Nursing for Magnetic Resonance Imaging

Discuss about the Nursing for Magnetic Resonance Imaging.

Introduction

This report will demonstrate the understanding of the clinical reasoning cycle by applying the first three components of the cycle to the given case study of Mrs. Amari who is a 59-year-old woman. Her husband brought her to the emergency department. She told her husband that she felt numbness on the right side of her face as well as in the right arm. Her husband is afraid that she had a stroke that is why he has brought her to the hospital. This clinical reasoning report will consider the patient situation; collect cues and information, and process the information.

Consider the patient situation

This 59-year-old female was admitted in the emergency department after her husband noticed the sudden slurring of speech and drooping of face on one side. Regarding her medical history, she has hypertension and hypercholesterolemia. The patient has a history of using tobacco for about 25 years but she quit this habit ten years ago. Her husband smokes one pack daily.  She has a family history of cardiovascular disease. She goes for walking occasionally in the neighbourhood with her friends and do not perform exercises on a regular basis. She has been married since 26 Years and has two daughters who live in other state. Her husband has good conditions of health and can perform the daily work independently.

The head computed tomography scan reveals that there is no acute intracranial change and the result of Magnetic Resonance Imaging is normal. She has been transferred from the emergency department to the stroke unit. She will be provided care by the neurologist who will diagnose her for a transient ischaemic attack (TIA), “mini stroke”.

Considering the health situation of the patient, it can be inferred that she her daily activities and past addictions of smoking has a significant impact on her present conditions. These factors might have triggered to encounter the patient with transient ischaemic attack.

Collect cues and information

As the patient felt numbness on the right side of her face as well as in the right arm together with sudden slurring of speech, there is a possibility that she had encountered a ‘transient ischemic attack’ or ‘mini stroke’, which results due to the temporary disruption in the supply of blood to the part of the brain (Higgins et al. 2014). This disruption results due to the lack of oxygen supply to the brain and can lead to the development of sudden symptoms, which are comparable to that of a stroke, such as numbness or lack of sensation in the face, legs and arms (Galvin et al. 2014). The face of the patient droops on one side (Markus et al. 2013). The other symptoms includes disturbance in speech and vision (Purroy et al. 2013). In this condition, the time for the blockage is short and therefore there is no permanent damage (Sposato et al. 2015).  In the given case scenario, it can be observed that when the patient was transferred from the emergency department to the stroke unit, her symptoms got resolved, there was no facial drooping, and she did not complaint regarding numbness or lack of sensation (Li et al. 2015).

The individuals having high blood pressure or hypertension are more prone to encounter transient ischaemic attack (Galvin et al. 2014). In the given case scenario, the patient has a history of hypertension, therefore it can be inferred that she had encountered a mini stroke or transient ischaemic attack. She also had the habit of smoking previously; hence, it acted as a risk factor to encounter TIA.

The diagnosis of TIA is usually diagnosed, after performing the physical exam and reviewing the history of the concerned patient. There are different radiological tests, which are performed for evaluating the patients who have had encountered TIA (Everson-Rose et al. 2014). The tests include an MRI of the brain, echocardiogram for the heart and ultrasound for the neck (Everson-Rose et al. 2014). The individuals diagnosed with TIA are occasionally warned for a forthcoming stroke (Markus et al. 2013).  If the duration of the impairment in the blood supply lasts for more than few minutes, then the death of the nerve cells of that particular area of the brain takes place and it leads to permanent neurologic damage (Kishore et al. 2014). About one-third of the individuals encountering TIA soon after have intermittent TIAs and about one third encounter a stroke due to the permanent loss of the nerve cells (Purroy et al. 2013).

TIA differs from Cerebrovascular accident (CVA) which is dangerous for their life. In CVA, an occluding or permanent blockage occurs in the nerves of the brain which results due to a travelling blood clot. The clot consists of fats. The individuals who are obese and have a high blood pressure are highly vulnerable to encounter stroke (Sposato et al. 2015).  On the other hand, TIA is less dangerous (Li et al. 2015). It occurs when there is a disruption of oxygen in the brain (Everson-Rose et al. 2014). Due to this, there occurs short-term loss of consciousness but there is an absence of the pulse in the patient, this becomes an emergency (Kishore et al. 2014).

Process the information

Interpret- The patient was presented in the hospital after the sudden slurring of speech and drooping of face on one side. She has a medical history of hypertension and hypercholesterolemia. In the emergency department, she was alert and oriented. The normal ranges of vital signs for adult’s are- temperature 35.8º-37.5 ºC, pulse 60-100 beats per minute (bpm), Blood pressure less than 120/80 mm Hg, and respiration rate 10-20 breaths per minute (bmp) (Elliott and Coventry 2012). A Glasgow coma Scale (GCS) measures the best motor response, best verbal response and eye opening. The lowest score for each category is 1, A GCS of 3 indicates no response to pain, no verbal response and no opening of the eyes. A GCS of 8 indicates severe injury, 9-12 indicates moderate injury and 13-15 indicates minor injury (Teasdale et al. 2014).

The vital signs of the patient in given case scenario are- Temperature: 36.7º C, Blood pressure: 148/97, Pulse: 81, Respiratory rate: 14, SpO2: 94%, Glasgow Coma Scale: 15, Blood glucose level- 6.6 mmol. Her vital signs revealed that she is having a high blood pressure i.e. she is having hypertensive symptoms. Her body temperature is within the normal ranges. In the current situation, Her Glasgow coma scale is 11 (eyes open =3, best verbal= 2, best motor= 6), which means that her injury is moderate.

