Case Study Example of a person diagnosed with pneumonia, dehydration, urinary tract infection (UTI) and pressure ulcer, common complications of stroke brought about by the difficulties and damages incurred on the different parts of the patient's body

Abstract

Helen is a 67-year-old white female admitted to a medical/surgical floor. She was brought to the emergency room by a friend. Her health history is as follows: right-sided cerebrovascular accident (CVA) with left hemiparesis, arthritis and hypertension. Her friend speaks for her since Helen is aphasic and reports a general decline in Helen's overall health over the past few weeks. Helen lives in a commune that practices New Age religious beliefs. They adhere to a vegetarian diet and believe in the power of prayer and crystals to heal body imbalances. They have been Helen’s caregivers since the onset of her stroke, approximately 1 year ago. Helen is incontinent of bladder and bowel.

Helen is diagnosed with pneumonia, dehydration, urinary tract infection (UTI) and pressure ulcer. All these are common complications of stroke brought about by the difficulties and damages incurred on the different parts of the patient’s body. Treatment interventions for Helen include a combination of strategies and procedures designed for the specific complication being experienced.

 

Discussion

            The history of the patient shows that she had a stroke or cerebrovascular accident (CVA). There was however no note as to what is its cause. CVA is a common cause of neurologic disability in Western countries. It is the third leading cause of death in the United States (Beers & Berkow, 2000). Although vascular injury to the brain can occur as part of a number of relatively rare diseases, most CVAs are secondary to atherosclerotic disease, hypertension, or a combination of both. Thus one could also explain the presence of hypertension and arthritis in the patient’s history and the interrelationship between the three conditions. Helen’s stroke affected the left hemisphere of the brain, thus the reason for aphasia. Her hemiparesis or partial paralysis of one side of her body could be explained by the neurologic injury caused by CVA.

Her aphasia, or language disorder, is secondary to the stroke that she has experienced. The stroke has probably injured or damaged some part of her brain that is responsible for language functions. Aphasia is considered to be the most common language disorder following the stroke (Potter & Perry, 2004). Helen’s aphasia and hemiparesis does not allow her voice out what she is experiencing and thus the friend needs to be the one to provide the nurses with the needed information. However, the health care professional should try to initially establish very basic communication and recognize that aphasia des not indicate intellectual impairment or degeneration of personality. The health care professional should explain situations and treatments that are pertinent to the patient, because she may be able to understand the speaker’s words (Ebersole & Hess, 2001). Additionally, if the patient has family or friends that are around, they should also be explained.

            The aspiration pneumonia that Helen experienced is brought about by dysphagia or difficulty swallowing as a common occurrence following a stroke (Kaplan, 2003; Olsen-Vetland, 2003). Pneumonia in the elderly is often caused by destruction of the defensive mechanisms such as cough and swallowing reflexes (Sasaki, 2001). Her UTI could be attributed to urinary and bowel incontinence experienced. Of the many people who experience a stroke each year, a significant proportion experience urinary incontinence as a consequence (Olsen-Vetland, 2003). Problems with physical mobility caused by arthritis or stroke can affect manual dexterity and the ability to grasp and hold a cup or glass (Walton, 2002), thus explaining the dehydration experienced by the patient. The pressure ulcer, or most commonly known as bedsore, is probably attributed to the fact that the hemiparesis allows Helen only little movement or no movement at all. Such a condition is seen most frequently in patients who have diminished or absent sensation, or are paralyzed, such as in the case of Helen.

 

Recommended Interventions

            The most important thing to here first is to provide an accurate diagnosis from facts gathered in present condition and the accurate history of the patient. The first and most important step in treatment consists of identifying patients with potential or impending strokes so that effective measures can be attempted to prevent further injury to Helen. The scope of interventions regarding stroke ranges from teaching older adults about risk reduction strategies to care of the adult after a CVA and during recovery and rehabilitation (Potter & Perry, 2004).

            Treatment with angiotensin-converting enzyme inhibitors has an advantage over angiotensin II in prevention of pneumonia in elderly hypertensive patients with stroke (Sasaki, 2001), and would likely benefit Helen in the treatment of her pneumonia without further complicating her condition. Treatment techniques for pneumonia also includes compensatory strategies (postural maneuvers) and indirect therapy (exercises to strengthen swallowing musculature) aimed at lessening dysphagia and help eliminate pneumonia. These techniques alter the physiology of the swallow to achieve improved efficiency or a safer swallow. There are also specific strategies for improving airway protection, pharyngeal, and laryngeal and upper esophageal sphincter function (Kaplan, 2003).

The promotion of continence and appropriate management of incontinence are also important elements of care for Helen. Promoting continence following a stroke relies on the same methods as promoting continence in any other instance. This could help eliminate the incidence of further UTI complications in the patient.

            Interventions for reducing and treating pressure ulcers are evaluated by determining the patient’s response to therapies and by determining whether each goal was achieved. The optimal outcomes are to prevent injury to the skin and tissues, reduce injury to the skin and underlying tissues, and restore skin integrity (Potter & Perry, 2004). With regards to the patient’s problem of dehydration, liquids should be provided through intravenous routes if it is not possible by the mouth.

Lastly, the care of a patient with stroke and presenting complications requires a multidisciplinary health care team approach. The health care team in charge of Helen should see to it that the interventions designed for a specific complication does not further complicate or worsen the condition of the patient.