief research instruments that show promise for clinical assessment in practice include the Oberst Caregiving Burden Scale (Bakas et al., 2004) and the Bakas Caregiving Outcomes Scale (Bakas & Champion, 1999). 

    JS Grant, Elliott, Weaver, Bartolucci, and Giger (2002) documented the effectiveness of a problem solving intervention in reducing stroke caregiver depression and improving caregiver perceived health. A search of the CRISP database (2004) revealed even more studies funded by NINR focused on family caregivers of stroke survivors. 

    Patricia Clark has been funded to explore family function, stroke recovery, and caregiver outcomes. Judith Matthews has been funded to determine the use of technology with stroke caregivers. 

    Rosemarie King was recently funded to evaluate the effectiveness of her problem-solving intervention for stroke caregivers, and Bakas has received funding to develop and pilot test the “Caregiver Telephone Assessment and Skill-Building Kit.” Linda 

    Pierce has been funded to test her intervention entitled, “The Caring Web” for stroke caregivers. All of these studies show great potential toward improving the care and well being of families of stroke survivors. 

    Now is a very fruitful time for nurses to conduct research in the area of stroke and stroke caregivers. With stroke being the number one cause of serious, long-term disability in the US, it is imperative that nurses take the lead in developing programs that improve the care of stroke survivors and their family members.