The emergency department for a rule-out Cerebrovascular Accident

You are caring for a 68-year-old Akio Kim in the emergency department for a rule-out Cerebrovascular Accident (CVA). Mr. Kim's daughter reported that he woke up that morning with left-sided weakness and slurred speech. Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of Cerebrovascular Accident (CVA), respond to the following prompts: Thoroughly explain the pathophysiology of Cerebrovascular Accident (CVA). Use a scholarly or authoritative source to support your answer. Examine each of the following three factors related to this disease process. Support all three with a scholarly source. cultural financial environmental implications Identify 3-5 priority nursing interventions for the client while in the emergency department. Describe labs and diagnostic testing you would want to include in the client’s plan of care and why. What are critical indicators? 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.

Pathophysiology of Cerebrovascular Accident (CVA)

A cerebrovascular accident (CVA), or stroke, occurs when blood flow to the brain is interrupted. This can lead to tissue damage and neurological deficits. There are two main types of stroke: ischemic and hemorrhagic.

Ischemic stroke is caused by a blockage of a blood vessel in the brain. This can be due to a blood clot (thrombosis) or an embolus that travels from another part of the body to the brain. Hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds. This can be caused by uncontrolled high blood pressure, aneurysms, or blood clotting disorders.

Source: National Institutes of Health, National Institute of Neurological Disorders and Stroke. (2023). Stroke. https://www.ninds.nih.gov/health-information/stroke

Cultural, Financial, and Environmental Implications

Cultural Implications:

Cultural beliefs and practices can influence a patient's understanding of illness, treatment, and decision-making. It is important to be aware of and respect cultural differences in healthcare.
Language barriers can hinder communication and understanding. Using interpreters or culturally appropriate materials can help to bridge these gaps.

Source: National Institutes of Health, National Institute on Minority Health and Health Disparities. (2023). Cultural competency in health care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571328/

Financial Implications:

Cost of treatment can be a significant burden for patients and their families. This can affect access to care, adherence to treatment plans, and overall health outcomes.
Insurance coverage can vary widely, and patients may face out-of-pocket costs for medications, therapies, and rehabilitation.

Source: Kaiser Family Foundation. (2023). Health insurance coverage in the United States. https://www.kff.org/other/state-indicator/total-population/

Environmental Implications:

Environmental factors such as air pollution, diet, and lifestyle can contribute to the risk of stroke. Addressing these factors can help to prevent strokes and improve overall health.
Access to healthcare can be limited in certain areas, especially for marginalized populations. This can affect early diagnosis and treatment of stroke.

Source: World Health Organization. (2023). Stroke prevention and control. https://www.who.int/southeastasia/news/detail/29-10-2016-prevent-brain-stroke

Priority Nursing Interventions

Maintain a patent airway and ensure adequate oxygenation.
Monitor vital signs frequently, including blood pressure, heart rate, respiratory rate, and oxygen saturation.
Elevate the head of the bed to reduce intracranial pressure.
Administer medications as ordered, such as antihypertensives, thrombolytics, or anticoagulants.
Provide emotional support to the patient and family.

Labs and Diagnostic Testing

Complete blood count (CBC) to assess blood cell counts and identify any underlying infections or bleeding disorders.
Basic metabolic panel (BMP) to evaluate kidney function, electrolyte balance, and glucose levels.
Coagulation studies to assess blood clotting factors and identify any bleeding or clotting disorders.
Computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain to identify the location and type of stroke.
Carotid ultrasound to assess for carotid artery stenosis, a common cause of ischemic stroke.

Critical indicators for a stroke include:

Sudden onset of weakness or numbness in the face, arm, or leg, especially on one side of the body.
Sudden confusion or difficulty understanding or speaking.
Sudden problems with vision, such as blurred or double vision.
Sudden severe headache with no known cause.
Sudden dizziness or loss of balance or coordination.

Source: American Heart Association. (2023). Stroke symptoms. https://www.heart.org/-/media/Stroke-Files/Lets-Talk-About-Stroke/About-Stroke/Lets-Talk-about-Stroke-TIA-Warning-Signs.pdf

Interdisciplinary Team Members

Neurologist: To diagnose the stroke, determine the cause, and recommend treatment.
Speech-language pathologist: To assess and treat speech, language, and swallowing deficits.
Physical therapist: To help the patient regain mobility and strength.
Occupational therapist: To assist with activities of daily living and adaptive equipment.
Social worker:
To provide emotional support, coordinate services, and address socioeconomic needs.
Case manager: To coordinate care, manage transitions, and ensure continuity of care.

Source: American Stroke Association. (2023). Stroke team. https://www.stroke.org/