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Understanding Stroke: Causes, Effects, and Prevention

  • 17 Pages
  • Published On: 06-11-2023

Introduction

In the world, stroke has been the leading cause of disability among adults and fourth in the rank for the cause of death. However, 80 percent of the strokes can be prevented. The occurrence of the stroke takes place when the artery is blocked by the blood clots (blood is carried by a blood vessel to the body from the heart) or a blood vessel being blocked by blood clots (through the body, the blood moves through a tube) and breaks with the interruption of blood flow to a brain area. When either of these takes place, there is beginning of the death of the brain cells and the occurrence of brain damage. When during a stroke, the brain cells die; there is loss of abilities controlled by that brain area. These abilities include memory, movement, and speech. The nature of the affect of the stroke patient is dependent on the extent to which the brain is damaged and the location of the brain, where there is occurrence of the brain (Davey and Gray, 2002). For instance, an individual having a small stroke may be experiencing minor problems like weakness of leg or arm. The individuals having larger stroke may have paralysis on one side or losing their speaking ability. Some individuals may be recovering from strokes completely, but they can have some forms of disability.

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This study aims at describing and analyzing the clinical problems attached with stroke and analyzes the illness of the patient and his experience pertaining to diversity and equality of experience and its impact on the patient. Various care models are also discussed as well as the professionals’ roles and the way support can be provided to the patient psychologically and socially.

Characteristics of stroke

Two main stroke classes

A. Ischemic stroke

In the daily life, there are benefits of blood clotting. When a wound bleeding takes place, there is working of the blood clots in slowing and eventually stopping the bleeding. When stroke takes place, there is danger with the blood clots as the arteries are blocked and the blood flow is cut off. This process is known as ischemia. The occurrence of an ischemia stroke can takes place in two ways: thrombotic and embolic strokes (Adams et al., 2003).

Embolic stroke: There is clotting of the blood forms in the body (generally in the heart) in embolic stroke and have been travelling through the brain’s bloodstream.

Thrombotic Stroke: there is impairment of the blood flow as there is blockage in one or more arteries types that supply blood to the brain. This process that leads to the blockage is called thrombosis.

B. Hemorrhagic Stroke

If the cause of the strokes is blowout or breakage of the brain’s blood vessel, it is known as hemorrhagic strokes. This type of breakage’s medical word is hemorrhage. The cause of the hemorrhages can be several disorders affecting the blood vessels, which includes cerebral aneurysms and long-standing high blood pressure. An aneurysm is a thin or weak spot on the wall of a blood vessel. At birth, usually, there is presence of these weak spots. The development of the aneurysms, usually, takes place over several years and detectable problems are not caused till they break. The hemorrhagic stroke is of two types: intracerebral and subarachnoid. In intracerebral hemorrhage, there is occurrence of bleeding from the vessels located within the brain. The high blood pressure or hypertension has been the principle cause of intracerebral hemorrhage. The bursting of the aneurysm near the delicate and thin membrane that surrounds the brain or in the large artery takes place in subarachnoid hemorrhage. The spilling of the blood in brain and the area around it, which has the filling of a protective fluid, is the causation of the blood-contaminated fluid surrounding the brain (Hemphill et al., 2015).

Treatment

The stroke’s treatment is in ways as follows:

  • Drug therapy
  • Surgical treatment
  • Rehabilitation therapy

Drug therapy

Medicinal Treatment

The platelets are nothing but blood cells, which have been helping the blood to be clotting and preventing bleeding. There is need for the platelet cells adenosine and thromoxane A2, which are clotting factors specific to vitamin K in making them sticking together (Abbott, 2009). These chemicals are nothing but glue that would be holding together the blocks in making the clot.

Aspirin

Aspirin has other uses apart from providing relief to inflammation, fever, and pain. There is also use of aspirin as an inhibitor of platelet/antiplatelet aggregation in patients who had stroke or TIA. The reduction of risk to have another stroke or TIA is done by aspirin (Abbott, 2009).