Distinguish: The symptoms of the patient such as high blood pressure and high cholesterol level are one of the predisposing factors, which suggest that there is a possibility that she had encountered an attack of Transient ischaemic attack. In addition, further information needs to be gathered for making a decision regarding her disease. Some specific tests can help to identify whether the patient had encountered a transient ischaemic attack.

Relate: The symptoms of the patient and the symptoms of TIA are almost similar and suggest that she might have encountered a TIA.

Infer: The head computed tomography scan reveals that there is no acute intracranial change and the result of Magnetic Resonance Imaging is normal. She has been transferred from the emergency department to the stroke unit. She will be provided care by the neurologist who will diagnose her for a transient ischaemic attack (TIA), “mini stroke”.

Match: The current symptoms of the patient and the past symptoms of the patient are more or less similar and suggest that she has encountered a transient ischaemic attack.

Predict: After carefully analysing the condition of the patient in the given case scenario, the most important and relevant cues at this time includes the drooping of face and slurring of speech which are the dominant factors that highlight the symptoms which are associated with transient ischaemic attack or stroke. The patient needs to be diagnosed with different types of tests for diagnosing TIA (Kishore et al. 2014).  There are different assessment techniques, which can be used to diagnose that whether the patient in the given case scenario has encountered TIA or mini stroke (Higgins et al. 2014). The patient in the given case scenario can be diagnosed through the neurological assessments such as cranial nerve testing, somatic sensory testing, determination of somatic motor strength, assessment of the cerebellar system and speech and language testing. For somatic motor testing, the muscle stretch reflexes of the triceps, biceps, patellar and brachioradialis and patellar testing should be done for diagnosing TIA (Fuller 2013).

Conclusion

To conclude with this case scenario, it can be said that the present conditions of the patient needs to be analysed thoroughly as the treatment of the patient will depend on the diagnosis. However, there is a high possibility that she has encountered transient ischaemic attack or mini stroke but still the the doctors should access the present conditions and diagnose the patient in order to prescribe an appropriate treatment effectively.

References

Elliott, M. and Coventry, A., 2012. Critical care: the eight vital signs of patient monitoring. Br J Nurs, 21(10), pp.621-625.

Everson-Rose, S.A., Roetker, N.S., Lutsey, P.L., Kershaw, K.N., Longstreth, W.T., Sacco, R.L., Roux, A.V.D. and Alonso, A., 2014. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke, 45(8), pp.2318-2323.

Fuller, G., 2013. Neurological examination made easy. Elsevier Health Sciences.

Galvin, R., Atanassova, P.A., Motterlini, N., Fahey, T. and Dimitrov, B.D., 2014. Long-term risk of stroke after transient ischaemic attack: a hospital-based validation of the ABCD 2 rule. BMC research notes, 7(1), p.1.

Higgins, P., Walters, M.R., Murray, H.M., McArthur, K., McConnachie, A., Lees, K.R. and Dawson, J., 2014. Allopurinol reduces brachial and central blood pressure, and carotid intima-media thickness progression after ischaemic stroke and transient ischaemic attack: a randomised controlled trial. Heart, pp.heartjnl-2014.

Khan, H. and Shuaib, A., 2014. Transient Ischemic Attacks And Minor Strokes: How Newer Technologies Are Helping In Better Diagnosis Of High-Risk Patients And Response To Treatment. Khyber Medical University Journal, 6(4), pp.183-191.

Kishore, A., Vail, A., Majid, A., Dawson, J., Lees, K.R., Tyrrell, P.J. and Smith, C.J., 2014. Detection of Atrial Fibrillation After Ischemic Stroke or Transient Ischemic Attack A Systematic Review and Meta-Analysis. Stroke,45(2), pp.520-526.

Li, L., Yiin, G.S., Geraghty, O.C., Schulz, U.G., Kuker, W., Mehta, Z., Rothwell, P.M. and Study, O.V., 2015. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. The Lancet Neurology, 14(9), pp.903-913.

Markus, H.S., van der Worp, H.B. and Rothwell, P.M., 2013. Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. The Lancet Neurology, 12(10), pp.989-998.

Purroy, F., Caballero, P.E.J., Gorospe, A., Torres, M.J., Álvarez-Sabin, J., Santamarina, E., Martínez-Sánchez, P., Cánovas, D., Freijo, M.J., Egido, J.A. and Ramírez-Moreno, J.M., 2013. Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study. Journal of Neurology, Neurosurgery & Psychiatry, 84(6), pp.596-603.

Sposato, L.A., Cipriano, L.E., Saposnik, G., Vargas, E.R., Riccio, P.M. and Hachinski, V., 2015. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. The Lancet Neurology, 14(4), pp.377-387.

Sundararajan, V., Thrift, A.G., Phan, T.G., Choi, P.M., Clissold, B. and Srikanth, V.K., 2014. Trends over time in the risk of stroke after an incident transient ischemic attack. Stroke, 45(11), pp.3214-3218.

Teasdale, G., Maas, A., Lecky, F., Manley, G., Stocchetti, N. and Murray, G., 2014. The Glasgow Coma Scale at 40 years: standing the test of time.The Lancet Neurology, 13(8), pp.844-854.