Stroke Case Study (45 min)

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Study Tools For Stroke Case Study (45 min)

Stroke Pathochart (Cheatsheet)
Stroke Locations (Cheatsheet)
Circle Of Willis Showing Stroke (Image)
Hemorrhagic Stroke Risk Factors (Mnemonic)
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Outline

Mrs. Blossom is a 57-year-old female who presented to the Emergency Room with new onset Atrial Fibrillation with Rapid Ventricular Response (RVR). She is admitted to the cardiac telemetry unit after being converted to normal sinus rhythm with a calcium channel blocker (diltiazem). When you enter the room to assess Mrs. Blossom, her daughter looks at you concerned and says “mom’s acting kinda funny.”

Critical Thinking Check
Bloom's Taxonomy: Application

What nursing assessments should be completed at this time?

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You assess Mrs. Blossom to find she has a left sided facial droop, slurred speech, and is unable to hold her left arm up for more than 3 seconds.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What is/are your priority nursing action(s) at this time?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What may be occurring in Mrs. Blossom?

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You call a Code Stroke and notify the charge nurse for help. You obtain suction to have at bedside just in case. The neurologist arrives at bedside within 7 minutes to assess Mrs. Blossom. He notes her NIH Stroke Scale score is 32. He orders a STAT CT scan, which shows there is no obvious bleed in the brain.

 

Critical Thinking Check
Bloom's Taxonomy: Analysis

What are the possible interventions for Mrs. Blossom at this time?

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Critical Thinking Check
Bloom's Taxonomy: Comprehension

What are the contraindications for thrombolytics like tPA (alteplase)?

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You administer tPA per protocol, initiate q15min vital signs and neuro checks. You stay with the patient to continue to monitor her symptoms.

Critical Thinking Check
Bloom's Taxonomy: Comprehension

What are possible complications of tPA administration? What should you monitor for?

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After 2 hours, Mrs. Blossom is showing signs of improvement. She is able to speak more clearly, though with a slight slur. She is still slightly weak on the left side, but is able to hold her arm up for 10 seconds now. Her NIHSS is now 6. Mrs. Blossom’s daughter asks you why this happened.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What would you explain has happened to Mrs. Blossom physiologically?

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Two days later, Mrs. Blossom has recovered fully. She will be discharged today on Clopidogrel and Aspirin, plus a calcium channel blocker,  with a follow up appointment in 1 week to see the neurologist.

Critical Thinking Check
Bloom's Taxonomy: Application

What education topics should be included in the discharge teaching for Mrs. Blossom and her family?

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Neuro

Concepts Covered:

  • Multisystem
  • Neurological
  • Nervous System
  • Emergency Care of the Neurological Patient
  • Central Nervous System Disorders – Brain
  • Cognitive Disorders
  • Neurologic and Cognitive Disorders
  • Medication Administration
  • Central Nervous System Disorders – Spinal Cord
  • Studying
  • Terminology
  • Peripheral Nervous System Disorders
  • Neurological Emergencies
  • Cardiac Disorders
  • Neurological Trauma
  • Emergency Care of the Trauma Patient
  • Shock

Study Plan Lessons

07.01 CVA (Cerebrovascular Accident/Stroke) for CCRN Review
07.02 Neuro Anatomy for CCRN Review
Acute Confusion
Adjunct Neuro Assessments
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Anticonvulsants
Autonomic Nervous System (ANS)
AVPU Mnemonic (The AVPU Scale)
Blood Brain Barrier (BBB)
Encephalopathies
Electroencephalography (EEG)
Increased Intracranial Pressure
Levels of Consciousness (LOC)
Mannitol (Osmitrol) Nursing Considerations
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Neuro A&P Module Intro
Nervous System Anatomy
Nerve Transmission
Neuro Terminology
Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)
Nursing Care Plan (NCP) for Guillain-Barre
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Multiple Sclerosis (MS)
Nursing Care Plan (NCP) for Myasthenia Gravis (MG)
Seizure Causes (Epilepsy, Generalized)
Seizure Disorder for Progressive Care Certified Nurse (PCCN)
Seizure Management in the ER
Stroke Assessment (CVA)
Stroke Case Study (45 min)
Stroke Concept Map
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
07.05 Supratentorial Herniation: Cushings Triad for CCRN Review
Alteplase (tPA, Activase) Nursing Considerations
Cerebral Angiography
Cerebral Palsy (CP)
Brain Tumors
Brain Death v. Comatose
Cranial Nerve Mnemonic 01 Nursing Mnemonic (Olympic Opium Occupies Troubled Triathletes After Finishing Vegas Gambling Vacations Still High)
Cranial Nerve Mnemonic 02 Nursing Mnemonic (Oh Oh Oh To Touch And Feel Very Good Velvet AH!)
Cranial Nerves
Head Trauma & Traumatic Brain Injury
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meropenem (Merrem) Nursing Considerations
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Seizure
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)