Dipyridamole Aggrenox: the conjunction of two platelet/antiplatelet aggregation inhibitor, dipyridamole’s (200mg) extended release, and aspirin (25mg). These medications have been working together separately and in similar ways, although in blood’s separate chemicals help in preventing future stroke or TIA (Abbott, 2009).

Ticlopidine

This medicine helps the prevention of another stroke. The 250 mg tablets are taken twice a day with food (Ederle et al., 2009).

Thrombolytic

The usage of thrombolytic therapy is in relation to the breaking up of the clot that causes blood flow disruption to the brain (Ederle et al., 2009).

Anticoagulants

The class of drugs as the anticoagulants has the usage of preventing the blood from the formation of dangerous clots that could be resulting in a stroke (Holloway et al., 2014). Often, the first prescribed medication is the anticoagulants that the doctors prescribe following a stroke.

Heparin

Heparin can be given sub-cutaneously or intravenously, rather than by mouth. The usage of Heparin is sometimes for reducing stroke risk or acute stroke damage amongst the hospitalized patients (Meschia et al., 2014).

Warfarin

This is another anticoagulant drug that is given by mouth. If the warfarin is taken daily, the risk of stroke can be reduced in some patients (Meschia et al., 2014).

Surgical Treatment

The surgical techniques of various kinds have emerged for patients with aneurysms and arteriovenous malformations. These are hypothermia, cerebral revascularization and stereotactic microsurgery (Harbison et al., 2003). There is also offering of interventional neuroradiology and stereotactic radiosurgery. The surgery is a way to prevent the patients with regards to stroke in certain conditions. The surgical techniques of several conventional types for some time have been in use that includes "clipping" aneurysms in preventing bleeding further and the removal of AVMs.

Stroke rehabilitation therapy

The activities of the stroke rehabilitation depend on the type of the affected ability or part of the body. These are mostly physical activities such as, exercise for the improvement in the coordination and muscle strength and strengthening motor skills. These also include therapy in helping to swallow (Spence et al., 2010).

Illness experience of the patients

The survivors of the stroke have been setting themselves goals and developing strategies in achieving these. For certain people, the expression of these goals are in general terms, while for others these have been quite specific. One goal’s achievement can fulfill others often, such as improvement of self esteem, reduction in dependence, career burden and stress, getting independently to the toilet. The personal goals outside and inside the house has often been in relation to mobility and to get about independently. Inside the house, survivors strive in becoming mobile and in performing their own personal care and in regaining activities and skills as gardening or cooking (Bury, 2005). To go back to work has been important for certain young aged people, although they had been forced to accept less demanding position or shorter hours in succeeding. One of the essential skills has been driving, and loss of this is a hindrance to identity and independence.

With regards to strategies, the people have been using short term goals in reaching the long term goals, such as to break a journey to different stages or to use a taxi in getting to the shops in ensuring sufficient energy for shopping.

The people having experiences stroke faces an uncertain future featured with uncertainties with regards to the probable recurrence and the extent to which recovery they would be able to achieve (Burton, 2000). The stroke has one of the primary causes of long term disability among the older people and adults. The increase disability has been a significant factor being associated with ageing. The strokes’ incidences augment from the rate of 2 per 1000 cases in the age group of 55-64 years and then the rate increases in the age group of over 85 years to 20 incidences per 1000 people (Department of Health, 1999). The people that have succeeding in surviving a stroke are 5-7 per 1000 cases. Amongst the survivors, not less than 50 percent are the ones who are left with physical disability and there are several others that have experienced a magnitude of memory impairment (Rudd et al, 1999).

While, there can be varying cerebro-vascular accidents from events which are relatively minor, such as, life threatening strokes and transient ischemic attacks, such events can bear major impact on both the patient and their carers (Chang and Johnson, 2008). The impact can be psychological trauma or varying magnitude of physical and mental disability (Anderson, 1992).

