INTRODUCTION:

“Health is wealth”, a person with a healthy body and mind is a wellbeing for the family and the society. To adapt healthy life person would be able to lead a socially and economically effective life. Health is not a material which is buy in the market. Health can be affected by various disorders. Among these “Stroke” (CVA) is the most common disorders of the central nervous system and it can also affect the other systems of the body which can be lead to disability or the death of the Individual.

The Global burden of disease (GBD) study provided the first global estimate on the burden of disease. The cerebrovascular accident disease ranked as the second leading cause of death after ischemic heart disease.¹Stroke, is the sudden death of the some brain cells due to the lack of the oxygen when the blood flow to the brain is lost by blockage or rupture of an artery to the brain, is also leading cause of dementia and depression.

Data on causes of death from the 1990 have shown that cerebrovascular diseases remain a leading cause of death. In 2001 it was estimated that cerebrovascular disease (stroke) accounted for 5.5 million deaths worldwide, equivalent to 9.6% of all deaths.²Two third of these deaths occurred in people living in developing countries and 40% of the subjects were aged less than 70 years.

Thus, by affecting both patients and loved ones, stroke is a family illness and family relationships and dynamics are changed irrevocably. Unfortunately, it has been explained that the neurologic symptoms do not accurately reflect the presence or absence of infarction, and the severity of symptoms does not indicate the cause of the ischemia.³

NEED FOR THE STUDY:

Worldwide about 20 million people are affected from stroke each year and the 5 million will die as a consequence and 15 million will survive, of those who survive 5 million will be disabled by their stroke⁴

The clinical manifestations of stroke include Headache (42%), some patients experiencing vomiting (26%), and some patients gone through convulsions (4%), altered sensorium (40%), and motor weakness (88%), the sensory symptoms (16%), speech difficulty were (38%), dysarthria (16%) and Aphasia were (22%), the cranial nerve palsy were (2%), most of patients experiencing right hemiparesis (46%) as well as left hemiparesis were (38%), and monoparesis were (4%)⁵

For investigating the cerebrovascular accident accurate brain imaging plays an important role in in the diagnosis and treatment of stroke. A non-contrast computed tomography (CT) scan of the head is performed to rule out the hemorrhagic stroke as a cause of acute neurologic deficits. Standard magnetic resonance imaging (MRI) has limited value in diagnosing acute ischemic stroke because the infarct is usually not apparent until 8 to 12 hours after the onset of symptoms. New MRI technique- diffusion-weighted imaging (DWI) and perfusion imaging (PI) may improve the diagnosis and treatment of acute stroke. Further diagnostic studies include ECG to rule out atrial fibrillation and echocardiogram it atrial emboli are suspected. Carotid duplex scanning is used to identify carotid artery stenosis or occlusion⁶

STATEMENT OF THE PROBLEM:

Assess the clinico-investigative profile and treatment outcome of cerebro-vascular accident (CVA) patient admitted in Pravara Rural Hospital. Loni (Bk).

OBJECTIVE OF THE STUDY:

The objectives of the Study are

1. Assess the clinico-investigative profile and treatment outcome of cerebro-vascular accident patients.

2. Correlate the clinico-investigative profile and treatment outcome with their clinical variables.

Delimitations:

Study was limited to the cerebrovascular accident patients, who were

1. Cerebro-vascular accident patients who were above 30 years of age and available during the data collection period.

MATERIAL AND METHODS:

Research design:

Descriptive study design.

Research approach:

Cross sectional survey approach

Research variables:

Research variables in the present study were clinico-investigative profile of cerebrovascular accident patients and treatment outcome of cerebrovascular accident.

Setting of the study:

The present study was conducted in the Pravara Rural Hospital Loni, Maharashtra

Sample:

In the present study the sample were patients with cerebro-vascular accident patients who are admitted in medicine ward of Pravara Rural Hospital.

Sample size:

The sample size for present study was 50 patients with cerebro-vascular accident patients Admitted at Pravara Rural Hospital

Sampling technique:

Sampling techniques used for the present study was non-probability method, purposive sampling technique.

Criteria for sample selection:

Inclusive criteria:

The patients diagnosed as cerebro-vascular accident who are;

1. Above 30 years of age

2. Available during the study period and provide written informed consent (Guidelines)

Exclusive criteria:

Cerebro-vascular accident patients who are;

1. Critically ill and unable to respond tool

2. Mentally ill.

Method of data collection:

A Proforma was used to collect the data from the samples.

