Advanced Nurse Practice in Stroke Care
Advanced nursing Practice
The aim of this essay is to demonstrate the development of existing skills in health assessment and critically utilise outcomes of advancing health assessment as the basis for expert decision making in stroke patient care.
This assignment will compare four cases describing my journey through the development of health assessment skills using the medical model of assessment, ‘history, examination and diagnosis ‘and joining it with the nursing assessment to give a holistic approach. The process of formulating a diagnosis will be explored, together with how advancing practice has enabled me to use collaborative working and expert decision making to improve the care of stroke patients. The identity of all patients and colleagues referred to in this essay will be anonymised as in accordance with the NMC Code of Conduct (2008)
Stroke is now considered a medical emergency. The department of health now categorise potential stroke event as category A response similar to a Myocardial infarction (DH 2007a).Saver (2006) had estimated that for each minute untreated a person will lose 1.9 million neurones and 14 billion synapses. The acute care of a patient with a suspected stroke is dependent on rapid recognition of the symptoms and signs of the stroke, immediate CT scanning to exclude a haemorrhage and treatment where possible including potential thrombolysis to improve blood flow to the ischaemic brain. Once a diagnosis of a stroke has been made and haemorrhage excluded on CT and a symptom onset within four and half hours has been determined (ECASS 3) the patient may benefit from thrombolysis using alteplase. In selected patients alteplase can considerably improve the outcome for patients in reducing long term disability (NINDS 1995). The increasing focus on acute and hyperacute stroke care together with development of stroke units and community stroke
services mean
The aim of this essay is to demonstrate the development of existing skills in health assessment and critically utilise outcomes of advancing health assessment as the basis for expert decision making in stroke patient care.
This assignment will compare four cases describing my journey through the development of health assessment skills using the medical model of assessment, ‘history, examination and diagnosis ‘and joining it with the nursing assessment to give a holistic approach. The process of formulating a diagnosis will be explored, together with how advancing practice has enabled me to use collaborative working and expert decision making to improve the care of stroke patients. The identity of all patients and colleagues referred to in this essay will be anonymised as in accordance with the NMC Code of Conduct (2008)
Stroke is now considered a medical emergency. The department of health now categorise potential stroke event as category A response similar to a Myocardial infarction (DH 2007a).Saver (2006) had estimated that for each minute untreated a person will lose 1.9 million neurones and 14 billion synapses. The acute care of a patient with a suspected stroke is dependent on rapid recognition of the symptoms and signs of the stroke, immediate CT scanning to exclude a haemorrhage and treatment where possible including potential thrombolysis to improve blood flow to the ischaemic brain. Once a diagnosis of a stroke has been made and haemorrhage excluded on CT and a symptom onset within four and half hours has been determined (ECASS 3) the patient may benefit from thrombolysis using alteplase. In selected patients alteplase can considerably improve the outcome for patients in reducing long term disability (NINDS 1995). The increasing focus on acute and hyperacute stroke care together with development of stroke units and community stroke
services mean
References: Bald H (2006) Differential diagnosis in advanced nursing practice. British Journal of nursing Vol15 No 8 pg 1007-101 Carryer J., Gardner G., Dunn S., Gardner A. (2007) The core role of the nurse practitionercr: practice, professionalism and clinical leadership. Journal of Clinical Nursing. 16, 1818-1825. Department of Health (2007a) A New Ambition for Stroke: A Consultation on a National Strategy. The Stationary Office. London. Epstien O, Perkin GD, Cookson J and de Bono DP (2004) Clinical Examination. Mosby, London. ECASS 3 trial Kirk,R.M.(2006)Basic Surgical Techniques.Churchill Livingstone.London.pg49 Mursell, I. (2009) Looking towards a model of advanced practice in the UK. Journal of Paramedic Practice. 1 (6); 245-251. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischaemic stroke. New England Journal of Medicine.333, 24, 1581-1587 Nursing and Midwifery Council (2008) The NMC Code of Professional Conduct: Standards for conduct Performance and Ethics.NMC London. Saver JL (2006) Time is brain – quantified. Stroke.37,1,263-266