Stroke

Ellen is a 74-year old woman admitted to hospital with an ischaemic stroke. Ellen was at home alone when her stroke occurred. Her husband John, who had been out playing bowls for 4-5 hours, found her slumped to one side in her armchair with her left arm dangling towards the floor. Ellen was unable to communicate clearly with him, so he was unsure when this happened and how long Ellen had been in the chair. He telephoned her general practitioner (GP), who told him to call an ambulance immediately. The ambulance was delayed for almost an hour. Ellen arrived at the Emergency Department and received a CT scan ninety minutes after she arrived at the hospital, at which point an ischaemic stroke was diagnosed. Ellen did not have a large vessel occlusion (LVO) and so was not eligible for thrombectomy. As the time of stroke incidence was unknown, but was likely to be more than 6 hours previously, she was also ineligible for thrombolysis therapy.

The stroke was categorised using the NIH Stroke Scale as being of moderate severity and has left Ellen with a mild weakness on the left side of her body. Within a week, her speech recovered fully and she is not cognitively impaired. However, she is extremely fatigued after the stroke and is having difficulty finding the energy to do even the smallest of tasks, such as eating or washing. She is receiving physiotherapy and occupational therapy, both of which she finds exhausting. She gets particularly annoyed with the physiotherapist, who she thinks is pushing her too hard, and is expecting too much of her.

This is Ellen’s first stroke. While she is not very co-operative with the physiotherapists, she is very distressed at the possibility of long-term disability. She considered herself to be quite healthy up to now, taking medication for blood pressure and, in the past 6 months, an anti-cholesterol drug. Since her admission to hospital, she has said to her family that if she is not going to make a good recovery from the stroke, she would rather die. Her family is distressed by her reaction to this event. She has always been a ‘fighter’ and was always able to cope in her life up to now. Her belief that she is not going to make a good recovery and that she will have to live with long-term disability has resulted in her not eating or drinking. As she was becoming dehydrated in hospital, the medical team inserted an intra-venous drip to ensure adequate fluid intake. Ellen’s family tries to coax her to eat and drink when they come to visit each day, but she is not willing to cooperate.

Social circumstances

Ellen lives in a rural location with her husband John, who is four years older than her. The general hospital to which she was admitted is 30 miles from her home. John has also had some health problems recently. He has had a persistent cough which is not responding to treatment. John is otherwise fit. He is aware that he will be Ellen’s main caregiver when she comes home, as Ellen is restricted in mobility due to the stroke. Neither Ellen nor John smoke. They both drink alcohol occasionally. They have 3 children, all of whom live within an hour’s drive of their home. They also have a number of grandchildren.

Ethical considerations

Ellen has indicated a wish to die, both verbally to her family, and in her behaviour by refusing to eat and drink. Her family is very distressed by this and the medical team, nurses and therapists are doing all they can to ensure they address Ellen’s and the family’s concerns. Ellen continues to be distressed and uncertain about the likelihood of a good recovery. She is finding therapy very demanding and extremely tiring, and is not at all sure that it is doing her any good.

Problem Specification: answer them in essay style not Q and A please

450 word count Using Medline as your main source of published research, conduct a literature review on your assigned case

• What are the clinical presentations and diagnostic criteria for an ischaemic stroke?

What is happening to the brain as patients’ delay presenting for treatment?

• Are psychological difficulties common in stroke patients? If yes, what difficulties are particularly prevalent? What are the implications of psychological difficulties for stroke recovery?
• What treatment recommendations would you make for Ellen, including her own self-care behaviours?

Sample search strategy template for the articles used

At least 4-5 and please reference them in Vancouver style and add the link to the article as well

-Comment on the overall strengths and weaknesses of having the same personalities of all the group members and reflect on the strengths/weaknesses of your team,

and whether these were representative of your true team functioning. (no)

– Summarise the three best aspects of working on this project in your team.

– Summarise the three most difficult aspects of working on this project in your team . Describe any conflict within your team and how this was managed.

– Outline five strategies you recommend, on the basis of this team project experience, for improving the functioning of any new team project you may undertake in the future.

No word count for this part try to answer it ( no reference needed ) just give