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Symptoms of Stroke

Question:

Discuss about the Burden of Stroke in Australia for Diabetes Mellitus.

Stroke denotes a condition in which the flow of blood to the brain is poor which results in cell death. In existence, it manifests itself in two distinct ways, that is, either due to insufficient blood also called ischemic or as a result of hemorrhagic that is often referred to as hemorrhagic. Both types of strokes make the brain not to function properly thus affecting various parts of the body and activities that the brain controls. In addition to that, for one to notice or identify whether a person is suffering from stroke, there are various symptoms that one looks at, such as severe head ache and loss of bladder control. Nowadays, stroke is becoming a burden in Australia, for many reasons, least of which is that it is affecting old people at an alarming rate (Feigin et al., 2014). Diabetes mellitus, obesity, and high blood pressure are attributed to be one of the risk factors that have the potential to cause a stroke. However, of importance in this paper is the management of stroke in elderly people. In doing so, the paper aims to come up with specific objectives, that is, the identification and application of the best management programs for the elderly.

The aim of this task is analyzing the burden of stroke in Australia is to identify and apply the best management practices that medics can use for elderly patients. In doing this, one has to come up with smart objectives that can be used to stay put in achieving the aim. The first smart objective is to increase the number of patients that are discharged from hospital by fifty percent in a period of two years. In addition to that, the other objective is to encourage three-quarter of health care practitioners working with the aged people on the best management practices for stroke patients in a period of one year. Lastly, is to use the latest scientific information that spans for less than five years to all medics managing or administering management practices to the aged suffering from a stroke. In regards to the issue at hand, the SMART objectives will relate to the aim of addressing the burden of stroke in Australia and more especially, to the old age population. Below is the template:

 Aim: To identify and apply the best management practices that medics can use for elderly patients.

Objectives

Strategies

Actions

Outcome measures

Outcome

indicators

By who

Timeline

To increase the number of patients that are discharged from hospital by fifty percent in a period of six-months

Ensure that there are competent health care practitioners working for aged group.

All medics to have a mentor before starting practicing on their own in management of stroke.

Survey whether there is an increase in the patients discharged with satisfaction of management of stroke.

Patients satisfied with the services rendered by medics in management of their stroke. Take a survey.

Medics, health care heads, patients of stroke

2 years.

To educate three quarter of health care practitioners working with the aged on the best management practices in a period of one year.

Medics to continue learning on the best management practices of stroke.

Partner with the government to fund medics in training.

Receipts of financial assistance from the government.

Post program survey.

Increase in the number of health care practitioners who have undergone further training on management practices.

Government, medics

1 year.

To use of scientific information in the latest five years by all medics in the management of stroke in the aged for the next two years.

Avail the latest information to medics and patients.

Get the latest information from scientific research and studies.

Survey the practices used by medics.

Change of management practices, that is, past and present.

Practices in line with those being advocated in recent studies.

Questionnaire.

Medics, patients.

2 years.

Risk Factors for Stroke

The first strategy is to provide information to the carers. Information is key to knowledge and without information; it is very difficult for one to carry out specific tasks diligently. However, studies reveal that unlike the general misconception of the importance of formal information, written and verbal information may at times be more essential than the former (Emberson et al., 2014). In addition to that, information is not only limited to carers but patients who are in need of management of stroke as well. In one study conducted on old people, about 77 percent were eager to know the best way that can make them manage the current state of stroke that they were facing. In addition to that, a study conducted in the United Kingdom to determine the usefulness of information established that 61 percent of patients do not see the need for a patient-held record (Meretoja et al., 2012). Thus, it is an indication of encouraging health care professionals to offer the best management practices.


In addition to that, offering training is another strategy that can be used to encourage or rather promote the ability of medics to practice the best management practices on patients of old age. It is no longer a secret that for any professional to become competent, he or she must undergo continuance training on various specialties (Thrift et al., 2014). Additionally, training can also be in the form of having a mentor that act as a teacher for inexperienced medics before becoming seasoned. In so doing, medics will gain the necessary skills and knowledge in managing and offering guidance on the management program of stroke among the old. On the other hand, training will help medics learn new ways of management (Feigin et al., 2016). Many new management practices may not be well versed with all medics. Thus, inculcating new practices is essential in curbing stroke as far as a management practice is concerned.

