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  • Subject Name : Nursing

The Relevance of Nurses and Midwives Code of Conduct in Australia

Introduction to Mr. Sam Kwan Case Study

Acute stroke or cerebrovascular accident is one of the most common causes of deaths and results in high incidences of mortality and morbidity (Liu et al., 2019). This paper presents an analysis of a case 74-year-old patient, Mr. Sam who has suffered from an acute stroke. This paper presents pathophysiology of cerebrovascular accident and develops a treatment and management plan for the patient with interdisciplinary care and with long term and short term interventions for holistic care and recovery of the patient. 

Part I: Pathophysiology of Cerebrovascular Accident (CVA)

CVA is also commonly known as an acute stroke and is defined as a clinical scenario when a part of the brain fails to get the adequate blood supply and results in blood deprivation in neurons and thus ceases their function (Clare, 2017). This inadequacy of blood availability can be ischemic, that is due to limited blood flow or hemorrhagic, that is due to bleeding in the brain or tissue. The ischemic acute stroke is more common and accounts for about 85% of the total CVAs. The relatively less common is a hemorrhagic stroke with about 5% of total incidents and is caused by direct bleeding in the brain due to rupturing of blood vessel of injury. Multiple causes direct the incidence of CVA in a patient (Clare, 2017). These include a prolonged history of hypertension and arteriosclerosis, history of cardiac disease and atrial fibrillation. Medical history of clotting disorders is also associated with an increased risk of CVA in the patients (Chen et al., 2016). In the given case scenario, Mr. Sam Kwan possesses a medical history of hypertension along with cardiac conditions like congestive heart failure. The patient also has a long history of smoking and diabetes mellitus. These factors have together resulted in an incidence of acute stroke in the patient.

The pathophysiology of the condition is directly linked with atherosclerosis that results in plaque formation and hinders the flow and supply blood into the brain. The atrial pressure increases and thus results in rupture of the artery causing a hemorrhagic stroke (Liu et al., 2019). The difficulty in blood flow increases the atrial pressure also contributes to an increase in the blood pressure in the patient. This is also evident in the case of Mr. Sam where the patient is suffering from a CVA and has the blood pressure of 140/105 mmHg which signals hypertension as it should ideally be in the range of 120/80 mmHg (Ginsberg, 2018). The patient also possesses a medical history of hypertension that also contributes to the high blood pressure in the patient. As the atrial blockage occurs, the adjacent neurons in the brain are rendered deficit of blood and oxygen supply an undergo damage. The cellular metabolism of the neurons is hindered and as a consequence depolarization of neurons takes place and this results in neuron death through cellular toxicity (Chen et al., 2016). Cytotoxic edema is observed in the first 12 hours and is often associated with swelling. The early signs of edema were also observed in the case of Mr. Sam with a CT scan with an increased density in the left middle and the cerebral artery. As the brain function is lost, contralateral hemi-paralysis is observed along with hemianopsia and agnosia.

A left-side hemi-paralysis is also being observed in the case of Mr. Kwon. This can be directly associated with the pathophysiological manifestation of the CVS and indicates a weakening of the muscles in the body due to stroke (Mann, 2018). The aphasia and apraxia are observed in the case of CVS as the brain function is hampered. In the given case scenario, the patient has suffered significantly from the effects of CVS and requires a communication board and is able to answer to the closed questions via nod. As the blood supply is hindered in the brain the body tries to compensate for the lack of oxygen and the respiratory rate of the patient goes up (Wong et al., 2016). This is evident in the case of Mr. Sam who has developed the respiratory rate of 24 breaths per minute that should ideally be in the range of 12-20 breaths per minute (Mann, 2018). Therefore, immediate management of the condition is required. Poor management of the CVA can result in long term disabilities, brain damage, and even death (Ginsberg, 2018).

Part II: Interprofessional Care and Management Plan for Mr. Sam Kwon

Interprofessional care and management plan aim to improve the health condition of the patient by providing multidisciplinary care and suitable interventions to promote health and ensure the beneficence of the patient (Vilela, 2017). In the given case scenario, the patient has suffered from an acute stroke and requires both immediate and long-term management for his health and well-being. The first goal should be to ensure clot dissolution and restoration of the vitals (Chen et al., 2016). The long term management goals for the patient will include management of health condition and coping mechanisms for stroke-induced health problems after recovery.

