Behavioral And Psychological Responses To Stroke: A Case Study Analysis

Provide a narrative description of the case study patient and their family using the information given in all of the case notes you have for the patient. Give information about the patient’s/family’s presentation pre-, peri-, and post- hospitalisation.

Marking rubric: Provides a clear and thorough summary of the patient’s / family’s background and presentation with information about the patient’s/family’s presentation pre-, peri-, and post-hospitalisation to provide context to the case report 

Explain the behavioural and psychological responses identified in the patient/family to their illness in relation to the literature presented in your introduction and literature review section. Use evidence to support the key issues you identified in your literature review. In order to do this effectively, you will need to critically analyse and evaluate your literature, the concepts discussed in the unit, and compare and contrast these to your patient/family. Also, consider external (e.g., social and physical environmental) factors – NOT just the internal causes such as the illness, biology, or personality etc. In this section, also discuss how the nursing/paramedic care management issues contributed to the patient/family’s behavioural and psychological responses and how they affect the patient’s outcome.

Marking rubric: Explains all of the major behavioural and psychological responses to having the illness presented in the case study by critically analysing, applying, comparing, and contrasting these with the relevant research literature and unit content. Information and evidence selected for inclusion clearly links with the case patient/family presentation.

Information and evidence presented is effectively synthesised so that the reader is clear how the nursing/paramedic care management issues seen in the case study contributed to the patient’s poor outcomes 

Background and Presentation of the Patient/Family

Stroke is a condition that occurs when flow of blood is occluded in a part of brain. The disruption of oxygenated blood causes a damage to the cells of brain hence causing disabling influence on an individual.  Grant Baker being of older age and from Torres Strait Islander Descent was more prone to stroke. Tracing the family history of Baker his grandfather was from Fiji where stroke is a common occurrence. The main cause of Baker’s stroke may be due to stress from the death of his mother and father, divorce and having no child. His long smoking habit, lack of exercise, overweight and being not active since he had retired increased the chances of stroke to occur (Feigin et al, 2016).

Before hospitalization Grant had presented possible signs of stroke like hypercholesterolemia, hypertension and transient ischemic attack about six weeks ago. Grant had been presented to Broome hospital after he had suffered from cerebrovascular accident at sleep which confirmed the presence of stroke. At Perth hospital, Grant portrayed symptoms of stroke like increased hypertension, increased heart beat rate, increased respiratory rate, decreased muscle tone and hyperreflexia. At hospitalization, Baker was diagnosed of stroke and the results confirmed that he suffered from stroke. Later after hospitalization he displayed signs of stroke like feeling exhausted at night, complaining of being overwhelmed from friends and families visits and due to this he becomes restless and agitated, teary when speaking, incapacity to rest during the day, denial of his conditions, depression and continuous quarrels with health care providers (IST-3 Collaborative Group, 2015).

The physical damage of the brain that is as a result of stroke causes many behavior and psychological responses. It is because parts of brains controls how our body functions. Examples of behavioral and psychological effects of stroke as presented in the case scenario include;

Post stroke depression.  Post stroke depression is a common incidence for a person suffering from stroke. The common symptoms of post stroke depression include; lack of interests, disturbed appetite, disturbed sleep, reduced energy, feeling guilt, thoughts of suicide or death and psychomotor retardation or agitation (Micaela Silva et al, 2016). Prior conditions like excessive alcohol intake and divorce increases the likelihood of post stroke depression occurring. Depression is also associated with cognitive distortions. Therefore, a person who believes he will not get better or feels his conditions are uncontrollable is at high chances of experiencing depression.  Grant chances of experiencing depression is increased by divorce and excessive alcohol intake. He portrayed symptoms and signs of post stroke depression like eating problems, inadequate sleep, and thoughts of death since he believed he will not get better.

Behavioral and Psychological Responses to Stroke

Physical impairment. Stroke affects a person ability to carry out normal activities of daily living (ADLs), the patient experience difficulties when conducting daily activities. Difficulties in carrying out ADLs may be as a result of poor coordination, influence of paralysis and lack of awareness. As presented in the case scenario Baker is unable to carry out activities like dressing himself, cooking and writing (Nicholson et al, 2014).

Catastrophic reactions and Emotional problems. Stroke causes pseudobulbar affect and catastrophic reactions. Patients portray emotional glitches like sudden anger, aggression or crying, sudden anxiety, and uncontrollable laughing. Catastrophic reactions are the emotional reactions a patients present when unable to carry out a task resulting from neurologic deficits. The conditions mainly arises due to disturbing thoughts concerning the stroke and the feelings of hopelessness and helplessness. The emotional glitches causes overwhelming which causes moodiness. Studies show that most people who suffer from stroke are more likely to experience emotional hitches because stroke affects brains which controls our emotions. Grant has portrayed emotional problems as he feels overwhelmed by the continuous visits from friends and families. Also, Grant emotional problems is portrayed when he had an outburst with a staff due to feeling of restlessness and agitation (Crowe, Coen, Kidd, Hevey, Cooney & Harbison, 2016).

Denial of condition. Many of the people who suffer from stroke do not accept their conditions and are not willing to take any action to address their condition. The patients may not be willing to accept their conditions because they fear being rejected by friends and family members or lack of adequate awareness of their conditions.  Brain injury that is as a result of stroke can influence patient’s ability to appreciate and understand their certain mental issue (stroke) and its effects (Morris, MacGillivray & Mcfarlane, 2014). As in the case study, Baker denied his physical limits, and he is not ready to take therapy. Also, even though Baker had paresis, he attempted to have a shower and repeatedly got outside the bed at the hospital in the absence of a nurse assistance and refuses to attend physiotherapy for reorientation and reassurance.

