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Ischemic strokes account for 80% of all strokes and are caused by a lack of blood supply (oxygen) to the brain, causing sudden loss of function. In contrast, hemorrhagic strokes account for 20% of all strokes and are caused by a blood vessel rupturing or abnormal vascular structure in the brain. Intracranial hemorrhages (ICH) comprise 80% of hemorrhagic strokes and subarachnoid hemorrhages (SAH) comprise 20% of hemorrhagic strokes. Uncontrolled hypertension is the main cause of ICH and aneurysms, AV malformations, intracranial neoplasms, and anticoagulants cause the majority of SAH (Donkor, 2018).
When providing medical treatment to a Muslim woman, it is important to consider her culture. Muslim women usually prefer a health care provider of the same sex. Eye contact and physical touch are discouraged between a Muslim woman and a care provider of the opposite sex. Muslim women dress modestly and keep the majority of their body covered at all times; when examining a Muslim woman, it is important to consider her modesty and communicate the need for removing any clothing. The Muslim religion requires several dietary restrictions including no alcohol intake, no pork or by-products of pork, and discourages non-Halal animal fats. It is also important to consider the communication needs of a Muslim patient by offering and providing a professional interpreter that speaks Arabic or Urdu/Hindi. Hospitalization of a Muslim patient during Ramadan, the most blessed and spiritual month of the Islamic year, may require special considerations in their care. Muslims usually fast between sunrise and sundown during the month of Ramadan and may choose to refuse food, liquids, IV fluids, and oral medications while hospitalized during these times. Extended family is extremely important to the Muslim culture and many times family is included in important decisions, including those that affect health. Many Muslims believe that illness, suffering, pain, and dying are a test from God and they perceive illness as a trial in which one’s sins are removed. Muslims pray 5 times during the day while facing Mecca; the patient’s religious practices should be respected by providing privacy and uninterrupted time to pray. Some Muslims use folk remedies in the treatment of certain medical ailments such as cupping, cautery, honey, olive oil, and Nigella sativa. Other herbs, food, and plants used in treating medical ailments are aloe, capers, chicory, dates, dill, fenugreek, pomegranate, indigo, senna, olive oil, mustard, and truffles. It is important to discuss any herb/supplement intake with the patient to avoid harmful interactions been the herb/supplements and the patient’s prescribed medications (Attum et al., 2021).
Fifty percent of stroke survivors have lifelong disabilities related to mobility, speech, swallowing, and cognition which require costly, long-term nursing care in the home or in a nursing facility. If the patient is unable to swallow on her own after a stroke, she may require the insertion of a feeding tube for the long-term administration of nutrition and medications. Patients that have severely impaired mobility and are bedridden will require around the clock care to help them with repositioning, meals, bowel/bladder management, and activities of daily living. If the patient is left severely disabled, the patient will no longer be able to work or help contribute to the family’s income. Although the treatment of an ischemic stroke is costly, requiring the administration of a thrombolytic (TPA) and possible endovascular procedures, the cost is offset by the increased quality of life and health status of the stroke survivor (Lapchak & Zhang, 2017).
Environmental factors that may affect the incidence of stroke are exposure to air pollution, exposure to cigarette smoke, excessive alcohol consumption, and illicit drug use (Boehme et al., 2017).
Priority nursing interventions when ruling out stroke would be a prompt FAST (Face, arm, speech, time) and NIH stroke scale assessment which assesses the patient for neurological deficits frequently caused by stroke. A stat CT of the patient’s brain to assess for the presence of a hemorrhagic stroke will help determine if the patient is a candidate for a thrombolytic (TPA infusion). Once the CT of the brain is completed, a neurologist reviews the CT scan and assesses the patient in person or by telehealth remotely. The neurologist discusses the findings of the CT exam with the patient and family and a decision is made whether the patient is a candidate for TPA infusion for an ischemic stroke diagnosis or if a neurosurgery consult is necessary for a hemorrhagic stroke. If the patient is to receive TPA, weight-based dose calculations must be made for the bolus and infusion of TPA prior to administration of the medication. The medication is then administered and the patient is frequently assessed for signs and symptoms of bleeding and any neurological changes (American Heart Association [AHA],n.d.).