Ethical and Legal Considerations

The nursing and Midwifery Board of Australia has established the code of conduct for the action of the nurses. This code is applied to ensure that the care is provided to the patient with ethical and legal guidelines of the government of Australia (Cowin et al., 2019). In the particular case of Mr. Sam Kwon, the nursing principle of person-centred care, collaborative efforts for cark and health promotion should be applied. The nurses should also ensure person-centred care for Mr. Sam as he is an elderly patient and requires critical care (Bouchez et al., 2017). Breach of these implications can result in loss of practice license (Cowin et al., 2019). The patient should be kept in constant observation and the care should be enhanced through communication and through the assistance of the family to provide the highest quality care. The items and commodities that the patient might need should be provided in reach and the patient specific considerations must be followed to promote quality care (Farfield & Smithard, 2020). Collaborative efforts are required from multiple teams to carry out the assessments and to maintain care of the patient. Health promotion strategies are also crucial in the case of Mr. Sam Harris as it will allow the patient to recover from the disabilities after the management of acute stroke to promote holistic recovery (Bouchez et al., 2017). 

Laboratory tests and assessments required

The imaging analysis has already been done for Mr. Sam Kwon. It should be ensured that routine blood tests are conducted for the patient with coagulation studies. ECG and the chest roentgenograms should be conducted in 24 hours of the service (Su et al., 2017). These tests and monitoring are crucial as the patient has been admitted to the ward after several hours and the magnitude of damage caused by stroke is required for the development of suitable interventions. This will require a team of care nurses and laboratory specialists (Leung et al., 2018). An ABCDE assessment should be done by the nurses to assess the Airway, breathing, circulatory, disability, and exposure for the patient as the primary assessment and priority problem areas should be identified (Su et al., 2017). A Glasgow Coma scale assessment should be done for the patient to record the motor, cognitive, and verbal response to assess the orientation in the patient and to develop suitable interventions for the same. A GCS assessment can be conducted by the Registered nurse of the facility (Tong et al., 2018).

Nursing goals and Interventions

The primary nursing goal should be the management of the stroke in the patient. It is suggested that acute stroke patients should be provided with blood thinners like aspirin immediately for the dissolution of the clots after the brain imaging. An antiplatelet or an anticoagulant agent can be added for the patient as a secondary precaution (Phan et al., 2018). The second primary goals for the nurses should be to ensure the restoration of patient vitals and normalization of the health condition. The patient should be provided with oxygen supplementation to prevent the incidence of hypoxia and to normalize the respiratory rate (Tong et al., 2018). The patient should also be positioned into high Flower’s position to promote the respiration and promote normalization of respiratory rate. The blood pressure of the patient along with other vitals must be critically monitored with the application of nursing interventions to evaluate the progress of the interventions and record to develop further care regimens required (Kalkonde et al., 2018).

Multidisciplinary team actions

Along with the management of stroke, the patient also contains the history of cardiac condition, a cognitive cardiac arrest with history of hypertension, diabetes type II and chronic smoking and thus requires multidisciplinary management for holistic care.. The care professionals required in the management of the health of Mr. Sam are, cardiologists, care nurses, laboratory specialists, physical therapists and nutritionist.

  • Cardiologists: Assistance from cardiac specialists is required s it will help in maintaining the circulatory and cardiac health of the patient. Precautions for cardia health will also help in prevent atherosclerosis and prevent smoking relapse (Kalkonde et al., 2018).
  • Laboratory specialists: the patient requires multiple tests and screening and thus assistance from laboratory specialists is required to ensure the secondary assessments required by the patient (Phan et al., 2018).
  • Physical therapists: muscle weakness and paralytic impacts are common after acute stroke, therefore, physical therapy and basic exercises must be ensured for the patient to promote patient empowerment and independence (Su et al., 2017).
  • Nutritionist: The patient requires high nutrition diet for complete recovery and also for the management of the blood glucose levels that are significantly high at 9.4mmol/L and requires management to be normalized at 4 to 8mmol/L (Leung et al., 2018).
  • Care nurses: Care nurses are required to facilitate care for the patient. The care nurses are also required to monitor the progress of the patient for holistic recovery (Su et al., 2017) .

Health promotion

Health promotion is a critical aspect of care that must be included in the overall management for the health of the patient. Health promotion is crucial for the patients with stroke as it helps in the adoption of a healthy lifestyle and prevents the incidences of future strokes and limits hospital readmission (Leung et al., 2018). Mr. Sam requires management of his health in long terms to prevent health complications and thus promote the overall wellbeing of the patient. This will include Mr. Sam to consume a healthier diet, take suitable precautions and promote health (Phan et al., 2018).

Conclusion on Mr. Sam Kwan Case Study

This document provides a critical analysis of the case study of a 74-year-old patient, Mr. Sam who has suffered from an acute stroke. This paper presents pathophysiology of the health condition and presents a detailed analysis of the care, treatment, and management for the patient with multidisciplinary care and ethical considerations to be followed along with the need of health promotion for the patient.