Health care providers should ensure that they pay attention to patient’s behaviors that occur after stroke like catastrophic reactions and overt or denial sadness. It is because these behaviors are more likely to cause depression. Health care providers should also examine risk factors that may cause mental illness, for example, negative thoughts, the harshness of disability, isolation, and psychiatric history. In the case scenario, the healthcare providers did not pay attentions to emotional problems of Grant, and this might be the main cause of post stroke depression in Grant (Jamison, Sutton, Mant & De Simoni, 2017).

Post Stroke Depression

When a healthcare providers encounters a patient like Grant treatment approaches that can be effective include; practices that straight adjust the patient physiology like medication and approaches mechanisms that address the patients behaviors, coping methods and thoughts. Medications that can be effective for Grant include stimulants, tricyclic, antidepressants (Crayton, Fahey, Ashworth, Besser, Weinman & Wright, 2017). Therapeutic approaches like Cognitive Behavioral Therapy (CBT) could be useful in addressing post stroke behavioral and psychosocial problems.  CBT assist a patient to get access to effective coping approaches and constructive ways of thinking hence helping in recovery process and acts as portion of treatment even after medications have been employed (O'Carroll, Chambers, Dennis, Sudlow & Johnston, 2014). If CBT was administered to Grant, it could have helped him to change ineffective behaviors and thoughts hence affecting his mood and alleviating depression. Non-medication practices should be considered first before medication. Also, a health care provider should help a patient to get appropriate supportive social network to assist in facilitating coping with stroke and in alleviating depression (Bennett, Luker, English & Hillier, 2016).

Reading materials associated with stroke were not provided to Grant. Reading materials related to stroke would have assisted Grant to feel that he can manage his stroke condition and decrease his denial (Cahill, Carey, Lannin, Turville & O'Connor, 2017).

Encouraging Grant to undertake rehabilitation and social interaction would have assisted him to accept his condition. Asking him to spend time with his old friends and continually partaking the rehabilitation process would have assisted Grant to manage frustration hence accepting his illness and limitations (Lindsay, Furie, Davis, Donnan & Norrving, 2014)

References

Bennett, L., Luker, J., English, C., & Hillier, S. (2016). Stroke survivors’ perspectives on two novel models of inpatient rehabilitation: seven-day a week individual therapy or five-day a week circuit class therapy. Disability and rehabilitation, 38(14), 1397-1406.

https://doi.org/10.3109/09638288.2015.1103788

Cahill, L. S., Carey, L. M., Lannin, N. A., Turville, M., & O'Connor, D. (2017). Implementation interventions to promote the uptake of evidence?based practices in stroke rehabilitation. Cochrane Database of Systematic Reviews, (3).

https://doi.org/10.1002/14651858.CD012575

Crowe, C., Coen, R. F., Kidd, N., Hevey, D., Cooney, J., & Harbison, J. (2016). A qualitative study of the experience of psychological distress post-stroke. Journal of health psychology, 21(11), 2572-2579.

https://doi.org/10.1177/1359105315581067

Crayton, E., Fahey, M., Ashworth, M., Besser, S. J., Weinman, J., & Wright, A. J. (2017). Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies. Annals of Behavioral Medicine, 51(6), 833-845.

https://doi.org/10.1007/s12160-017-9906-0

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.

https://doi.org/10.1016/S1474-4422(16)30073-4

IST-3 Collaborative Group. (2015). Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial. The Lancet Neurology, 14(5), 485-496.

https://doi.org/10.1016/S1474-4422(15)00012-5

Jamison, J., Sutton, S., Mant, J., & De Simoni, A. (2017). Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors and caregivers views from an online stroke forum. BMJ open, 7(7), e016814.

doi: 10.1136/bmjopen-2017-016814

Lindsay, P., Furie, K. L., Davis, S. M., Donnan, G. A., & Norrving, B. (2014). World Stroke Organization global stroke services guidelines and action plan. International Journal of Stroke, 9, 4-13.

https://doi.org/10.1111/ijs.12371

Micaela Silva, S., Carlos Ferrari Corrêa, J., da Silva Mello, T., Rodrigues Ferreira, R., Fernanda da Costa Silva, P., & Ishida Corrêa, F. (2016). Impact of depression following a stroke on the participation component of the International Classification of Functioning, Disability and Health. Disability and rehabilitation, 38(18), 1830-1835.

https://doi.org/10.3109/09638288.2015.1107774

Morris, J. H., MacGillivray, S., & Mcfarlane, S. (2014). Interventions to promote long-term participation in physical activity after stroke: a systematic review of the literature. Archives of physical medicine and rehabilitation, 95(5), 956-967.

https://doi.org/10.1016/j.apmr.2013.12.016

Nicholson, S. L., Donaghy, M., Johnston, M., Sniehotta, F. F., van Wijck, F., Johnston, D., ... & Mead, G. (2014). A qualitative theory guided analysis of stroke survivors’ perceived barriers and facilitators to physical activity. Disability and rehabilitation, 36(22), 1857-1868.

https://doi.org/10.3109/09638288.2013.874506

O'Carroll, R. E., Chambers, J. A., Dennis, M., Sudlow, C., & Johnston, M. (2014). Improving medication adherence in stroke survivors: Mediators and moderators of treatment effects. Health Psychology, 33(10), 1241.

https://psycnet.apa.org/doi/10.1037/hea0000082