On the other hand, looking into the modern literature on management practices is another approach that can be used to manage patients properly. It is essential especially for old people that do not need preventive measures but the management of stroke. According to a study conducted on 2014, beta blockers, nitric oxide donors, and calcium channels blockers are known to lower blood pressure to the level that is recommended for old age patients with stroke (Lu et al., 2014). In addition to that, in situations that need an increase in blood pressure, phenylephrine can be used while dexamphetamine is associated with elevating blood pressure faster than the other. On the other hand, Nimodipine is an agent or rather drug that when used, has shown to have negative effects on decreasing diastolic blood pressure but does not give the same effect on systolic blood pressure. Still concerning blood pressure, Lisinopril tends to be safer when given in acute phase (Powers et al., 2015). However, it has not been documented to have any significant clinical benefit. These are some of the best management strategies that can be identified and applied to the old people in managing blood pressure if they happen to be affected by stroke.

Objectives

About management of blood glucose, the best practice, it is not always advisable to use insulin substance to manage blood glucose especially and more particularly for patients that have registered moderate hyperglycemia. In this group of patients, the best way to manage them is to formally assess them to exclude or even ascertain a diagnosis of diabetes (Menon et al., 2015). The best way to correct hypoglycemia is through local protocols. Additionally, old age stroke patients need to be managed in line with local protocols.

Another thing that poses a threat to old age patients that experience stroke is feeding. More often than not, oropharyngeal dysphagia is a condition that manifests in many groups of old age people suffering from the stroke. This condition leads to swallowing difficulties which may be a precipitate to dehydration, under nutrition and aspiration pneumonia. There are clear guidelines that medics can use to monitor patients that are under this condition (Khatri et al., 2014). For instance, it is advisable for medics to provide nutrition through nasogastric tube for stroke patients that have the problem with ingesting food or taking oral medication as a result of low consciousness or rather the existence of dysphagia as one of their characteristics (Party, 2012). The best approach here is that application of nasogastric feeding tube ought to be carried on patients who appear to be unable to have an oral intake. Additionally, it is not a good management practice to have a regular nutritional supplement.

Another recommended management practice that needs to be inculcated by medics or carers for the old age patients of stroke is about pyrexia. Old age patients suffering from stroke often experience increased body temperature which is linked to poor outcome and its source ought to be properly determined (Adams et al., 2012). Although antipyretic drugs are often used to reduce body temperature, studies reveal that they do not have any significant effect in the reduction of body temperature. Rather, 6000mg daily intake of paracetamol can have that desired effect of reducing the temperature.

Also, lifestyle changes are essential for old age suffering from a stroke. One of the causes of stroke is embracing a lifestyle that brings about lifestyle diseases. Also, when an old person experiences a stroke, the best way to facilitate recovery is through a total transformation of lifestyle that predisposes one to the dangers of diabetes, high blood pressure, and excessive cholesterol (Jauch et al., 2013). Another aspect closely related to lifestyle is physical activity, this important in the sense that old age stroke patients who exercise regularly have been shown to register improvement in the disease condition unlike those that either does not follow or assume exercising (Ciccone et al., 2013). In the early stages of stroke, the medics can assist one in coming up with the best way to manage him such that there will be no progression of the same.

Management Strategies for Elderly Stroke Patients

There is the need for medics to attend seminars and other educational programs to sharpen their skills. Moreover, the treatment that old age patients obtain must not be similar to that of other age groups. In relation to the management of stroke, the old age ought to be treated with utmost respect, while medics are conforming with all the principles of ethics and professional code of conduct, such that there is no disrespect or treating a patient without him or her giving consent for the same (Trialists’Collaboration, 2013).


In creating the approach that can best serve the old age, in managing their stroke, a time frame must be put in place to measure the progress that health care professional has made so far. One way of determining this is by looking at the number of patients that feel safe and are discharged from hospital based on improvement in health conditions (Sun, Tan, & Yu, 2014). Additionally, other factors that can determine whether the method is working is measuring the degree of competency of medics that come from training. On the other hand, whether the health facility applies outdated methods or the latest ones is another aspect that can tell the suitability of the objectives in achieving its intended purpose.   Survey to determine the suitability of each method can be carried out so that one can determine what to correct or amend (Network, 2008). Additionally, old age patients can be given questioners to answers on whether as a result of training, there has been any significant change in their stroke condition or how the medics treat them. Another way to measure the outcome of the specific objectives is to look at to take statistics on the number of old age stroke patients that have the information on management of their condition in relation or then compare with data from previous years. It is also prudent to take note of the number of outpatients who continue with their programs of treatment and management way before or after they visit health centers (Wu, & Grotta, 2013). It will indicate how serious or enlightened old age patients can become or the other way round.

