Nursing Crisis Intervention: Stroke

Nursing Crisis Intervention: Stroke Stroke is a global problem of the increasing elderly population. According to the Department of Health (2007a), stroke is the third leading cause of death in the UK, with more than 110,000 individuals falling victim to a stroke each year at a cost to the National Health Services exceeding  £2.8 billion. The Stroke Association (2007) places this number at 130,000 with a mortality rate at 67,000 per year, including indirect costs of  £1.8 billion and costs for informal healthcare following stroke at  £2.4 billion. Incidence of stroke is equally as prevalent elsewhere, such as in the United States where, as the third leading cause of US deaths (Becker Wira 2006; Nolan Naylor 2003) stroke is the leading cause of disability (Becker Wira 2006; Stroke Association as cited by Amber 2003, p. 316; Stroke Association 2007). Becker and Wira (2006) state the incidence of stroke within the United States is 400,000 individuals per year with an anticipated growth to over 1 million yearly st roke victims by 2050. The American Stroke Association (as cited by Amber 2003, p. 316) states â€Å"every 45 seconds, someone in America has a stroke. Every 3.1 minutes, someone dies of one.† Nolan and Naylor (2003) state an average of 35,000 individuals suffer strokes when hospitalized for other unrelated illnesses. Such was the case for Ms. C., who suffered an ischemic stroke while hospitalized for a pacemaker implant. As the unit nurse assigned to care for Ms. C., subtle signs of her stroke were noticed and reported to the Code Gray[1] team for immediate response. The many roles of a unit nurse in the presence of a crisis are vital in providing adequate care to her patient, including the need to maintain a calm demeanour in the face of chaos. A number of rapid physical assessments must be performed including the use of the FAST criteria[2] (Mathiesen et al, 2006), response teams must be alerted and the nurse must keep the patient calm and oriented throughout the flurry of activity that can easily upset an elderly individual. While all emergencies call for rapid response, it is even more critical in the case of stroke when, if the patient is eligible for recombinant tissue plasminogen activator (t-PA)[3] a detailed physical history and examination, a neurological assessment, computed tomography (CT) scan and additional blood work must be performed before irreparable damage from the stroke occurs. With a focus on patient impact and nursing interventions, this paper will present the case study of Ms. C. Case presentation Ms. C., a 78-year-old, ambulatory, Caucasian female was admitted to the hospital for the replacement of a cardiac pacemaker. Ms. C. was widowed 5 years prior to her current hospitalization and lived alone having two married children living in Scotland and Wales. Prior to admission Ms. C. was diagnosed with high blood pressure (HBP), high cholesterol, was diabetic, and was on pharmaceutical medication for all three conditions. In spring 1995, Ms. C. had recurrent bouts of tachycardia alternating with bradycardia. Following an attempt to control the situation through pharmaceutical intervention, her cardiologist recommended she receive a cardiac pacemaker; which was implanted without complication the same year. She reports remaining in good health since that time; although additional medical notes indicate the onset of dementia, as she appears confused at times. Upon admission, vitals were normal, with the exception of her blood pressure (BP) which was 175/95. Her physician ordered Ms. C. be started on Losartan[4]. Subsequent vitals indicated a fluctuation in BP ranging from a low of 170/90 at 1AM to a high of 195/110 at 10AM. As Ms. C. was not responding to medication or fluid balancing recommended by her physician and her BP continued to climb, her cardiologist postponed surgery until her BP was brought under control. At 11:48am, when taking Ms. C.’s vitals, she appeared confused, her speech was slurred, there was slight facial droop and she could not extend her arm for the blood pressure cuff. At 11:50am a Code Gray alert was sounded. Impact on the patient When assessing the impact to the patient when a stroke occurs, the nurse must be aware of the implications on a