In this paper I will be discussing a patient who at 49 years of age became incapacitated by a left sided cerebrovascular accident (CVA) following a motor vehicle accident. To keep her identity completely confidential, I will be referring to her as Mary. I will not refer to any medical staff or buildings by name for this same reason. Mary had two seizures while in hospital recovering from the motor vehicle accident (MVA). Mary's recovery was progressing normally but was compromised by a CVA following the seizures which left Mary with a permanent disability. Mary can not walk at all. She can stand with assistance for clothing adjustments. Mary can not talk properly, she responds with "yes", "no" or "oh no". Mary is cognitively disabled, although slightly, it can be difficult to tell when Mary is answering the questions or just responding to being spoken to.
Prior to the MVA and CVA, Mary had some health problems that include a long history of hypertension, asthma, an aortic valve replacement, diagnosed major depression, anxiety and epilepsy. The cerebrovascular accident has left Mary unable to perform any activities of daily living so has been forced to reside in a nursing home. Mary is surrounded by elderly patients primarily affected by dementia, leaving her susceptible to other possible problems such as depressive episodes, (although she is on medication for depression), boredom, or possible withdrawal just to name a few (Newcombe, 2005).
This paper will discuss how the nursing staff uses the nursing process to encourage Mary to be involved in activities and her surroundings and how they try to cater for a much younger patient living in the nursing home (Seaback, 2001). I will address areas such as medical and pharmacological management, mobility, and some of the other needs that Mary finds are now compromised, for example, spiritual, sexual, social, and cultural and the difficulties in general family contact.
Epidemiology & Aetiology
Stroke is the third leading cause of death in the United States (McCance & Heuther, 2002), and in Australia (National Stroke Foundation, 2004), after heart disease and cancer, and is the most common cause of Neurologic disability (Springhouse, 1998). The majority of stroke victims are over 65 years of age. Strokes can be hereditary, and seem to be more common in women ( McCance & Heuther, 2002). Stroke is slightly more common in African Americans that Caucasians, affecting African Americans with greater impairment and are twice as likely to die from a stroke as Caucasian people seem to be. This is also the case in Australia according to the Bureau of Statistics, (2005), Aboriginal people are 10 to 20 times more likely to be affected by stroke and heart disease than non-Aboriginal people. The risk factors include modifiable risk factors, which are things like lack of exercise, being overweight, cigarette smoking, alcohol abuse, hypertension, and contraceptive pill, basically the things that we can be changes through lifestyle changes or medical treatment. Non-modifiable riskfactors include age, gender, race and family history of cerebrovascular disease (Brown & Edwards, 2005). The most common cause of CVA in the elderly is thrombosis, resulting from obstruction in the extracerebral vessels or less frequently the intracerebral vessels (Springhouse, 1998). The second most common is the embolism. An occlusion caused by a fragmented clot, and can occur at any age and occurs suddenly, and thirdly, is a CVA caused by hemorrhage, this also can occur at any age and suddenly (Springhouse, 1998). Mary had been exposed to many of the common risk factors, hypertension, contraceptive pill, smoking, alcohol, aortic valve replacement, and being over weight (Brown & Edwards, 2005).
Awareness of the risk factors and being in control of modifiable risk factors is the most effective way of decreasing the likelihood of becoming victim of a stroke.