Nursing Care for Ischemic Stroke Patients Based on Intermediate Continuous Care Guidelines : A Comparative Case Study of Two Cases, Donchedi Hospital, Suphanburi Province.

Abstract

      Stroke is a severe neurological disease and a leading cause of death worldwide and in Thailand. Most survivors are left with residual neurological deficits requiring continuous rehabilitation. Intermediate Care (IMC) serves as a critical bridge connecting hospital-based treatment to community-based recovery, aiming to reduce disability and improve patients' quality of life. Aim to study and compare nursing care for stroke patients during intermediate care rehabilitation: two comparative cases. Method to Situational analysis of stroke patients during the intermediate care period. Two purposively selected case studies receiving inpatient and home-visit intermediate care services at Don Chedi Hospital, Suphanburi Province.

      Results: 1) Case Study 1: A 69-year-old Thai man with discontinued psychiatric treatment, living alone on relatives' land in poverty, with severe malnutrition (BMI 13.84), presented with left-sided weakness, facial droop, and slurred speech three days after an alleged physical assault. He was diagnosed with Ischemic Stroke (cerebral infarction due to thrombosis); motor power on admission was right grade 5, left grade 0. He was admitted to the Intermediate Care ward for 6 days and discharged with a multidisciplinary home-visit plan due to lack of a primary caregiver and inability to travel for physiotherapy. Over 6 home visits, the team modified the home environment, installed handrails, provided physiotherapy and herbal compress massage, and gave dietary, medication, and psychological support. The patient ultimately regained the ability to walk with a full Barthel Index score of 20. 2) Case Study 2: A 45-year-old Thai woman with poorly controlled hypertension and obesity (BMI 36.5-41) presented with sudden drowsiness and left-sided weakness, diagnosed with Hemorrhagic Stroke (intracerebral hemorrhage with intraventricular extension), requiring intubation and transfer to a tertiary hospital before being referred back for 12 days of intermediate care. A urinary tract infection complicated her course and was treated with antibiotics. She was discharged with residual left hemiplegia; the multidisciplinary team continued home visits and outpatient physiotherapy, with particular emphasis on pressure injury prevention given her body weight and limited mobility, no pressure injury occurred throughout care. 3) Both cases shared 12 total nursing diagnoses, with 8 identical and 4 differing according to underlying pathophysiology and individual risk factors. Both received systematic care from admission through the continuing and community discharge phases. Conclusion, Despite differing stroke subtypes (ischemic vs. hemorrhagic) and starkly contrasting socioeconomic and nutritional contexts (severe malnutrition vs. obesity), systematic application of the nursing process integrated with a hospital-to-community intermediate care model successfully controlled complications, restored function, and enabled both patients to return to meaningful life in their communities.