Construction of the Tool:

The tool was prepared in the form of structured Performa to evaluate the clinico-investigative profile and treatment outcome of cerebrovascular accident.

Patients under the following steps-

I. Review of literature

II. Construction of tool

III. Consultation with experts and guide

I. Review of literature:

Related books, journals, article, reports, and newspaper, published and unpublished research studies were reviewed and used to construct the Proforma.

II. Construction of Tool:

The tool consist of four sections;

Section A:

Description of socio demographic characteristics and Responses of Glasgow coma scale of cerebrovascular accident patients

a. Socio demographic characteristics of cerebrovascular accident patients

b. Responses of Glasgow coma scale of cerebrovascular accident patients

Section B:

Description of the Clinico-investigative Profile of Cerebrovascular accident patients

Section C:

Description of outcome of cerebrovascular accident patients

Section D:

Comparison of outcome of cerebrovascular accident patients with their selected sociodemographic characteristics

III. Consultation with experts and guide:

The tool was given to the experts in various discipline such as department of medical surgical Nursing, department of surgery, department of medicine, department of statistics. Their opinion and suggestions were taken into consideration to modify the tool, with consultation of guide to finalize the tool.

Validity:

The content validity of the tool was established in consultation with guide and experts. The Validity was established by consulting the experts from the department of medical surgical nursing, department of medicine, department of statistics.

Reliability:

Reliability of the tool was tested with inter rater reliability method by implementing the tool on 5 CVA patients, who were other than samples of study. The tool was found to be reliable to evaluate the clinical profile and outcome of patients with cerebro-vascular accident patient. (r =0.8)

Pilot study:

After obtaining approval from the concerned authority, pilot study was conducted on 5 CVA patients admitted in medicine ward. At Pravara rural Hospital, loni (BK) other than samples that fulfils the inclusion criteria. In pilot study patients with cerebrovascular accidents found were male predominance and more patients are Hemiplegic in the study.

Data collection procedure:

Ethical consideration:

The Approval was obtained from institutional ethics committee Registration No. (PIMS/CON/R/IEC/PG/009/2018) at Pravara Institute of Medical Sciences (DU). The legal permission was sought from medical superintendent, head of department of medicine and nursing superintendent of Pravara Rural Hospital. The written consent was obtained from all patients participated in the study. All data were treated confidentially.

Planned for data analysis:

The collected data was analyzed using descriptive statistics like frequency, percentage, The analyzed data will presented in the form of tables, figures and diagrams.

FINDINGS OF THE STUDY:

Section A: Description of socio-demographic characteristics and responses of Glasgow coma scale of cerebrovascular accident patients

a). Findings related to Socio-demographic characteristics of cerebrovascular accident patients

1. Majority of participant (76%) were in age group above 55 years and the remaining (24%) were belongs to below 55 years of age.

2. Majority of (68%) patients were male whereas remaining (32%) were female

3. Highest percentage (58%) patients did not had any formal education whereas (40%) had primary education and (4%) had secondary education.

4. Highest percentage (90%) were doing agriculture and remaining (6%) were homemaker and (4%) were doing private job among study participants.

5. Majority of (66%) patients had mild cerebrovascular accident, while significant (34%) had moderate level of cerebrovascular accident.

6. Highest percentage (94%) of them had Hemiplegia, while a more proportion (4%) had paraplegia, and a (2%) had quadriplegia. It highlights that the most of patients under study had hemiplegic.

7. Majority of participant (32%) patients had a hypertension whereas (22%) patients had diabetes mellitus and (2%) patient had a heart diseases, remaining (56%) of them did not had any comorbid diseases.

8. Majority of (62%) of patient had history of smoking whereas (26%) patient had history of alcoholism and remaining (32%) patient did not had any ill habits.

b). Responses of Glasgow coma scale of cerebrovascular accident patients n= 50

S N	Glasgow coma scale	Day-1		Day-3		Day-6		On Discharge
S N	Glasgow coma scale	F	%	F	%	F	%	F	%
1	Mild 13-15	11	22	17	34	27	54	50	100
2	Moderate 9-12	39	78	33	66	10	20	0	0

The above mentioned table depicts that in on day one, most 39 (78%) had moderate GCS score and the remaining 11% had mild level GCS score whereas on the day of discharge all the patient had mild level GCS score and none of the patient had severe level GCS score. It interprets that the patient under study had improved outcome on the day of discharge.