Health care centers must ask for the government to ask them about funding or put up policies that not only ensure that stroke is a health issue that raises a lot of concern but one that supports professional to gain more knowledge and skills through training. The contribution of the government and other agencies cannot be overemphasized (Katzenellenbogen et al., 2011). Questionnaires and evaluation ought to be carried out periodically to determine the changes that stroke patient’s needs. In old people who have terminal illnesses, palliative care may be incorporated with other skills of stroke management as this will be more beneficial to the old man or woman at this stage and point of life more than the stroke management process. Lastly, all the objectives and strategies ought to be given a timeline. This is for many reasons; firstly, it helps in self-evaluation. Secondly, it is good in making necessary changes and lastly, noting positive changes can serve as a motivation for even more success.  

Conclusion

It is evident that stroke is an important disease that can be fatal if not well maintained. There are many causes of stroke; however, old people need good care and management as far as stroke is concerned. In Australia, like in many other countries, stroke has been attributed to be a burden for many reasons which include but are not limited to lack of information to the public to fight for the disease. For healthcare professionals, management of stroke in older people is of paramount importance, and it is, therefore, crucial for them to come up with objectives that will see old age receives the best management that is attainable based on current scientific literature. In the discussion above, it is evident that various management program exists that can be implemented by healthcare professionals to solve the problem of stroke. Some of the ways that medics can be made better in delivering their services to old age include, through training, finding a mentor, that is, gaining experience from someone. These are some of the measures that medics need to prepare themselves in regards to skills essential in the management of stroke in old people. Lastly, medics need to apply latest scientific practices in the management of stroke patients.  

References

Adams, T., Stacey, E., Stacey, S., & Martin, D. (2012). Exertional heat stroke. British Journal of Hospital Medicine (17508460), 73(2).

Ciccone, A., Valvassori, L., Nichelatti, M., Sgoifo, A., Ponzio, M., Sterzi, R., & Boccardi, E. (2013). Endovascular treatment for acute ischemic stroke. New England Journal of Medicine, 368(10), 904-913.

Emberson, J., Lees, K. R., Lyden, P., Blackwell, L., Albers, G., Bluhmki, E., ... & Grotta, J. (2014). Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. The Lancet, 384(9958), 1929-1935.

Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., ... & O'Donnell, M. (2014). Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet, 383(9913), 245-255.

Feigin, V. L., Roth, G. A., Naghavi, M., Parmar, P., Krishnamurthi, R., Chugh, S., ... & Estep, K. (2016). Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology, 15(9), 913-924.

Jauch, E. C., Saver, J. L., Adams, H. P., Bruno, A., Demaerschalk, B. M., Khatri, P., ... & Summers, D. R. (2013). Guidelines for the early management of patients with acute ischemic stroke. Stroke, 44(3), 870-947.

Katzenellenbogen, J. M., Vos, T., Somerford, P., Begg, S., Semmens, J. B., & Codde, J. P. (2011). Burden of stroke in indigenous Western Australians. Stroke, 42(6), 1515-1521.

Khatri, P., Yeatts, S. D., Mazighi, M., Broderick, J. P., Liebeskind, D. S., Demchuk, A. M., ... & Goyal, M. (2014). Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. The Lancet Neurology, 13(6), 567-574.

Lu, Y., Hajifathalian, K., Ezzati, M., Woodward, M., Rimm, E. B., & Danaei, G. (2014). Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1· 8 million participants.

Menon, B. K., Qazi, E., Nambiar, V., Foster, L. D., Yeatts, S. D., Liebeskind, D., ... & Broderick, J. P. (2015). Differential effect of baseline computed tomographic angiography collaterals on clinical outcome in patients enrolled in the Interventional Management of Stroke III trial. Stroke, 46(5), 1239-1244.

Meretoja, A., Strbian, D., Mustanoja, S., Tatlisumak, T., Lindsberg, P. J., & Kaste, M. (2012). Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology, 79(4), 306-313.

Network, S. I. G. (2008). Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention. Edinburgh: Scottish Intercollegiate Guidelines Network.

Party, I. S. W. (2012). National clinical guideline for stroke.

Powers, W. J., Derdeyn, C. P., Biller, J., Coffey, C. S., Hoh, B. L., Jauch, E. C., ... & Meschia, J. F. (2015). 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke, 46(10), 3020-3035.

Sun, J. H., Tan, L., & Yu, J. T. (2014). Post-stroke cognitive impairment: epidemiology, mechanisms and management. Annals of translational medicine, 2(8).

Thrift, A. G., Cadilhac, D. A., Thayabaranathan, T., Howard, G., Howard, V. J., Rothwell, P. M., & Donnan, G. A. (2014). Global stroke statistics. International Journal of Stroke, 9(1), 6-18.

Trialists’Collaboration, S. U. (2013). Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev, 9(9).

Wu, T. C., & Grotta, J. C. (2013). Hypothermia for acute ischaemic stroke. The Lancet Neurology, 12(3), 275-284.

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