The Problem of Stroke: Etiology and Risk Factors

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Patient Background Information

The problem of stroke in African American patients has not been gaining enough attention recently. There is the presence of a tangible health disparity that needs to be addressed in order to ensure the well-being of the vulnerable population (Stringer, 2018). According to the report published by the Centers for Disease Control and Prevention (2016), of all American population groups, African American men are the most prone to having a stroke. By placing emphasis on the immediate management of the stroke and the active enhancement of patient education, one will be able to reduce the threat of another stroke significantly.

According to the details of a case under analysis, a patient is a 58-year-old postal worker of an African American background, who has experienced hypertension. The patient smokes a pack of cigarettes a day. After the stroke, the patient has acquired a significant speech impediment, which has been evolving very fast, and a left-sided deficit. The left side of his face has been paralyzed, and his speech has become considerably slurred. For the same reason, the patient has left-sided drooling. His vitals are 161/90, pulse 92, whereas the CT scan has shown a thrombus in a branch of the right internal carotid artery with 90% occlusion caused by to atherosclerosis.

Etiology and Risk Factors

Exploring the problem of a stroke, one should mention that the specified phenomenon comes in three categories, which are the ischemic stroke and hemorrhagic stroke. The latter implies that the stroke is caused by the presence of an excessive amount of blood in the closed cranial cavity (Jagani, Kallmes, & Brinjikji, 2017). Ischemia, on the other hand, occurs once the amount of oxygen supplied by the bloodstream to the brain decreases, thus causing insufficiency in oxygen and other nutrients required for the proper brain functioning (Jagani et al., 2017). A stroke should not be confused with a Transient Ischemic Attack (TIA), which is similar in its symptoms to the former yet takes place if the blood flow interrupts only temporarily (Kernan et al., 2016; Kerkar, 2018).

Since a stroke is primarily developed due to poor blood flow, the causes thereof include the diseases such as hypertension, heart disease, a change in the number of lipids in a patient’s blood, the risk factors of a stroke are rather numerous. For instance, smoking, drinking, diabetes, and any activity that may lead to a rise in blood pressure levels can be seen as the potential cause of a possible stroke in a patient (Kernan et al., 2016).

In addition, there are several non-reducable factors that may make one more prone to a stroke, such as age, gender (men are more susceptible to stroke than women), and race (African Americans, Latin Americans, and Asian-Pacific Islanders are typically seen as key risk groups) (Carty et al., 2015). Having diabetes and being genetically predisposed to developing a stroke due to the family health history is also a high probability (Berman & Lutsep, 2018). Therefore, a stroke affects a wide population and leads to devastating outcomes unless successfully prevented or properly managed.

Incidence/Prevalence

A stroke is a rather common disease that has a drastic effect on the U.S. population. At present, stroke affects a vast number of Americans, its death toll reaching the annual rates of 140,000 people (Centers for Disease Control and Prevention, 2015). Put differently, an incidence of a stroke occurs every 40 seconds, whereas lethal outcomes take place every 4 minutes (American Heart Association & American Stroke Association, 2018).

Therefore, the problem of a stroke has been growing out of proportions in American society, and it needs to be addressed on a nationwide level. The specified decision requires a vast program aimed at building awareness and increasing health education levels of the vulnerable population.

People of certain backgrounds are especially susceptible to stroke. Of all races in the U.S., African Americans are threatened to develop a stroke to the greatest degree (Carty et al., 2015). Moreover, Black patients die of stroke more often than the Caucasian population of the U.S. The death toll among Hispanic patients that have suffered a stroke has also been on the increase since 2013 (Centers for Disease Control and Prevention, 2015). Nevertheless, the African American population remains the most vulnerable to stroke.

As stressed above, age and gender can also be seen as an important characteristic that defines the propensity toward a stroke in patients. For example, at present, approximately 55% of patients with a stroke are 65 years or older, which proves that the threat increases with age (Centers for Disease Control and Prevention, 2015). Furthermore, after 65, the threat of stroke doubles (Centers for Disease Control and Prevention, 2015).

However, recent cases and studies have shown that even younger patients may be affected by a stroke (Carty et al., 2015). Therefore, patient education should be regarded as a crucial step toward preventing the instances of a stroke. An ischemic stroke, as well as hemorrhage, may affect a person from any age group and is a particularly dangerous threat to African Americans, which means that a culture-specific approach toward its prevention is needed.

Pathophysiology

Being a neurological disease, stroke has a rather complex pathophysiology. The mechanism of stroke development is composed of the mechanisms leading to excitotoxicity, as well as the inflammation of pathways (George & Steinberg, 2015). In addition, a stroke implies that a patient’s brain suffers the oxidative damage and develops ionic imbalances leading to apoptosis (George & Steinberg, 2015). Therefore, the subject matter needs to be scrutinized closely. During an ischemic stroke, plaques in cerebral arteries affect the stenotic area, making it form ulcers on the artery wall, with fibrin and platelets attaching themselves to it (Kuk et al., ‎2014). As a result, clots emerge and occlude the artery, thus impeding the blood flow. Due to the rapid progression of the process, neurons die fast.

