Stroke Concept Map

Concept maps
1. Many types, variations, layouts
2. Primary diagnosis
  1. Typically in center of maps
  2. Connects to
    1. Contributing factors
    2. Medications
    3. Labwork
    4. Patient education
    5. Nursing diagnoses
      1. Interventions
      2. Evaluations

Nursing Points

General

Nursing diagnosis
1. Ineffective cerebral tissue perfusion
  1. Assess and monitor patient’s neuro status
    1. Patient will have normal ICP levels
  2. Monitor vital signs
    1. Patient will have non-fluctuating vital signs
  3. Provide quiet/calm environment
    1. Absence of increased ICP
2. Impaired physical mobility
  1. Assess the extent of impairment
    1. Physical deficiencies identified
  2. Change positions q2h
    1. Absence of tissue breakdown
  3. Provide active/passive ROM
    1. Absence of muscle atrophy
3. Ineffective coping
  1. Provide psychological support
    1. Patient shows confidence in new regimen
  2. Encourage patient to express feelings
    1. Patient shows acceptance of new condition
  3. Support patient’s interest in rehabilitation
    1. Patient continues rehabilitation

Assessment

Contributing factors
1. High blood pressure
2. Diabetes
3. Heart disease
  1. Cardiomyopathy
  2. Heart failure
  3. Atrial fibrillation
4. Smoking
5. Advanced age
6. Personal/family history
7. Obesity
8. Race
  1. African American

Therapeutic Management

Labwork
1. Blood work
  1. CBC
  2. Coagulation studies
    1. PT
    2. PTT
    3. INR
  3. BMP
2. Other diagnostic tests
  1. CT
  2. MRI
  3. Echocardiogram
  4. Carotid ultrasound
  5. Cerebral angiogram
Medications
1. Ischemic stroke
  1. Aspirin (160-325 mg oral)
  2. tPA (0.9 mg/kg IV)
2. Hemorrhagic stroke
  1. Labetalol (bolus 5-20 mg IV, continuous 2 mg/min)
  2. Diazepam (2-10 mg IV)

Nursing Concepts

Clinical judgment
Communication
Functional ability
Mobility

Patient Education

Patient education
1. Teach about new diagnosis
  1. Symptoms
  2. Treatment
  3. Contributing factors
  4. Prevention
2. Rehabilitation needs

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Transcript

Hey guys! Today we are going to take a look at the concept map for stroke!

So in this lesson we will take a look at the components of a concept map including contributing factors, medications, lab work and the significance, patient education, and associated nursing diagnoses with interventions and evaluations!

Ok so here is a basic example of a concept map, guys there are many different variations and this is just one example. First, we start with the primary diagnosis typically in the center of the concept map which leads to nursing diagnoses and interventions and also contributing factors, medications, labwork, and patient education which are associated with the primary diagnosis. Lets jump in! Lets start with contributing factors in the upper corner. Contributing factors for a stroke or in other words your patient may have high blood pressure, diabetes, or heart disease like cardiomyopathy, heart failure, and atrial fibrillation. If your patient smokes, is of advanced age, has a personal or family history of a stroke or TIA, is African American, or is overweight/obese these would all be contributing factors also.

Ok so in this next circle here we will place medications necessary in the event of a stroke. Remember there are different types of strokes so this will determine the type type of medication that is administered. If the patient is diagnosed with an ischemic stroke, aspirin 160-325 mg oral may be administered as aspirin suppresses the production of prostaglandins. Tissue plasminogen activator also known as alteplase (0.9 mg/kg IV) will be given to break up the clot as tpa is actually a protein involved in the breakdown of a clot. For hemorrhagic strokes often times anti-hypertensives are given such as labetalol (5-20 mg IV, then continuous 2 mg/min) as labetalol blocks beta1, beta2, and alpha adrenergic receptor sites to decreases blood pressure. Also in hemorrhagic stroke anticonvulsants like diazepam (2-10 mg IV) are used to decrease the risk of seizure by modulating the post-synaptic effects fo GABA-A.

Ok additional information included in a concept map is commonly patient education and significant labwork. So in this circle here lets add important patient education information teach the patient about their new diagnosis including symptoms and treatment. It’s also important for the patient to understand what may have increased their risk of stroke and how to prevent in the future. Teach the patient they will be assessed to determine rehabilitation needs. Labwork to diagnose the stroke may include complete blood count to measure the platelets and red and white blood cells, coagulation tests including PT, PTT, INR to gain understanding of clotting abilities, and basic metabolic panel for information on electrolytes and kidney function. Other diagnostic testing may include CT, MRI, echocardiogram, carotid ultrasound, or cerebral angiogram.

Finally, in the three circles that are left we will add nursing diagnoses with interventions and evaluations for stroke. There are quite a few possible nursing diagnoses for stroke lets start with ineffective cerebral tissue perfusion due to interruption in blood flow. Interventions include closely assessing and monitoring the patient’s neurological status and compare with the patient’s baseline which is evaluated by normal ICP levels. Monitor the patient’s vital signs closely noting changes in blood pressure, heart rate, respirations which could be indicative of cerebral injury, evaluated by vital signs not flucuating. Another intervention is to provide a quiet and calm environment for the patient as stimulation can increase intracranial pressure.

Another nursing diagnosis associated with stroke could be impaired physical mobility with interventions including assessing the extent of impairment on a regular basis which can help to identify the deficiencies in the patient which is evaluated by the idenfication of these issues. Help the patient to change positions every 2 hours to reduce the risk of injury evaluated by absence of tissue breakdown. Finally, provide active and passive range of motion to all extremities to minimize the risk of muscle atrophy which is evaluated by absence of atrophy.

Although there are many nursing diagnoses that can apply here one more we will talk about is ineffective coping due to the new diagnosis. Interventions can include provide psychological support to the patient and short term goals, evaluated by increased confidence in patient’s new regimen. Encourage the patient to express feelings including anger, denial, or depression which is evaluated by the patient accepting their new condition. Finally, support the patient’s interest in rehabilitation exercises evaluated by the patient’s continued interest in recovery.

Here is a look at the completed concept map for stroke!

We love you guys! Go out and be your best self today! And as always, Happy Nursing!

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