A common neurological issue that affects millions of American per year are strokes or cerebrovascular accident (CVA). The majority of these are ischemic, and the minority are hemorrhagic. Hypertension is the primary cause of ischemic strokes (Khaku and Tadi, 2020). An Ischemic stroke is a stroke that occurs when an artery to the brain is blocked and decreases blood flow to some regions of the brain (Strokecenter.org, n.d.). Blood from the lungs and heart contain oxygen, nutrients that the brain needs to carry out our normal lives. This blood not only delivers oxygen to the brain but also removes wastes such as carbon dioxide and cellular debris to be metabolized or removed by the lungs. When the artery is blocked the brain, cells do not receive oxygenated blood that is needed to function, and the brain cells affected if blocked for more than a few minutes, resulting in brain cells to die and cause permanent cell and possible brain damage. Symptoms of a stroke depend upon what area of the brain is affected: Acute changes in the level of consciousness or confusion, acute onset of weakness or paralysis to extremities or part of the body, Numbness, partial vision loss, double vision, difficulty speaking or understanding speech, or difficulty with balance and dizziness (Wedro, 2019). Predisposing factors such as high blood pressure, high cholesterol, diabetes, smokers, a-fib, and heart dysrhythmias, are at increased risk for stroke (Wedro, 2019).
Not every patient diagnosed with this will display the common symptoms of hypertension, which means they may not take proper precautions because the symptoms are not severe. The disease will continue to progress and lead to a higher risk of stroke. It is essential to explain to patients that they need to monitor their blood pressure, adhere to a proper diet, quit smoking if they do, and even engage in more physical activity. It is also important to explain the symptoms of a stroke. Most people recognize FAST, which is F (facial drooping) A (arm weakness) S (speech symptoms such as slurring words or unable to find them) and T (time to call 911). It is vital to recognize these symptoms not only because they are life-threatening but also because if proper intervention, the patient may be eligible for the thrombolytic. The patient and family should all be educated on this because this is lifesaving information. The nurse should assess the patient’s readiness and willingness to learn and find the learning style for education to be effective. Once that is done, a thorough explanation of lifestyle modification due to the dangers of stroke. Teach back method is the best way to assess how well the patient has understood the teaching and the patient’s primary language used. Patients and families should be involved in the plan of care for teaching to be effective.
Wedro, B. (2019). Stroke: FAST, Symptoms, Causes, Types, Treatment, Prevention. Retrieved July 20, 2020, from https://www.medicinenet.com/stroke_symptoms_and_treatment/article.htm
StrokeCenter.org. (n.d.). The Internet Stroke Center. Retrieved July 20, 2020, from http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/
Khaku, A. and Tadi, P., 2020. Cerebrovascular Disease (Stroke). [online] Ncbi.nlm.nih.gov. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK430927/> [Accessed July 20 2020].
Migraine -is characterized by recurrent attacks of moderate to-severe, lateralized, throbbing, or pulsatile pain in the head and often associated with photophobia, phonophobia, nausea, and vomiting.
Migraine is a syndromic disorder that occurs as a result of abnormalities involving membrane channels, receptor families, and enzyme systems (changes in the brainstem and its interactions with the trigeminal nerve a major pathway be involved, imbalances in brain chemicals (serotonin which help regulate pain in the nervous system). Migraine is often associated with various comorbidities like Hypertension, Hypotension, Elevated lipid profile, Thyroid disorders, Depression, Ophthalmic disorders, Chronic sinusitis and Elevated intra‑cerebral pressure (AlQarni, Fayi, Alsharif, Siddiqui, & Alhazzani, 2020).
Contributing factors to migraines include; -Family history of migraines (inheritable), smoking, stress high levels of stress anxiety and depression, hormonal changes in in women poor sleep quality significantly associated with higher risks of migraine (Hsu et al., 2020) and hormonal changes in women. The primary step for appropriate and efficient therapy of migraine is correct diagnosis, eliminating alternative causes, educating the patient and finding better treatment for management of pain pressure (Ahmad et al., 2020).
To promote health and prevent migraines, and improve the patients quality of life ,patients can be referred to through Biobehavioral treatments which include therapeutic patient education (TPE) and self-care, cognitive behavioral interventions, and biobehavioral training (Hsu et al.,2020).Psychotherapy, group therapy helps the patient to overcome withdrawal ,isolation and find support to build skills and learn on how to live with pain,build relationships and avoid negative thinking management, educate on relaxation techniques such as self-hypnosis an bio feedback for stress management (Wotton & Kissoon,MD, 2020), ask the patient to log triggers that cause the migraines and how to prevent and manage them life style management(,importance of exercise, diet medication adherence, hormonal therapy .
Ahmad, A., Ali, M. D., Hassan, M., Dhefairy, A., Saad, A., & Khalifa, A. (2020). Treatment Pattern and Awareness of Migraine in Eastern Provinces, Saudi Arabia: A Descriptive Cross Sectional Study. International Journal of Pharmaceutical Investigation, 10(2), 221–224. https://doi.org/10.5530/ijpi.2020.2.41.
AlQarni, M., Fayi, K., Alsharif, M., Siddiqui, A., & Alhazzani, A. (2020). Prevalence of migraine and nonmigraine headache and its relation with other diseases in the adults of Aseer Region, Saudi Arabia. Journal of Family Medicine & Primary Care, 9(3), 1567–1572. https://doi.org/10.4103/jfmpc.jfmpc_962_19
Hsu, Y.-W., Liang, C.-S., Lee, J.-T., Chu, H.-T., Lee, M.-S., Tsai, C.-L., … Yang, F.-C. (2020). Associations between migraine occurrence and the effect of aura, age at onset, family history, and sex: A cross-sectional study. PLOS ONE, 15(2), e0228284. https://doi.org/10.1371/journal.pone.0228284
Wotton, R. J., MDiv, PHD, & Kissoon,MD, N. R. K. (2020, February 24). UpToDate. Retrieved July 19, 2020, from www.uptodate.com website: https://www.uptodate.com/contents/migraines-in-adults-beyond-the-basics