Section B: Description of the Clinico-investigative Profile of Cerebrovascular accident patients

a). Description of percentage of cerebrovascular accident patients according to their vital parameters

Majority of the patients under study had vital parameters within normal range during the time of admission. However a significant no. of patients 17(34%) had blood pressure more than normal, followed by 25(50%) had dyspnea and on admission (5%) of patient had elevated body temperature followed by 14(28%) had more than 80 beats per minute. Whereas on the day of discharge almost all the patients had all vital parameters within normal limits.

b). Description of percentage of cerebrovascular accident patients according to their local examination

Local examination including on the day of admission none of patient were low tone speech and on the day of admission patient having 48 (96%) of hemiplegia. And Irrelevant speech were 45(90%), and some patient had 44(88%) slurred speech. And patient had a hemiparesis 38% (76). And some patient had a vertigo or syncope 32% (64%). And incontinence were 44% (88%), visual changes were 38% (76%). On the day of discharge the hemiplegia were 14% (28%) and on the day of discharge the slurred speech were 11% (22%) and irrelevant speech were 7% (14%), hemiparesis were 6% (12%).

c). Description of percentage of cerebrovascular accident patients according to their systemic examination

Systemic examination depicts that on the day of admission mere percent i.e. 5 (10%) of patient had pallor, cyanosis were 2% (4%) and respiratory distress were 2% (4%), and abnormal respiratory sounds were 2% (4%) however on the day of discharge almost all had normal systemic parameters.

d). Description of percentage of cerebrovascular accident patients according to their level of consciousness.

Study findings depicts that on the day of admission most 49(98%) of patients were confused and 21(42%) had lethargic while less significant no. patients 41(82%) had oriented whereas 48% (96%) were conscious and the obtundation and stupor were absent in the patient while study.

e). Description of percentage of cerebrovascular accident patients according to their Radiological examination n=50

S N	Radiological Examination	Frequency (F)	Percentage (%)
1	Hemorrhage	14	28
2	Ischemia	36	72
3	Subdural Hematoma	12	24
4	Intracerebral hematoma	10	20
5	Subarachnoid hemorrhage	08	16
6	Cerebral edema	17	34
7	Thalamocapsular bleed	03	6

Majority of the patients under study had significant findings/diagnosis through radiological examination. However mere no. of patients 36(72%) patient had ischemia and 34(17%) patients had a cerebral edema. Hemorrhage had 14(28%), subdural hematoma had 12(24%) and intracerebral hematoma had 10(20%) and subarachnoid hemorrhage had 08(16%) and the thalamocapsular had 03(06%). It interprets that majority of the patients had significant findings/diagnosis as majority had mild level of cerebrovascular accident.

f). Description of percentage of cerebrovascular accident patients according to their medical management

findings depicts that 42(84%) had vitamin supplement, osmotic diuretic had 41(82%) and some patient had anticoagulant therapy 40(80%) and neuromuscular blocker had 33(66%), intravenous fluid 33(66%), antibiotic had 23(64%), Ryle’s tube feeding had 27(54%), vasopressor 07(14%), Oxygen administration had 05(10%), analgesics had 04(08%) and some patient had a tracheostomy tube 01(02%).

Section C: Description of percentage of cerebrovascular accident patients according to their outcome n= 50

S. No	Outcome of cerebrovascular accident patients	Frequency (F)	Percentage (%)
Neurological system
1	Hemiplegia	47	94
2	Paraplegia	02	04
3	Quadriplegia	01	02
Recovery
4	Good Recovery	50	100
5	Vegetative state	-	-
6	Death	-	-
7	Referred	-	-
8	Discharge	50	100

In above depicts table Description of percentage of cerebrovascular accident patients according to their outcome in neurological system the hemiplegia was common among all the neurological disorders hemiplegia 47(94%), Paraplegia 02(04%) and Quadriplegia 01(02%). And in recovery state the total sample size was 50 cerebrovascular accident patients and all patients got discharge from the hospital with good recovery.

