Effectiveness of Nursing Care for Stroke Patients with Also Diabetes and Hypertension

Abstract

This study aims to evaluate the nursing outcomes of a stroke patient presenting with comorbid diabetes mellitus and hypertension. Using a descriptive case study methodology, the research focuses on a 60-year-old Thai male admitted to Rajavithi Hospital with symptoms of dizziness, dysarthria, facial drooping, right-sided hemiparesis, and ataxia. Although initially diagnosed with a Transient Ischemic Attack (TIA) and treated with intravenous recombinant tissue plasminogen activator (rt-PA), subsequent Electrocardiogram (EKG) and Computed Tomography (CT) of the brain led to a definitive diagnosis of Ischemic Stroke involving the Left Middle Cerebral Artery. The patient was hospitalized for intensive physical therapy and rehabilitation under a nursing care plan integrated with Orem's Self-Care Deficit Nursing Theory, utilizing both wholly and partly compensatory systems. The nursing outcomes demonstrated significant clinical improvement across multiple dimensions. Post-intervention, the patient exhibited stable vital signs and normotension, with a complete resolution of neurological deficits, including headache, blurred vision, nausea, and vomiting. The patient remained fully conscious with motor strength in all extremities restored to Grade 5. No bleeding complications or falls occurred during the hospitalization. Functional independence improved significantly, as evidenced by the Barthel Index score increasing from 80 to 90. Furthermore, the Modified Rankin Scale (mRS) and Fall Risk Score were recorded at 2 and 2, respectively. Psychosocial and educational outcomes were equally positive. The patient and his family actively participated in shared decision-making regarding treatment and rehabilitation, demonstrating a profound understanding of the disease and self-care protocols. A notable reduction in anxiety was observed, characterized by improved emotional stability and cooperation with the medical team. In conclusion, systematic nursing care and comprehensive rehabilitation are vital in restoring functional capacity and enhancing the quality of life for stroke patients with multiple chronic comorbidities.