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Original Question
Mr. Evans is transferred to the intensive care unit (ICU) and placed on cardiac monitoring. A CVA care path is initiated. A CT scan confirms an ischemic stroke of the right parietal/temporal region, and he continues to have trouble managing his secretions. His WOB is increasing. Mr. Evans is now receiving supplemental O2 delivered via nonrebreather mask. His O2 saturations are in the high 80s. Vitals are now T 99.8°F; P 94 bpm; R 26/min; and BP 120/76 mmHg. Shortly after Mr. Evans’s arrival in the ICU, you notice bilateral crackles in his lungs. On auscultation, you note they are worse on the right side. Mr. Evans has pitting edema in his lower extremities, and his urine output has decreased significantly. He is difficult to arouse and is oriented to person only. HCP and respiratory therapist have been called to assess the need for possible mechanical ventilation. Clinical Reasoning Questions Level I 1. Describe the pathophysiology of an ischemic stroke. 2. Why might Mr. Evans’s urine output be decreasing? 3. If you were going to ask the off-going nurse three questions, what would they be? Why? Clinical Reasoning Questions Level II 1. Identify two potential alterations in perfusion that may arise as complications of the CVA. 2. What signs or symptoms are indicative of increased ICP? 3. How does increased ICP affect cerebral perfusion pressure?
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