Case Study

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Student Number: 21127187

Module: Assessment and Therapeutic Care Management

Module Code: AN 602

Assignment Title: A Case study: Stroke Care Management and Pressure Ulcer Assessment Tool

Word Count: 3296

Date Submitted: 11th January, 2012

This academic work aims to present a clinical case study of a patient who is diagnosed of cerebrovascular accident (CVA), also called “stroke”, achieve a deeper understanding of debilitating post-stroke complications using an assessment guide and nursing interventions to the nursing diagnosis of impaired skin integrity. This essay aims to incorporate the utilisation of a pressure ulcer grading assessment tool to establish baseline assessment data and facilitate ongoing wound care management in relation to pressure ulcers (PrUs) as one of long term problems encountered in the care of a stroke patient. A holistic assessment of the patient will be required, identifying activities of daily living to enable the nurse to devise a plan involving the therapeutic team in line with identified nursing diagnoses. Due to limitation on word count, the essay will focus more on the present health status in relation to areas pertinent to PrUs management during the rehabilitation process. For the purpose of this academic work, the patient will be protected by the Nursing and Midwifery Council (NMC) Code of Conduct (2008) by use of a pseudonym, ‘Mr. X’. Mr. X, is an 87 year-old elderly obese patient, with long-term diagnosis of Hypertension (HPN) and Non-Insulin Dependent Diabetes Mellitus (DM), on maintenance medications, who was recently diagnosed of Cerebrovascular Accident (CVA). Mr. X was transferred to a nursing home after the acute hospitalisation for long-term care. Brunner (2008) defines CVA, Ischemic Stroke, or “Brain Attack” as sudden loss of neurologic functioning resulting from blood flow disruption in cerebral blood vessels. Stroke has two main types, Ischaemic and Hemmorhaegic: the former is caused by an infarct of blood clot in brain artery and accounts for 80 % of all stroke cases; while the latter is caused by bleeding into the brain tissues accounting to 20 % of stroke occurrences (Feigin et al, 2003). Stroke is the third leading cause of death and is a major cause of adult neurological disability which affects approximately 130,000 people a year in the UK (National Audit Office, 2005). Mr. X was diagnosed of having left middle cerebral artery (MCA) infarct 7 months ago resulting to neurological deficits on the contralateral side of the body. The extent of deficits following stroke depends upon the affected cerebral artery and subsequent areas of brain tissue compromised of blood supply by the damaged vessel (Porth, 2007). Upon assessment, Mr. X has right side hemiplegia, contralateral sensory impairment, dysphasia, bowel and bladder incontinence, and an existing Category I PrUs on both heels. The hemiplegia is explained by Brunner (2008) that because motor neurons decussate, a disturbance of motor control on one side of the body may reflect damage to the motor neurons on the opposite side of the brain. Williams et al (2010) states that following a MCA infarct, there is alteration of the brain’s ability to process and interpret sensory data which results in Mr. X’s sensory impairment. Porth (2007) defines aphasia as a general term with varying degrees of inability to comprehend, integrate, and express language. Porth (2007) further states that a stroke on the MCA territory is the most common aphasia-producing stroke. It is then imperative to understand the pathology of affected areas of the brain to anticipate presence of motor, sensory, and speech deficits where the nurses and entire therapeutic team can intervene. For the purpose of data gathering and assessment, Gordon’s Functional Health Pattern (1987) is utilised as a framework of this essay. The model presents 11 functional health patterns categorized systematically for...
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