variety of levels, including biological, psychological and sociological. In the case of Ms. C., there were additional implications for each of these due to the combination of her low-level, yet progressive dementia. Biological changes in an ischemic stroke (confirmed by the CT scan as opposed to hemorrhagic) were the result of a thrombolytic occlusion at the cerebral artery branch point due to atherosclerosis. On the cellular level, neuronal damage occurs when neurons become depolarized and allow for inordinate amounts of calcium to cross the cellular membrane that ultimately leads to a destruction of said cellular membrane and other structures within the neuron (Becker Wira 2006). Becker and Wira (2006) also comment on the neuronal damage caused by free radical, arachidonic acid and nitric acid generation that takes place during the ischemic cascade[5]. Genetic activation also takes place and leads to the production of cytokines in response to and as a cause of inflammation that can â€Å"consume† the ischemic penumbra (Becker Wira 2006). If one can limit the degree of injury to the ischemic penumbra located within the origami, the degree of permanent damage due to the ischemic episode is limited and is the goal of immediate stroke response (Becker Wira 2006). A combination of diagnostic laboratory tests[6] and rapid nursing assessments would be required to assess the level of damage. Although the Code Gray approach is geared towards rapid response to allow for administering t-PA within the three-hour window, Ms. C. was not eligible for t-PA treatment due to her uncontrolled hypertension (Bonnono et al. 2000, p. 300). The psychological impact on Ms. C was the most dramatic as her post-stroke status left her more confused and fearful than one might find in a strike victim due to the comorbid dementia. In addition to being frightened of the unknown and feeling very alone as a widow and without her children present, Ms. C. felt betrayed by her body and didn’t understand what was happening to her or why. Psychologically Ms. C. had to be kept calm and be reminded of what was occurring and why, with such orienting comments as â€Å"You are going to be examined by Dr. X† or â€Å"You are going to have a test done that won’t hurt you. There is no need to be afraid; I’ll be with you to assure you’re safe.† With the unknown of any comprehension deficits caused by the stroke it was also important to remind other team members that Ms. C. had problems with confusion and that it was important â€Å"for patients with dementia in particular to understand what is about to happen to them† (Cunningham McWilliam 2006, p. 14). Cunningham and McWilliam (2006, p. 14) suggest that nursing staff must compensate in their communication with dementia patients and that this often requires nurses to re-prioritize their tasks and sense of immediacy in order to offer the patient the greatest level of psychological and/or emotional support. Lipley (2005) states one of the most important nursing tasks is offering support to a stroke patient. The sociological impact relating to Ms. C.’s crisis was limited for the immediate future while hospitalized, although she indicated that she wanted her children contacted and requested they come to the hospital. The biggest sociological change and challenges facing Ms. C. would be following her discharge from the hospital. Depending on the amount of total damage suffered from her stroke and the subsequent progress with therapy to regain lost functionality, it was probable that Ms. C. would relocate to either live with one of her children and/or settle in a home for the aged. This required the nurse to contact a social worker to help Ms. C. with her adjustment. Implications for the organization One of the six strategic goals established by the Department of Health’s National Stroke Strategy (2007b) is to â€Å"accelerate the emergency response to stroke and improve coordination between different agencies and professionals involved including through improved access to CT scanning.