References for Mr. Sam Kwan Case Study

Bouchez, L., Sztajzel, R., Vargas, M. I., Machi, P., Kulcsar, Z., Poletti, P. A., ... & Lövblad, K. O. (2017). CT imaging selection in acute stroke. European Journal of Radiology, 96, 153-161. https://www.sciencedirect.com/science/article/pii/S0720048X1630331X

Chen, R., Ovbiagele, B., & Feng, W. (2016). Diabetes and stroke: Epidemiology, pathophysiology, pharmaceuticals and outcomes. The American Journal of the Medical Sciences, 351(4), 380-386. https://www.sciencedirect.com/science/article/pii/S0002962915379337

Chen, S., Luo, J., Reis, C., Manaenko, A., & Zhang, J. (2017). Hydrocephalus after subarachnoid hemorrhage: Pathophysiology, diagnosis, and treatment. BioMed Research International, 2017. https://www.hindawi.com/journals/bmri/2017/8584753/abs/

Clare, C. S. (2017). The role of community nurses in stroke prevention. Journal of Community Nursing, 31(1), 54-58. http://www.jcn.co.uk/files/downloads/articles/stroke-prevention.pdf

Cowin, L. S., Riley, T. K., Heiler, J., & Gregory, L. R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review, 66(3), 320-328. https://onlinelibrary.wiley.com/doi/abs/10.1111/inr.12534

Fairfield, C. A., & Smithard, D. G. (2020). Assessment and management of dysphagia in acute stroke: An initial service review of international practice. Geriatrics, 5(1), 4. https://www.mdpi.com/2308-3417/5/1/4

Ginsberg, M. D. (2018). The cerebral collateral circulation: Relevance to pathophysiology and treatment of stroke. Neuropharmacology, 134, 280-292. https://www.mdpi.com/2308-3417/5/1/4

Kalkonde, Y. V., Alladi, S., Kaul, S., & Hachinski, V. (2018). Stroke prevention strategies in the developing world. Stroke, 49(12), 3092-3097. https://www.ahajournals.org/doi/abs/10.1161/strokeaha.118.017384

Leung, V., Sastry, A., Srivastava, S., Wilcock, D., Parrott, A., & Nayak, S. (2018). Mechanical thrombectomy in acute ischaemic stroke: A review of the different techniques. Clinical Radiology, 73(5), 428-438. https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.118.004981

Liu, X., Weng, Y., Liu, R., & Zhao, J. (2019). Significant stroke knowledge deficiencies in community physician improved with stroke 120. Journal of Stroke and Cerebrovascular Diseases, 28(12), 104323. https://www.ahajournals.org/doi/abs/10.1161/str.49.suppl_1.190

Mann, S. J. (2018). Neurogenic hypertension: Pathophysiology, diagnosis and management. Clinical Autonomic Research, 28(4), 363-374. https://www.ahajournals.org/doi/abs/10.1161/strokeaha.118.0384

Phan, K., Dmytriw, A. A., Teng, I., Moore, J. M., Griessenauer, C., Ogilvy, C., & Thomas, A. (2018). A direct aspiration first pass technique vs standard endovascular therapy for acute stroke: A systematic review and meta-analysis. Neurosurgery, 83(1), 19-28. https://www.sciencedirect.com/science/article/pii/S0720048X17301870

Su, Q., Li, C., Long, F., Chen, B., Wan, Z., Wu, Y., ... & Wang, B. (2017). Effects of a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan Province, China. Vascular, 25(3), 242-248. https://www.ahajournals.org/doi/abs/10.1161/strokeaha.118.01734

Tong, X., Wiltz, J. L., Georg, M. G., Odom, E. C., Coleman King, S. M., Chang, T., ... & Merritt, R. K. (2018). A decade of improvement in door-to-needle time among acute ischemic stroke patients, 2008 to 2017. Circulation: Cardiovascular Quality and Outcomes, 11(12), 004981. https://www.sciencedirect.com/science/article/pii/S0720048X45666.227301870

Vilela, P. (2017). Acute stroke differential diagnosis: Stroke mimics. European journal of radiology, 96, 133-144. https://www.sciencedirect.com/science/article/pii/S0720048X17301870

Wong, K. S., Caplan, L. R., & Kim, J. S. (2016). Stroke mechanisms. In Intracranial Atherosclerosis: Pathophysiology, Diagnosis and Treatment (Vol. 40, pp. 58-71). USA: Karger Publishers https://www.ahajournals.org/doi/abs/10.1161/str.49.suppl_1.190

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