Section D: Comparison of outcome of cerebrovascular accident patients with their selected socio-demographic characteristics

a) Comparison of outcome of cerebrovascular accident patients with their age n= 50

S. No	Age	Good recovery
S. No	Age	F	%
1	Below 35	04	8
2	36-40	01	2
3	41-45	02	4
4	46-50	01	2
5	51-55	04	8
6	>55	38	76

Findings depicts that below 35 age 4(8%) patient had good recovery and patient between 36-40 age 1(2%) had good recovery whereas in patients between 41-45 of age 2(4%) had good recovery and in 46-50 of age 1(2%) had good recovery and in 51-55 of age patient 4(8%) had good recovery and in above >55 of the age 38(76%) had good recovery.

b). Comparison of outcome of cerebrovascular accident patients with their Gender n= 50

S. No	Gender	Good recovery
S. No	Gender	F	%
1	Male	34	68
2	Female	16	32

Comparison of outcome of cerebrovascular accident patients with their age and gender depicts that irrespective of age and gender all the patient under study had good recovery. That is male 34(68%) and female 16(32%), similarly irrespective of presence of Glasgow coma scale all patient had good recovery.

c). Comparison of outcome of cerebrovascular accident patients with severity of cerebrovascular accident n= 50

S. No	Severity of CVA	Good recovery
S. No	Severity of CVA	F	%
1	Mild	33	66
2	Moderate	17	34

Comparison of outcome and severity of cerebrovascular accident patients depicts that majority 33(66%) of patients of mild 33(66%) of patients of mild cerebrovascular accident had good recovery whereas 17(34%) of patients of moderate level of cerebrovascular accident.

DISCUSSION:

Majority (76%) of the cerebrovascular accidents patients under study were above 56 years of age (Fig No.2). it was consistent with the study conducted by C V Vaidya and D K Majmudar who noted that Higher percent (32.8%) of the cerebrovascular accident are seen in the age group of 61-70 years of age⁷

Majority (68%) of the cerebrovascular accident patients under study was Males and remaining (32%) were females Similarly R P Eapen also found male predominance of (67%) among the cerebrovascular accident patients⁸

On (100%) of the patient under study was married. It was Concurrant with the study carried out by Z H Ali who noted that (96%) of patients under study were married⁹

Majority (58%) of patient under study did not had any formal education. It was similar to the study conducted by J S who also noted (78%) patient had No formal education¹⁰

Most (94%) of cerebrovascular patient had a Hemiplegia. This was Concurrant with the study performed by S V Patne who noted the most common clinical feature was Hemiplegia (55.28%) in cerebrovascular accident patients¹¹

One third (32%) of the cerebrovascular accident patient had Hypertension. (Fig No.9). It was similar with the study conducted by W Wang, BIN Jiang, H Sun, X Ru, D Sun, L Wang et al. who noted that (88%) patient had Hypertension in cerebrovascular accident patients¹²

Majority (62%) of patients under study had history of smoking. (Fig No. 10). It was Consistent with the study conducted by P Kumar who found that (70%) patient had a history of smoking in the cerebrovascular accident patients¹³

Most (78%) patient had moderate level score of Glasgow coma scale and (22%) patient had mild level score of Glasgow coma scale, it was similar with the study conducted by M T who found that (36%) patient had mild Glasgow coma scale and (20%) of patient had moderate Glasgow coma scale¹⁴

All (100%) of patient under study had good recovery following cerebrovascular accident. It was similarly coincidental with the study M T Lakshmikumar who noted that (76.47%) of the patient had good recovery¹⁵

CONCLUSION:

This study creates the complete spectrum of cerebrovascular accident patients. The findings of the study have shown that cerebrovascular accident were common among older adult with male predominance. Majority had cerebrovascular accident due to old age, hypertensive disorder and stress. Significant percent of them had cerebral edema, subdural hematoma, intracerebral hematoma, subdural hematoma and subarachnoid hemorrhage and changes in the reflexes. It was evident from the results that most of the cerebrovascular accident patients had good recovery as patients under study were managed with collaborative management (Medical, surgical, nursing etc.).

IMPLICATIONS FOR NURSING:

The findings of the study are significant and relevant in the area of nursing profession. The implications of this study could be discussed under nursing practice, nursing education, nursing administration and nursing research.

ACKNOWLEDGEMENT:

The Author are Thankful to the authorities of Pravara Institute of Medical Sciences, Pravara Medical Trust Hospital and College of Nursing Loni, Maharashtra.

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Received on 04.11.2019 Modified on 30.11.2019

Asian J. Nursing Education and Research. 2020; 10(1):09-14.

DOI: 10.5958/2349-2996.2020.00003.8