Nursing care of Acute ischemic stroke with Atrial fibrillation: case study

Abstract

Abstract: Stroke is a major public health problem in Thailand and has a rising trend that causes death and disability. Acute stroke is a stage in which the brain is deprived of blood supply to the brain. But the brain tissue is not dead, the patient still has a chance to recover if the right treatment and care suddenly according to professional standards It also found that people with atrial fibrillation have a five times greater risk of stroke than normal people.

Objectives of the study: The study to increase knowledge and skills of nursing process in caring for acute ischemic stroke with cardiac arrhythmia correctly and appropriately according to professional standards and to ensure that patients are safe from critical conditions without complications. Relatives and patients can return to take care of themselves properly.  

        A case study of this patient showed that the patient was present with acute cerebral ischemic attack and was diagnosed with atrial fibrillation (AF) asymptomatic.

Patients come with the correct emergency medical services (EMS) system fast from the scene were taken into the fast track stroke system of Angthong Hospital.Recieved Recombinant Tissue Plasminogen Activator (rt-PA) was administered within 2 hours 35 minutes, Door to needle 55 minutes, assessed by NIHSS (National Institute of Health Stroke Scale) prior to administration, 13 points. The result of receiving drugs that dissolve blood clots quickly make the patient out of crisis Progressive improvement was achieved with the ability to elevate the flaccid limb with a repeat NIHSS rating of 5 points. Observing clinical post rt-PA, there were no complications from fibrinolysis. No additional weakness. CT brain after 24 hours of rt-PA administration found no Hemorrhage. During the admit stroke unit, the patient had AF tachycardia, HR 160-180 beats/min, palpitations, no chest pain, agitated. The patient has been treated until improved without complication. The patient received prompt care right from multidisciplinary patient is safe, out of crisis, without complications. The patient was admitted to the hospital for 8 days and was able to go home. After discharge he has follow-up examination cardiogram for 1 week and follow-up medicine 1 month. Cost 53,032 bath.