Application of Transition Theory in Nursing of Ischemic Stroke Patients After Craniectomy: A Case Study
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Abstract: Stroke, resulting from cerebral artery stenosis or occlusion, disrupts blood flow to the brain, leading to neuronal damage, functional deficits (hemiparesis/plegia), and potential death. Prompt acute-phase medical and nursing care is vital in reducing the severity and disability associated with stroke. This study aimed to explore the application of transition theory in the nursing management of acute ischemic stroke patients undergoing decompressive craniectomy. Data collection, problem identification, nursing diagnosis formulation, and care planning were conducted across the pre-operative, post-operative, and rehabilitation phases. Case Study of a 70-year-old Thai male presented with a 4-hour history of left-sided limb weakness and was diagnosed with ischemic stroke and atrial fibrillation. He was transferred from a community hospital to a tertiary care center. Twenty-four hours post-admission, the patient exhibited atrial fibrillation, hypertension, and worsening left-sided limb weakness (Grade 0 muscle strength). He also presented with signs of increased intracranial pressure (IICP). A brain CT scan revealed a large right middle cerebral artery (MCA) infarction with evidence of cerebral edema. The patient subsequently underwent decompressive craniectomy. Nurses identified problems and provided care across the pre-operative, post-operative, and rehabilitation phases. Discharge planning and continuous care were implemented to facilitate the patient's transition through the critical and recovery periods, enabling the patient and family to cope with the transition from hospital to home effectively. Ultimately, the patient was successfully discharged home. In summary, this case study demonstrates a successful transition through the acute, sub-acute, and rehabilitation phases of critical illness, free from complications, with a comprehensive discharge plan allowing the patient to return home for self-care.
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