Social support

The socializing with friends and family has been a key part of stroke recovery. The stroke survivors need support without exception (Larkin, 2014).

There are several ways with which support can be obtained by the stroke survivor.

Support group

The patient can interact with other survivors of stroke that have the knowledge of the patient’s experience. This is allowed by the support group, and the people belonging to the support group can be:

  1. Helping the patient finding ways of solving problems in relation to his stroke
  2. Encouraging the patient trying new things
  3. Listening to the frustrations and concerns of the patient
  4. Giving patient a chance of getting out of the house
  5. Giving the patient a chance of sharing his story
  6. Becoming the new friends of the patient (Barry and Yuill, 2016).

Friends and family

The family and friends can also be providing support. They can be:

  • Involving patient in their activities
  • Encouraging the patient in joining support groups or community recreation programs
  • Arranging for the patient in attending the fun activities and social gathering
  • Listing to all the people and their phone numbers that patient care most that allows the patient accessing easily to them when the patients needs them most
  • Helping the patient buying and writing letters and cards and sending them to the people
  • Giving the patient rides to social events

Medicines

The patient’s doctor, his family and the patient himself are required to be working as a team in ensuring the medicines produce the benefits as desired, especially if the medicines are taken for the conditions that are more than one.

Psychological support

There can be emotional problems occurring after stroke. The problems that are common are anxiety and depression. There are evidence of emotional liabilities, such as, apathy, frustration, aggression, and anger. The fear of falling and the post traumatic stress disorder are further concerns. An intense emotional reaction is known as “catastrophic reaction” which the inability of performing tasks after the occurrence of the neurological damage taking place to up to 20 percent of the stroke survivors. The catastrophic reactions and emotional liability not always, but often have association with depression. In after stroke period, as a feature of depression, there is demonstration by the patients with apathy, which is lacking of concern, interest, and emotion. This kind of apathy is prevalent in approximately 27 percent of the people after having the stroke (Nys et al., 2007). The medication has significant, although small effect on the symptoms of psychological problems in the stroke patient.

The effect of cognitive impairment has been with 80 percent of the stroke patients (Nys et al., 2005). In the acute phase, they have been more common, although there is persistence of many problems over time. The importance of the cognitive impairment is because they have association with rehabilitation outcome (Nys et al., 2005). The occurrence of the impairment takes place with the cognitive domains, which includes praxis, executive functions, visuospatial abilities, language, memory, and attention. The provision of the cognitive rehabilitation is the reduction of the cognitive impairment following the stroke and the improvement of the functional outcomes. The evidences are there that there can be reducing of the cognitive rehabilitation in relation to some cognitive impairment.

Professional’s response to disease and illness

During the recovery and rehabilitation phases, the patient will be working with a team of professionals coming from various specialties. It is important that the patient knows his healthcare team and there is an air of comfort to address the issue of recovery with them.

Physical therapy

Physical therapy provides help in restoring physical skills and functioning such as range of motion and walking, and addressing issues like foot drop, faulty balance, one sided or partial paralysis (Bury, 1982).

Occupational therapy

Occupational therapy has been involved with the skill’s re-learning required for daily living that includes dressing, going to bathroom, eating and taking care of him.

Speech therapy

Because of stroke, the patient may face problems in swallowing, thinking and communicating. SLT (Speech and language therapy) has involvement with techniques in compensating and reducing these problems.

rehabilitation team

Recreational therapy

The reintroduction of therapeutic recreation to social and leisure activities takes place. The activities are inclusive of playing, going to museums, swimming, or taking art and music lessons. The therapy’s important factor is enabling the patient to get back to the community and develop again the social skills (Charmaz, 1983). A therapeutic recreational specialist may have the availability through the patient’s hospital and in the organizations that runs community based programs such as, senior centers or YMCA and adult day programs.

Conclusion

There is a great deal of difficulty in regenerating brain cells after their death. A fair amount of work has been done on this area that has given some hope. The brain cells are damaged by strokes and the severity and the amount of damage can enormously vary. On one hand, is the physical movement being affected, although on the other hand, the reasoning and the memory are lost. The greatest danger is the victim’s death being affected by stroke.