The pathophysiology of a hemorrhagic stroke is slightly different. The disease occurs due to the development of a vascular occlusion caused by rapture of a blood vessel supplying oxygen to the brain (Chang & Liebeskind, 2017; George & Steinberg, 2015). As a result of the hematoma that expands rapidly, the tissue is affected severely, whereas the brain experiences an increasingly high pressure (Kanyal, 2015). The following reduction in the levels of blood supply leads to the development of infraction.

After a stroke, the cell hypoxia takes place, thus causing a patient to experience the deprivation of oxygen at the tissue level. Moreover, a stroke is followed by the depletion of cellular adenosine triphosphate (ATP), which makes it impossible to retain the ionic gradients. As a result, a patient’s cell membrane experiences severe depolarization with a severe cell edema (Huether & McCance, 2017). The vascular occlusion observed as a result of the identified changes leads to a drop in the local blood flow (Ferdinand & Roffe, 2016; Anderson, 2018). The release of glutamate coupled with the rapid influx of calcium creates the premise for the initial ischemic insult to grow exponentially and affect a patient increasingly.

Furthermore, as the aftermath of the initial ischemic attack, changes occur at the genetic level, leading to the release of cytokines and the aggravation of the inflammation process. Due to the death of astrocytes, a patient’s tissue experiences liquefaction necrosis (Anderson, 2018). Known as the ischemic cascade, the specified process leads to a rapid aggravation of a patient’s condition and may cause the further development of seizures and a poststroke edema.

Signs/Symptoms

The rapid nature of a stroke is what makes it especially dangerous. Since a stroke occurs very fast and leads to a drastic aggravation of a patient’s condition, key signs and symptoms must be identified immediately (Centers for Disease Control and Prevention, 2018). Herein lies the significance of patient education; in order to ensure that a stroke is located and treated respectively, a nurse must teach a patient to locate the essential symptoms as early as possible.

Any signs of sudden physical weakness in body limbs should be seen as the reason for concern. An unexpected feeling of weakness in one’s arm or face, especially if the observed sensation can be located only in one side of a patient’s body, is the key symptom of a stroke (Centers for Disease Control and Prevention, 2018). In case a patient speaks in a slurred manner, one should also suspect a stroke.

Similarly, any problems associated with the coordination of movements, such as difficulty walking, frequent stumbling, and loss of balance are also the signs of a stroke, especially if they are coupled with dizziness and sudden and quite intense headache (Centers for Disease Control and Prevention, 2018). If the described issues are observed simultaneously, a patient must contact healthcare services immediately. Additionally, several less obvious symptoms that may be indicative of a stroke should also be regarded as the reason for concern. Particularly, the painful sensations in arms, legs, or chest, as well as shortness of breath, hiccups, or nausea, are also indicative of a stroke.

Diagnostic Tests/Labs

In order to diagnose a stroke, one should consider brain imaging as the primary tool. The specified type of tests will allow determining the presence of an issue with the greatest amount of precision. A computerized tomography (CT) scan or a magnetic resonance imaging (MRI) technique are the most common diagnostic tools. With the help of X-rays, a CT scan can be used to detect a hemorrhage or a tumor that may be obstructing the blood flow.

While the CT scan offers general information about the location and extent of the injury, as well as allow determining possible causes thereof, the MRI tool offers a more accurate analysis of the situation, including smaller injuries. The specified opportunity emerges due to the use of a combination of radio waves and magnets (Merali et al., 2015). Furthermore, to enhance the image, dye needs to be injected into a blood vessel in order to improve the clarity of the image. The described process is known as magnetic resonance angiography (MRA).

Using the carotid arteries on a patient’s neck, one may also conduct a Carotid Ultrasound Test (CUT). The identified approach allows showing the carotid arteries located in a patient’s neck. The results of the test will also indicate the presence of plaques and evaluate the consistency of the blood flow. Similarly, the cerebral angiogram can be deployed to improve the quality of the X-ray imaging process.

Particularly, a dye is injected into the carotid or vertebral artery after a tube is guided to it through an incision (Johri, Calnan, Matangi, MacHaalany, & Hétu, 2016). Furthermore, the tools such as NIHSS can provide important information (“What is the NIH stroke scale (NIHSS)?” 2017). In the specified situation, the use of the CUT should be seen as a necessity. Due to the presence of carotid atherosclerosis, the application of the CUT is likely to provide the exact data required for an in-depth assessment of the patient’s current problem, as well as determining the methods of addressing it.

