Background of the Study

The case is about a previously healthy 18 year-old patient with learning disability who suffered from cerebrovascular accident or stroke. A cerebrovascular accident is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood vessel. There are two main types of cerebrovascular accident, or stroke. An ischemic stroke is caused by a blockage, and a hemorrhagic stroke is caused by a breakage in a blood vessel. In both cases, part of the brain is deprived of blood and oxygen, causing the brains cells to die. An ischemic stroke occurs when a blood clot blocks a blood vessel, preventing blood and oxygen from getting to a part of the brain. There are two ways that this can happen. When a clot forms somewhere else in your body and gets lodged in a brain blood vessel, it is called an embolic stroke. When the clot forms in the brain blood vessel, it is called a thrombotic stroke. A hemorrhagic stroke occurs when a blood vessel ruptures, or hemorrhages, which then prevents blood from getting to part of the brain. The hemorrhage may occur in a blood vessel in the brain, or in the membrane that surrounds the brain. In the patients case, embolic stroke was the cause of the abnormal signs and symptoms exhibited. According to the World Health Organization, 1 in ten in the 55 million deaths that occurs every year worldwide is due to stroke and two-thirds of which occur in people living among developing countries. CVAs are much more common among older people than among younger adults, usually because the disorders that lead to strokes progress over time. Over two thirds of all strokes occur in people older than 65. Slightly more than 50% of all strokes occur in men, but more than 60% of deaths due to stroke occur in women, possibly because women are on average, older when the stroke occurs. In the Philippines, stroke remains to be the leading cause of disability, afflicting 400,000 Filipinos yearly. (Manila Bulletin, 13 September 2008) making it one of the leading causes of death together with vascular diseases. The former Health Secretary Alberto G. Romualdez said in a press release that the cost of treating uncomplicated

stroke for 5-7 days ranges from Php 15,000-20,000 making it not only a burden emotionally but also economically to the family and community (www.doh.gov.ph). But before a stroke occurs, one needs to understand its risk factors so that the medical intervention is administered early and aggressively. The non-modifiable risk factors include age, sex, family history, race, ethnicity, congenital cardiovascular anomaly factors that we cannot control. However there are modifiable risk factors for stroke which when eliminated or controlled reduce the risk of stroke significantly. These are hypertension, cardiac diseases (particularly atrial fibrillation), diabetes, hyperlipidemia or elevated cholesterol, cigarette smoking, alcohol abuse, physical inactivity, asymptomatic carotid stenosis, and transient ischemic attack. There is a growing concern because of lifestyle and diet of Asians, particularly Filipinos, cholesterol levels are rising, resulting in an increased risk for stroke (brain attack). In addition to be a leading cause of heart attacks, high cholesterol is emerging as a major risk factor that is known as ischemic stroke. In this type of 1 stroke, the blood supply to the part of the brain is cut off because either atherosclerosis or a blood clot has blocked the vessel.

Competency Appraisal There are 11 key responsibilities that indicates the efficiency of care given to a client or patient inside a healthcare system. One of it is the safe and quality nursing care. Though not directly presented the case discussion of the patient, I can be drawn that quality care has been given. It has been said in the discussion that the patients condition is one where every moment is important because he patient may die from a wrong move or every lap in rendering care. But the patient, as stated in the course of the medical treatment, was monitored closely and specific care such as drug administration. Under this concept there are 11 core competencies which focuses on the skills of the nurse. These sub concepts are vaguely shown in the case discussion for the paper only focused more on the treatment process and medical therapy of the disease. The first core competency among the list is about the demonstration of knowledge based on health/illness status of individual/groups. It may be exhibited as being able to identify the health needs of the patient. It can be taken as done in the case for the patient did not develop any conditions that may result from inadequate care of the nurses taking care of the client at bedside. Second concept is about being able to provide sound decision making in care of individual considering their beliefs or values. This concept is not really shown in the case but this may be exhibited by being to decide on the adequate rendered to the patient if he /she has any special practices when it comes to their religion or personal practice. Like, for example, if the patient does not want to be visited or checked in a certain time due to a practice, the nurse must be able to decide when to administer a drug due or what way can be done for the patient to be able to take the drug at the given time. Third concept is focused on providing safety and comfort. This can be made apparent in the case thorugh the statements in the discussion about the patient not having developed any complication from incompetence. The patents case, as said previously, is a very delicate one for any mistake or mishandle can cause the patient to die. Fourth is priority setting in nursing care based on the patients needs. it can be shown through being able to determine which problems, the patient is currently experiencing, needs to be addressed first.

Fifth is the ability to ensure continuity of care which can be exhibited through preforming nursing care skills appropriate for the patients illness constantly and with the same degree of quality. As for the case, precise critical care was to be rendered for the client was in a coma after some time. Sixth on the list is medication administration and other health therapeutics. This was done appropriately though not indicated in the paper directly. This focuses on the 10 golden rules he nurse is to abide b to reduce medication errors. Next concept is about utilizing nursing process as framework for nursing. It deals with being able to perform comprehensive, systematic nursing assessment. It can be seen I the case study that appropriate assessment was done due to the fact that the treatment prescribed to the patient helped alleviate the the cause of the disease. The recovery of the patient was rooted all from very assessment of the patient. The eighth concept was focused in formulating care plan in collaboration with patients, other health team members. This core competency can be established by including the patient or his/ her relatives to planning the interventions to be done to the patient. Next is the two is correlated with each other. It is mainly about implementing NCP to achieve identified outcome. This was not stated in the case, whether it was done or not. But this only explains that the plans made by the nurse together with the patient or the patients significant others will be applied effectively and accurately to be able to address the problem and to come up with the desired results. Finally, the last core competency is about responding to the urgency of the patients condition. This can be drawn from the case study as done. The patients condition was critical especially when the client progressed to co ma but due to the fast action of the healthcare team including the nurses, the patient was able to be relived from the grave condition he was in.