NURSING ASSIGNMENT

Nursing Assignment

Nursing Assignment

Section One

Stroke is the third commonest cause of death and the most frequent cau of severe adult disability in Scotland. 70,000 individuals are living with stroke and its consequences and each year, there will be approximately 15,000 new stroke events. Immediate mortality is high arid approximately 20% of stroke patients die within 30 days.

For those who survive, the recovery of neurological impartment takes place over a variable time-span. About 30% of survivors will be independent within three weeks, rising to nearly 50% by six ms.' (Kalra and Crome 2003:14)

Disabling conditions such as stroke are best considered within an agreed framework of definitions. The World Health Organization (WHO) International Classification of Impairment Disabilities and Handicaps (ICIDH) provides the following framework for considering the impact of stroke on the individual:2

pathology (disease or diagnosis): operating at level of the organ or organ system

impairment (symptoms and signs): operating at the level of the whole body

activity (disability): observed behavior or function

participation (handicap): social position drill roles other individual.

A number of contextual factors may influence this framework as recognized in the International

Classification of Functioning, Disability and Health (ICF).4 ICF has two parts, each with two components:

Partial Functioning and disability

a) Body functions and structures

b) Activities and participation

Part 2 Contextual factors

c) Environmental factors

d) Personal factors.

The ICF also outlines nine activity anti participation, which can provide the locus rehabilitation efforts:

Learning and applying knowledge

General tasks arid demands

Communication

Mobility

Self-care

Domestic life

Interpersonal interactions and relationships

Major life areas

Community, social and civic life.

Within this framework, rehabilitation aims to maximize the individual's activity, participation (social position and roles) and quality of life, and minimise the distress to carers.

The conventional approach to rehabilitation is a cyclical process:

assessment: patients needs are identified and quantified

goal setting: goals are refined for improvement (long/medium/short term)

intervention: to assist in the achievement of the goals

reassessment: progress is assessed against the agreed goals.

Rehabilitation goals can be considered at several levels:

aims: often long-term and referring to situation after discharge

objectives: usually multi-professional at the level of disability

targets: short term time limited goals.

The process of rehabilitation can be interrupted at any stage by previous disability, co-morbidities and complications of the stroke itself.

Eariy Supported Discharge And Post-Discharge Support

Stroke unit care typically involves an early assessment of discharge needs and the development of a discharge plan involving the patient arid carers. A Cochrane review' of seven completed trials indicates that early supported discharge (ESD) services can reduce the length of hospital admission in selected stroke patients. ESD services were provickd bya co-ordinated multidisciplinary team who assessed individuals during hospital admission, coordinated their discharge arid provided post-discharge rehabilitation. Most services excluded those with very mild or very severe stroke and were available for approximawly 30% of all hospitalized stroke patients. These services appear to provide an outcome at least as good as hospital care. The impact on service costs is Iikely to be ...