Stroke education for this patient should include an explanation of the 2 different types of stroke, ischemic and hemorrhagic, and the type of stroke the patient experienced. The patient and her family should also be taught the FAST (facial drooping, arm weakness, difficulty with speech, and calling 911) stroke algorithm for recognizing the signs of a stroke. The patient will gain an understanding of modifiable and non-modifiable risk factors for stroke. Modifiable risk factors are diet, physical inactivity, smoking, obesity, hypertension, hyperlipidemia, atrial fibrillation with antiarrhythmic and anticoagulant medications or left atrial appendage clipping, carotid stenosis and carotid endarterectomy when appropriate, blood sugar control, alcohol use, and illicit drug use. Non-modifiable risk factors for stroke are age, genetics, gender, and race/ethnicity. The patient should be taught about blood pressure and the importance of monitoring her blood pressure daily, taking her medications and avoiding discontinuing any medication without discussing it with her doctor. The patient and her family should be instructed about rehabilitation after stroke and the possibility of needing home health, in-patient rehabilitation, or in-patient long-term care in a facility (Boehme et al., 2017).
The patient will benefit from an interdisciplinary team comprised of nurses, a neurologist, a neurosurgeon, physical therapist, occupational therapist, speech therapist, dietician, pharmacist, and a case manager. The nurse will monitor the patient’s vital signs, administer the TPA and antihypertensive medications if indicated, and monitor for any changes in the patient’s neurological status using the glasgow coma scale, NIH stroke scale, and frequent neurological assessments. The neurologist will review the patient’s CT scan of the brain, assess the patient, and decide on appropriate treatment for the patient whether it be thrombolytic therapy or medical management. If the patient has a hemorrhagic stroke, a neurosurgeon consult is appropriate to determine if the patient needs neurosurgery. Once the patient is cleared for therapy, a physical therapist, occupational therapist and speech therapist will evaluate the patient and treat the patient for any neurological deficits caused by the stroke such as dysphagia, dysphasia, paralysis, weakness, or problems with balance and mobility. After the speech therapist assesses the patient’s ability to swallow and rules out risk for aspiration with a bedside swallow test or modified barium swallow exam, she will recommend an appropriate diet for the patient. If the patient is deemed safe for oral intake, the dietician will make sure the patient receives the appropriate diet and education on eating healthy to prevent future strokes. The pharmacist will help calculate the correct dosage for TPA administration if necessary and will serve as a resource for the nurse and patient for any needed medication education or questions. The case manager will help arrange discharge plans for the patient whether it be home health, in-patient or outpatient rehabilitation, or a long-term care facility. In situations where the stroke is catastrophic and the patient will not make a meaningful recovery or have any quality of life, the patient’s family may elect to place the patient in hospice care (Rodgers & Price, 2017).
American Heart Association. (n.d.). Common diagnosis methods. www.stroke.org. https://www.stroke.org/en/about-stroke/types-of-stroke/common-diagnosis-methods.
Attum, B., Hafiz, S., Malik, A., & Shamoon, Z. (2021, July 7). Cultural competence in the care of Muslim patients and their families. StatPearls [Internet]. .
Boehme, A., Esenwa, C., & Elkind, M. (2017, February 3). Stroke risk factors, genetics, and prevention. Circulation Research. .
Donkor, E. (2018, November 27). Stroke in the century: A snapshot of the burden, epidemiology, and quality of life. Stroke Research and Treatment. https://www.hindawi.com/journals/srt/2018/3238165/.
Lapchak, P., & Zhang, J. (2017, August). The high cost of stroke and stroke cytoprotection research. Translational stroke research. .
Rodgers, H., & Price, C. (2017, April). Stroke unit care, inpatient rehabilitation and early supported discharge. Clinical medicine (London, England). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297619/.
Form a response to below discussion.