Get Answer: Stroke Nurse Caring Question Guide
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Original Question
Stroke The nurse is caring for a 56-year-old female who is brought to the emergency department by her family with severe dizziness and body weakness. This case consists of six clinical judgment questions. Read each question carefully and select the best answer(s). Use the chart to help answer the question. The chart is dynamic and may change as the case progresses. History and Assessment · Medical/Surgical history: Hypercholesterolemia and coronary artery disease x 5 years, 2 coronary artery stents placed after a “mild” myocardial infarction 5 years ago. Moderate hypertension x 10 years, controlled with medication, diet, and exercise. BMI of 26. Partial thyroidectomy 25 years ago for a benign growth on the gland. Thyroid replacement therapy never required, but may be in the near future as T3, T4, T7 levels were decreased at last appointment. TSH was normal. Hospitalized for COVID-19 infection 2 years ago, no lasting residual complications. Social history: Drinks alcohol and smokes socially. Occasionally uses marijuana “to relax.” Denies the use of illicit drugs and herbal supplements. Works as the CEO of a large company and travels internationally 75% of the time, returned last evening from a trip to Asia; works 80-90 hours a week. Lives with wife. Family history: Mother and father both died from complications of a CVA at ages 69 and 70 years. Sister has CAD. Physical Assessment: Anxious and restless. Wife holding her hand at the side of the stretcher. Color pale, skin warm to touch and moist. Alert and oriented. PERRLA. Moves all extremities but left side significantly weaker than right. States “I feel like a limp noodle.” Lungs clear to auscultation, dry cough. S1, S2 heart sounds, irregular with diastolic murmur. All distal pulses 3+. Capillary refill <3 seconds. Abdomen round, soft, and nontender. Bowel sounds active x 4 quadrants. States that her last bowel movement was last evening. Medications: Lisinopril 10 mg by mouth twice a day, carvedilol 6.25 mg by mouth twice a day, atorvastatin 80 mg by mouth daily, enteric-coated aspirin 81 mg by mouth daily. Nurses' Notes 9/17/XX 0315 Brought to the emergency department by wife. Returned home from an 18-hour airplane flight from Asia last evening, showered, and went to bed. Awoke at 0100 feeling "very dizzy" and weak "all over." Walked to bathroom and fell against the wall. Returned to bed and continued to feel worse as the night progressed. Awoke wife, who brought her to the hospital. 0320 Symptoms consistent with CVA. National Institutes of Health Stroke Scale (NIHSS) initiated with a score of 15. Emergency stroke team notified to activate brain attack protocol. Transported for STAT CT scan of the head without contrast and carotid duplex. 0510 Approached by the wife who said, "I need you to give it to me straight - what are all the problems my wife could have as a result of this stroke, both now and in the future?" Teaching provided to wife about possible complications of a CVA. 0530 rt-PA infusion completed, monitoring per protocol. 0700 Patient remains stable. Grips and pushes equal bilaterally. Moves all extremities when asked. Vital Signs 9/17/XX 0315 Temp 99.6°F (37.5°C) HR 102 bpm, irregular RR 24 breaths/min SpO2 93% on room air BP 178/101 mm Hg Pain 0 on 0 to 10 scale - states feeling "very weak all over" 0515 Temp 99.8°F (37.6°C) HR 89 bpm, irregular RR 22 breaths/min SpO2 98% on 2 L/NC BP 158/99 mm Hg Pain 0 on 0 to 10 scale - states feeling "very weak all over" 0645 Temp 99.0°F (37.2°C) HR 118 bpm, irregular RR 20 breaths/min SpO2 98% on 2 L/NC BP 143/89 mm Hg Pain 0 on 0 to 10 scale Laboratory Results 9/17/XX 0325 12-lead ECG shows atrial fibrillation with rapid ventricular response of 95 to 130 beats per minute. 0330 CT scan of head shows no acute bleeds or area of tissue ischemia, consistent with acute ischemic stroke. Carotid duplex shows high-grade blockage of right carotid artery and moderate-grade blockage of left carotid artery. Symptoms consistent with acute basilar artery occlusion. Recommend consideration of IV recombinant tissue plasminogen activator (rt-PA) if patient meets inclusion criteria. Question 1 of 6 The nurse is reviewing the patient's file. Select to highlight the findings that identify the risk for a brain attack. Medical/Surgical history: // Hypercholesterolemia and coronary artery disease x 5 years, 2 coronary artery stents placed after a "mild" myocardial infarction 5 years ago. // Moderate hypertension x 10 years, controlled with medication, diet, and exercise. // BMI of 26. // Partial thyroidectomy 25 years ago for a benign growth on the gland. //Thyroid replacement therapy never required, but may be in the near future as T3, T4, T7 levels were decreased at last appointment. // TSH was normal. // Hospitalized for COVID-19 infection 2 years ago, no lasting residual complications. // Social history: Drinks alcohol // and smokes socially. // Occasionally uses marijuana "to relax." // Denies the use of illicit drugs and herbal supplements. // Works as the CEO of a large company and travels internationally 75% of the time, returned last evening from a trip to Asia; works 80-90 hours a week. // Lives with wife. Family history: // Mother and father both died from complications of a CVA at ages 69 and 70 years. // Sister has CAD. // Question 2 of 6 The nurse reviews the patient's record. Which findings are most concerning? Select all that apply. Anxiety and restlessness Color and skin Level of consciousness Left side weaker than right side Weak "all over" Dry cough Irregular heart sounds Airplane flight Blood pressure Temperature Question 3 of 6 The nurse is reviewing the patient's health history and medical record. Drag each patient finding that meets inclusion criteria for the administration of recombinant tissue plasminogen activator (rt-PA) to the box on the right. Be sure to drag all that apply. Thyroid disease Age History of myocardial infarction Time since onset of symptoms Measurable neurological deficit using NIHSS Symptoms present for 30 minutes, not rapidly improving or attributable to another disease Imaging of head is consistent with an acute ischemic stroke, not hemorrhage or brain tumor ECG shows atrial fibrillation Question 4 of 6 For each possible complication for this patient, specify whether it is acute or chronic. Select one option in each row. Acute Chronic Agnosia Cerebral edema Paralysis Hemorrhage transformation Increased ICP Homonymous hemianopia Aspiration Apraxia Question 5 of 6 The nurse reviews the patient's record. Which actions should the nurse take to safely care for the patient? Select all that apply. Bedside swallow screening Continuous ECG Neuro assessments every 1 hour Elevate the head of the bed to 10 degrees Vital signs every 15 minutes Implement bleeding precautions for 24 hours Provide frequent repositioning Maintain blood pressure systolic goal <110 mm Hg Question 6 of 6 The nurse gives a hand-off report to the oncoming nurse. Complete the sentence. The patient's condition has 1 improved 2 not changed 3 deteriorated since administration of the rt-PA, as evidenced by 1 the decrease in blood pressure 2 equal grips and pushes 3 the ability to follow commands .
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