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A stroke may be the cause of a number of bewildering changes in the patient’s behavior and emotions.

All of a sudden, the patient seemingly becomes a completely different person than what he was prior to the stroke. The brains of the survivors of the stroke have been affected with injury and emotions and behaviors as well as his psychological aspects that are displayed may be the reflection of that injury. To understand and deal with such changes are equally important as the issues related to the physical changes that are dealt in the process of rehabilitation. The behavioral changes that are talked about can be resulting in the brain damage or depression occurring in the time of the stroke. Both conditions can be difficult for the family and caregivers. The patient, under such circumstances, is encouraged in seeking, when necessary, the professional help.

References

  1. Abbott, A. L. (2009) ‘Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis’, Stroke, 40(10): e573-e583.
  2. Adams, R. J., et al. (2003) ‘Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: A scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association’, Circulation, 108(10): 1278-1290.
  3. Anderson, R. (1992) The aftermath of stroke: the experience of patients and their families, Cambridge: CUP.
  4. Barry, A.M. and Yuill, C. ( 2016) Understanding The Sociology of Health [4th ed.], London, Sage
  5. Burton, C.R (2000) ‘Living with stroke: a phenomenological study’, Journal of Advanced Nursing, 32, p. 301.
  6. Bury, M. (1982) ‘Chronic illness as biographical disruption’, Sociology of Health and Illness, Vol. 4, no. 2, pp. 167-182.
  7. Bury, M. (2005) Health and Illness, Polity Press, Cambridge. (available on Google books).
  8. Chang, E. and Johnson, A. (2008) Chronic illness and disability, Churchill Livingstone, Australia.(available on Google books).
  9. Charmaz, C. (1983) ‘Loss of self, a fundamental form of suffering in the chronically ill’, Sociology of Health and Illness, Vol. 5. no. 2, pp. 168 – 195.
  10. Davey, B. and Gray, A. (2002), Health and Disease, Open University Press, Milton Keynes.
  11. DOH (1999) Our Healthier Nation, London: HMSO.
  12. Ederle, J., et al. (2009) ‘Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: A Cochrane systematic review’, Stroke, 40(4): 1373-1380.
  13. Harbison, J., Hossain, O., Jenkinson, D., et al. (2003) ‘Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test’, Stroke, 34(1):71–76.
  14. Hemphill, C. J., et al. (2015) ‘Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association’, Stroke, 46(7): 2032-2060.
  15. Holloway, R. G., et al. (2014) ‘Palliative and end-of-life care in stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association’, Stroke, 45(6): 1887-1916.
  16. Larkin, M. ( 2014) Social aspects of Health, Illness and Health Care, Open University via McGraw –Hill, London.
  17. Meschia, J. F., et al. (2014) ‘Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association’, Stroke.
  18. Nys, G. M. S., et al., (2005) ‘The Prognostic Value of Domain- specific Cognitive Abilities in Acute First-Ever Stroke,’ Neurology, Vol. 64, No. 5, pp. 821-827.
  19. Nys, G. M. S., van Zandvoort, M. J. E., de Kort, P. L. M., Jansen, B. P. W., de Haan, E. H. F. and Kappelle, L. J. (2007) ‘Cog-nitive Disorders in Acute Stroke: Prevalence and Clinical Determinants,’ Cerebrovascular Diseases, Vol. 23, No. 5-6, pp. 408-416.
  20. Rudd, A., Goldacre, M., Amess, M., Fletcher, J., Wilkinson E., Mason, A., Fairfield, G., Eastwood A., Cleary, R. and Coles, J. (eds.) (1999) Health outcome Indicators: Stroke. Report of a working group to the Department of Health, National Centre for Health Outcomes.
  21. Spence, J. D., et al. (2010) ‘Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis’, Archives of Neurology, 67(2): 180-186.

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