† Fortunately, the hospital where Ms. C. suffered her stroke complied with this goal and had a Code Gray team assembled. National Health Services (2007) approximates 90 percent of hospitals in England as prepared to administer specialized stroke services. The number of stroke victims is increasing every year. The nurses must be aware of required interventions. This paper has highlighted the ischemic stroke and patient impacts, as well as those on the organization and nurse. The charts below presents required nursing interventions in response to an inpatient stroke. Reference Amber, R., Watkins, W., 2003. The community impact of Code Gray. Critical Care Nursing Quarterly, 26 (4), pp. 316-322. Becker, J. U. Wira, C., R. 2006. Stroke, Ischemic [Online]. Available from: http://www.medscape.com/emerg/topic558.htm [cited March 16 2007]. Bonnono, C., Criddle, L. M., Lutsep, H., Stevens, P., Kearns, K., Norton, R., 2000. Emergi-paths and stroke teams: An emergency department approach to acute ischemic stroke. Journal of Neuroscience Nursing, 32 (6), pp. 298-305. Cunningham, C. McWilliam, K., 2006. Caring for people with dementia in AE. Emergency Nurse, 14 (6), pp. 12–16. Department of Health, 2007a. Stroke [Online]. Department of Health. Available from http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Stroke/index.htm [cited March 16, 2007]. Department of Health, 2007b. Developing a national stroke strategy [Online]. Department of Health. Available from http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Stroke/DH_4132138 [cited March 16, 2007]. Department of Health, 2007c. Good practice examples and case studies: standard five (strokes) [Online]. Department of Health. Available from http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Olderpeoplesservices/Olderpeoplepromotionproject/DH_4002291[cited March 16, 2007]. Lipley, N., 2005. Different strokes†¦ Emergency Nurse, 13 (5), p. 5. Mathiesen, C., Tavianini, H. D., Palladino, K., 2006. Best practices in stroke rapid response: A case study. Medsurg Nursing, 15 (6), pp. 364-369. Nolan, S., Naylor, G. Burns, M., 2003. Code Gray: An organized approach to inpatient stroke. Critical Care Nursing Quarterly, 26 (4), pp. 296-302. Spilker, J., Kongable, G., Barch, C., Braimah, J., Bratina, P., Daley, S., Donnarumma, R., Rapp, K. Sailor, S., 1997. Using the NIH stroke scale to assess patients. Journal of Neuroscience Nursing, 29 (6), pp. 384-393. Stroke Association, 2007. Facts and figures about stroke [Online]. The Stroke Association. Available from http://www.stroke.org.uk/media_centre/facts_and_figures/index.html [cited March 16, 2007]. Wojner, A. W., Morgenstern, L., Alexandrov., A. V., Rodriguez, D., Persse, D., Grotta, J., 2003. Paramedic and emergency department care of stroke: Baseline data from a citywide performance improvement study. American Journal of Critical Care, 12 (5), pp. 411-417. 1 Footnotes [1] The term generally accepted in the medical community for multidisciplinary stroke response teams. The typical composition of a Code Gray team includes a primary care RN, charge RN from the Stroke/cardio care unit, an ICU RN, ICU resident, a neurologist, CT technologist and an individual responsible for telecommunications (Nolan Naylor 2003, p. 297). The Department of Health (2007c) reports that other Code Gray teams also include occupational therapists, physiotherapists, speech and language therapists, dieticians, pharmacists, a clinical psychologist and social worker. [2] FAST criteria is the acronym also known as the Cincinnati Pre-hospital Stroke Scale, such that F = Facial Droop, A = Arm drift, S = Speech and T = Time (Mathiesen et al. 2006; Lipley 2005). [3] t-PA must be administered within three hours of the first onset of symptoms (Amber 2003). [4] Losartan is an angiotensin receptor blocker. The choice was made to use this type of intervention based on the muscle relaxing nature of the medication rather than incorporating those that lowered BP through a modification of electrical activity within the nervous or cardiac system due to the reliance on her pacemaker and the potential other such forms of medication might have on recurrent tachycardia or bradycardia. [5] Ischemic cascade is the term referring to the chain of events that takes place following an ischemic stroke. [6] Although a variety of diagnostic blood work was already performed on Ms. C, a CBC, chemistry panel and cardiac biomarkers were ordered following the stroke for comparison against pre-stroke values along with coagulation studies (Becker Wira 2006).