Treatment

The approach toward addressing a stroke depends on the type of stroke that a patient has. In the case under analysis, the stroke was caused by the atherosclerotic carotid artery occlusion, which means that the specified scenario is the instance of an ischemic stroke. In the specified situation, either an open surgery or revascularization as the primary method of managing the disease should be applied. In contrast to the open surgery approach, revascularization can be described as less invasive and ultimately less traumatic for the patient (Molina et al., 2015). Among the numerous benefits of the proposed method, the opportunity to reduce the instances of stroke in the future needs to be mentioned (Molina et al., 2015). Therefore, revascularization will need to be regarded as the first-choice tool for addressing the specified case.

In addition, the treatment process will also include patient education. The patient will have to be provided with detailed information about avoiding the threats of his health. Particularly, it will be required to make him quit smoking in order to reduce his blood pressure and create an improved environment for managing the disease. Moreover, the patient will have to be made aware of the methods of locating the threats to his well-being, such as the reasons for him to have developed the ischemic disease, the factors that may lead to a stroke, and the medications that he can take to avoid a stroke (Siegel et al., 2016).

Specifically, taking aspirin should be seen as an important measure for preventing a stroke. Checking the cholesterol levels should also be included in the list of strategies that the patient needs to use to manage his condition. Finally, it will be crucial to provide the patient with the means of contacting the nearby healthcare services in case of need.

EBP Precision Medicine

In addition to the surgical intervention, the patient will be administered medications for reducing the threat of a stroke in the future. Specifically, in order to prevent the platelets in the patient’s body from clotting, one will have to prescribe the medicine that will help to reduce his blood pressure, particularly, the medications for thinning his blood and addressing heart problems (Dasgupta et al., 2014). In addition to the traditional tools for reducing blood pressure the patient may need to consider taking diuretics and ACE inhibitors (Bansilal et al., 2015). While the former allows reducing the threat of an edema, the latter will help to relax the patient’s blood vessels, thus reducing the possibility of clogging.

When viewing the subject matter from the perspective of ethnopharmacology, one will have to take into consideration that there is a tendency in the African American culture to use alternative medicine along with the prescribed one. The observed health-seeking behavior should not be discouraged; however, a nurse will have to educate him about the myths associated with alternative medicine (Liu et al., 2016).

Specifically, certain traditional medications for managing blood pressure can be advised, yet the patient has to be aware of the significance of a pharmacological approach. Specifically, the health management techniques and tools that are defined a natural or supernatural are combined with the prescribed solutions quite often (Tamhane et al., 2014). For instance, the use of herbs should be seen as important (Ch, Naz, Sharif, Akram, & Saeed, 2015). Thus, a complex approach toward managing the patient’s needs is recommended. Therefore, encouraging a shift in behaviors and the use of not only herbs but also prescribed drugs will be necessary.

Prognosis

Given the current state of the patient and the timely identification of the threat to his health, it can be assumed that he will recover rather fast. While his current condition implies several threats to his health, a surgical intervention followed by a therapy and the education process will create the premises for a gradual improvement. Although the patient lacks awareness about his situation at present, an educational program based on the use of visuals and the creation of a simple yet informative set of guidelines for addressing high blood pressure and other negative factors will allow improving the situation. After the application of the proposed techniques, the patient is likely to experience a significant improvement.

Therefore, it is believed that the problem can be managed respectively as long as the culture-specific needs of the patient are addressed and the education process is completed. Although the surgery process may be fraught with certain difficulties associated with cleaning vessel blockages, it is believed that the issue will be managed successfully. However, the promotion of patient education may be difficult due to the presence of numerous myths linked to a stroke. For this purpose, a nurse will have to integrate different types of media, at the same time addressing the patient’s system of health beliefs. Thus, the patient will acquire the expected behaviors and attitudes, developing the ability to identify threats to his well-being and address them respectively.

Nursing Considerations/Care Plan

The first stage of the management of the patient’s needs involves identifying the key symptoms of the stroke in order to verify that it is the ischemic one. Both subjective data such as numbness, nausea, and headache, and objective information, such as facial droop, paralysis, vomiting, and other symptoms, will be collected. Afterward, the general assessment of the patient’s condition will be performed. The next step will involve more accurate tests such as the CT scan and MRI. As a result, the area that has been damaged and has caused the stroke will be located.

The identification of the issue will be followed by an intervention, which may be surgical if the current degree of clogging may jeopardize the patient’s life. Later, a nurse should proceed by introducing a combination of medical treatment and patient education based on his beliefs regarding healthcare. With the help of a continuous dialogue, a nurse will introduce crucial skills of identifying and addressing the threats to his health, especially the factors that contribute to a rise in his blood pressure levels. During the first several weeks after the release from the hospital, the patient may need to be monitored by a nurse to ensure that he is capable of managing his health needs independently.

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