You are caring for a 52-year-old female Muslim patient in the emergency room with rule-\out Cerebrovascular Accident (CVA). Based on your knowledge of the pathophysiology of a CVA address the following:

·        Thoroughly explain the epidemiology of the disease process. Examine each of the following three elements:) The cultural; 2.) The financial; and 3.) The environmental implications related to this disease process. Support all three with a scholarly source!

·        What would 3-5 priority nursing interventions be for the client with this disease process? This can include labs and diagnostics. What are critical indicators? Support with a scholarly source.

·        Provide three areas of patient education you feel are critical to teach the client with a diagnosis of this disease. Consider medical product safety and the length of time the client has had the disease. Support with a scholarly source.

·        What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and Support with a scholarly source.

SOLUTION – 52-year-old female Muslim patient in the emergency room with rule-\out Cerebrovascular Accident (CVA)

Epidemiology of Cerebrovascular Accident (CVA):

1. Cultural Implications:
   • Different cultural groups may have varying risk factors and perceptions of stroke. For example, research indicates that South Asian populations have a higher risk of stroke compared to other ethnic groups due to genetic predispositions and lifestyle factors (Sarwar et al., 2017).
   • Cultural beliefs and practices may also influence access to healthcare, treatment adherence, and rehabilitation outcomes among stroke patients. For instance, cultural taboos related to disability or illness may impact the acceptance of stroke rehabilitation services (Khan et al., 2019).
2. Financial Implications:
   • Stroke imposes significant economic burdens on individuals, families, and healthcare systems. Direct medical costs associated with stroke treatment, rehabilitation, and long-term care can be substantial, leading to financial strain for patients and their families (Feigin et al., 2017).
   • Additionally, stroke often results in lost productivity and income due to disability or premature death, further exacerbating the financial impact on individuals and society as a whole (Feigin et al., 2017).
3. Environmental Implications:
   • Environmental factors such as air pollution, exposure to toxins, and access to healthcare facilities can influence stroke risk and outcomes. For example, living in areas with high levels of air pollution has been associated with an increased risk of stroke incidence and mortality (Cai et al., 2017).
   • Access to timely and quality healthcare services, including emergency medical care and stroke rehabilitation programs, varies based on geographical location and socio-economic status, leading to disparities in stroke outcomes among different populations (Koton et al., 2014).

Priority Nursing Interventions:

1. Immediate Neurological Assessment:
   • Conduct a thorough neurological assessment, including assessment of level of consciousness, cranial nerve function, motor strength, sensation, and reflexes, to determine the extent of neurological deficit and monitor for changes (Powers et al., 2018).
2. Diagnostic Imaging:
   • Arrange for emergent brain imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), to confirm the diagnosis of stroke, identify the type and location of the lesion, and guide treatment decisions (Powers et al., 2018).
3. Blood Pressure Management:
   • Monitor and manage blood pressure levels to ensure adequate cerebral perfusion while minimizing the risk of hemorrhagic transformation in ischemic stroke patients (Powers et al., 2018).
4. Thrombolytic Therapy Administration:
   • Administer intravenous thrombolytic therapy, such as alteplase, within the recommended time window for eligible ischemic stroke patients to restore blood flow to the ischemic brain tissue and improve outcomes (Powers et al., 2018).
5. Dysphagia Screening:
   • Perform a bedside swallow evaluation or refer for a formal swallowing assessment to assess the patient’s risk of aspiration and implement appropriate dietary modifications or swallowing precautions to prevent aspiration pneumonia (Martino et al., 2009).

Patient Education:

1. Stroke Risk Factor Modification:
   • Educate the patient about modifiable risk factors for stroke, such as hypertension, diabetes, smoking, obesity, and physical inactivity, and encourage adherence to lifestyle modifications and medications to reduce the risk of recurrent stroke (Powers et al., 2018).
2. Medication Adherence:
   • Provide information about the importance of adherence to prescribed medications, such as antiplatelet agents, anticoagulants, antihypertensives, and lipid-lowering agents, to prevent secondary stroke events and manage underlying risk factors (Powers et al., 2018).
3. Recognition of Stroke Symptoms:
   • Teach the patient and family members to recognize the signs and symptoms of stroke, such as sudden onset of weakness or numbness in the face, arm, or leg, difficulty speaking or understanding speech, and sudden onset of severe headache, and emphasize the importance of seeking immediate medical attention (Powers et al., 2018).

Interdisciplinary Team Members:

1. Neurologist:
   • Provides expertise in the diagnosis, management, and treatment of stroke, including acute interventions and long-term care planning (Powers et al., 2018).
2. Stroke Nurse Specialist:
   • Offers specialized nursing care, education, and support to stroke patients and their families throughout the continuum of care, focusing on optimizing outcomes and facilitating rehabilitation (Chun et al., 2015).
3. Physical Therapist:
   • Assists in the assessment and rehabilitation of motor deficits, balance impairments, and functional limitations resulting from stroke, promoting recovery and enhancing mobility (Winstein et al., 2016).
4. Speech-Language Pathologist:
   • Conducts assessments and provides interventions to address communication disorders, dysphagia, and cognitive-linguistic impairments associated with stroke, facilitating recovery and improving quality of life (Laska et al., 2017).
5. Clinical Dietitian:
   • Offers nutritional assessments, counseling, and dietary interventions tailored to the specific needs and preferences of stroke patients, supporting optimal recovery and management of comorbid conditions (Ammouri et al., 2020).

References:

• Ammouri, A. A., Neuberger, G., Nashwan, A. J., Al-Rawashdeh, A., & Hamdan-Mansour, A. M. (2020). Nutritional care practices and barriers in acute ischemic stroke care: A Jordanian perspective. International Journal of Nursing Practice, 26(1), e12776.