Continuing Academic Success Essay

While being responsible for our academic success, prioritizing work to achieve goals can be valuable to students without a success driven mindset. Responsibility and action along with ethics help set the path for proper results and set standards for academic achievement. As I explore this new endeavor in my life, I will outline my failures, successes and the lessons I have learned along the way. Failure is something I have to accept. I have failed a lot in the past, and I have allowed those failures to effect me in the present. As a young boy in grade school, I would always work hard to obtain good grades. After my first semester in high school, I assumed it was natural for me to get good grades, so I refrained from working hard. After a few months of not striving to my full potential, my academics began to suffer, and I failed a few classes. I was very disappointed in myself, and I then became afraid to try because of a failure mindset. I started to expect failure in my immediate li fe, especially in my academics. I started to believe I was not good enough to achieve. I would psychologically defeat myself before attempting to do well. Now, I have realized the values in failing by allowing my disappointment to be my motivation for success. Since then, I have learned the importance of setting goals. â€Å"How can you expect to hit a target without aiming first† (Robusto, 2009). Goal setting is important to me because I am a person who likes to take on too many responsibilities. I have a tendency to overload myself with work and at times get overwhelmed when I cannot complete all tasks in a timely manner. I became aware of the process I needed to work on in order to achieve my set goals. I started to write down all tasks I needed to complete and the dates of completion. I set time apart to evaluate my works and prepare to setup a  procedure on how to fulfill these functions that allow me to feel accomplished and not overwhelmed on projects with sensitive time constrictions. While continuing with my academic success, I have been setting new goals academically and for my career. My educational goal will be to complete one assignment a day and participate in two-class discussions per day. My career goal is to mentor one of my peers every six months in the area I have already mastered. In doing this, I will assist someone in their career goals as well as my own to ensure everyone develops and succeeds. As I read through my results for the Ethical Lens Inventory and realize, ethics is a set of principles of right conduct (Ethics 2011). My core ethical lenses are sensibility and equality. I listen to my intuition to determine the characteristic traits and attributes that best serve the community. I remain attentive to the particular needs of those in a similar situation as I carefully evaluate their outcome for my resolution. Further sharpening my critical thinking skills in learning from others mistakes and not committing the same mistake twice. My blind ethical lens leads me to believe that I rely heavily on the attributes of the role. At times, this can be risky because I forget that individuals are fallible, and I should rely solely on people to solve problems. In kn owing this about my moral background, I run the risk of believing that my role is more important than other individuals and will not be susceptible to constructive criticism. So I do not hinder my development; I should allow others to assess the role and assure that all roles are important. Even though thinking is a process, and intelligence is the product (Jensen 2005), we have to understand without thinking of the ending result, we can never consider the product. Critical thinking has an important role in learning and development because if properly executed it allows me to see the entire situation instead of the individual task. I plan to take the necessary actions to determine the task with open eyes and an unbiased approach. Remembering the facts about the situation can help in resolving the issue. Understanding by reiterating the problem can help me further comprehend. Applying then analyzing the tasks and or situations so I can prepare the steps to come to the evaluation. I can see if the resources are accurate and thorough. The last thing I should be able to do to assure my critical thinking skills are complete is a form of creating. I take all the information of this situation, and use it in my final resolution. These  steps are crucial in the ability to think clearly and not be clouded by biased information. Advancing in my critical thinking skills is as important as my writing skills. I have to take the appropriate steps in continuing to engage the readers throughout the writing process. Writing is crucial as a student and everyday life because it is a form of communication. I will utilize the necessary resources to assist me in applying the lessons being instructed for completion of each assignment in accordance with the University guidelines. Allowing myself to create an outline for the topic before the rough draft is setting the priority of how the papers thesis will be well planned for the entire topic. I can use many of the University’s resources such as the thesis generator to begin the subject of the assignment. Grammarly is a great resource to assure the proper format and grammar for the paper . The University has various resources such as live assistance in the Center for Writing Excellence. The benefit of using external resources is that one cannot rely only on their opinion alone but can get a different perspective of the situation. The University library is an excellent option for researching credible information to guarantee educational success. Although, some information in the library could be bias, we have to do the research on each source to review the comparisons and understand which source is indeed accurate. In conclusion, the information obtained and lessons learned in this course have given me a boost of confidence in my critical thinking, reading and writing skills. I feel comfortable in continuing my academic success with this knowledge. I feel as though I have accomplished great things in these past five weeks and will continue to move forward. The University has given me the desire to continue the achievements in my educational career by showing me the proper approach of getting the job done correctly. I now realize that a failure does not define a person. The failures can be used as a stepping-stone in the journey to greatness. References Ethic. (2011). In The American Heritage dictionary of the English language. Retrieved from http://search.credoreference.com.ezproxy.apollolibrary.com/content/entry/hmdictenglang/ethic/0 Jensen, Eric. â€Å"Critical Thinking Skills.† Teaching with the

Family Presence Article Critique

Family Presence Article Critique Inez Robbins Liberty University November 26, 2012 Abstract Family presence at the bedside during resuscitation is starting to become standard protocol in many emergency departments but research is limited in this area. The objective of the article reviewed is to explore the nurse’s perception of the benefit and/or harm to the family in a facility that has well established family presence protocols. The nurses’ perceptions of the effects on the family provide a positive influence on both the family members and the interdisciplinary team that is caring for the patient.The study confirmed long-term participation yields positive effects on the perception of family presence at the bedside during resuscitation in the emergency department. The nursing perception offers insight on the care and compassion towards the family in their critical time of need. Future nursing implications, future nursing research, and ethical implications are discussed , as there is a further need for education and research in these areas of professional nursing development. Key words: Family presence, resuscitation, nurse, perception.Family Presence Article Critique Review of Article A review of the Elinar Lowry, PhD, RN’s article â€Å"It’s Just What We Do†: A Qualitative Study of Emergency Nurses Working with Well-Established Family Presence Protocol published in the Journal of Emergency Nursing volume 38, number four in July of 2012 aims to describe the benefits and harm to patients family members who were present during patient resuscitation based on the perceptions of nurses whom work within a facility with an established family presence protocol.The article describes a study performed in which fourteen emergency room nurses’ perception of their experiences with family presence during resuscitation is documented. The facility in which all fourteen nurses were employed had a family presence protocol since 1992 (Low ry, 2012). There were pointed open-ended questions asked. These questions were meant to allow the nurses to elaborate on experiences that were both positive and negative. The results of the study found that nurses perceived there were benefits experienced by the family in several ways (Lowry, 2012).Some of these were: family was able to see the evolution of events or the patient’s progress during the resuscitation. The family was also able to confirm the effort used to save their loved one. Lastly, nurses confirmed that they felt the families appreciated that everything possible was done to save their family member. There was no perception of harm done to the family through observation of resuscitative measures (Lowry, 2012). Future Nursing Practice Implications of this study for future nursing practice suggest that long-term participation is directly related to acceptance of family presence by nursing.This information is encouraging for nurses whom wish to write and establis h family presence protocols within their facilities (Lowry, 2012). Care should be taken to identify and educate on tolerance of family member behaviors. Family presence protocols should also include limitations for the number of family members allowed at the bedside during resuscitative measures so that the staff members feel secure and comfortable with family presence practices (Lowry, 2012).Future Nursing Research Implications for future nursing research related to family presence should include family members who take part in family presence. All staff members should be surveyed to conclude the overall cultural belief on family presence (Lowry, 2012). Other potential topics for studies include: the right time to request the family’s presence, how to integrate new hire nurses into a potentially unfamiliar family presence protocol or practice (Lowry, 2012). Ethical IssuesAll of the nurses interviewed during this study held that family presence during resuscitation was the et hically right thing. Some of the nurses reported feelings of personal anguish at the family members grieving their loved ones. They also describe compassionate care to those family members (Lowry, 2012). References Lowry, E. (2012). â€Å"It’s just what we do†: A qualitative study of emergency nurses working with well-established family presence protocol. Journal of Emergency Nursing, 38(4). 329-334. doi:10. 106/j. jen. 2010. 12. 016

The Key Elements to Effective Communication Essay - 751 Words

INTRODUCTION In the society that we live in we cannot survive without communication. It is not only limited to human beings but also animals communicate to each other to pass on information. There are different forms of communication but they vary based on the message being delivered or the sender and receiver. Communication is important in every relationship and without proper communication; people can easily disagree or be misled due to lack of it or assumptions. DISCUSSION Communication is exchanging of information and this can be through speaking, using some mediums or writing. As technology advances so does the mode of communication and communicating becomes easier and faster. Communicating is also a means of sending and also†¦show more content†¦When communicating, the key thing is to make sure that the receiver gets the message the right way and the feedback is effective. In an organization there are various modes of communication and it can be through listening, speaking or in written form. Within the office as much as there may be computers, individuals with the latest technology does not mean they communicate effectively. They can fail to have the communication skill. It is sometimes the technology that causes the failure of effective communication. Within an organization, there can be cases of mailed that are dashed off and they are short and this can replaced well thought-out letters. (Picards, 2001) When especially within an organi zation how you package information to a group of people is very important. People are very different they vary in culture, age, gender, religion and sex, there the message should be straight to the point and no leaving space for assumption or leaving an individual to guess what the meaning really is. 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