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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ER

Concepts Covered:

  • Cardiovascular
  • Emergency Care of the Cardiac Patient
  • Cardiac Disorders
  • Circulatory System
  • Fundamentals of Emergency Nursing
  • Emergency Care of the Neurological Patient
  • Emergency Care of the Respiratory Patient
  • Medication Administration
  • Vascular Disorders
  • Emergency Care of the Trauma Patient
  • Shock
  • Intraoperative Nursing
  • Communication
  • Delegation
  • Postoperative Nursing
  • Studying
  • Legal and Ethical Issues
  • Neurological Trauma
  • Neurological
  • Multisystem
  • Neurological Emergencies
  • Musculoskeletal Trauma
  • EENT Disorders
  • Central Nervous System Disorders – Brain
  • Perioperative Nursing Roles
  • Respiratory Emergencies
  • Health & Stress

Study Plan Lessons

02.01 Hypertensive Crisis for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.09 12 Lead EKG- Leads 1, 2, 3, aVL, and aVF for CCRN Review
02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
02.11 12 Lead EKG- Injuries for CCRN Review
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
06.05 Wide Complex Tachycardia for CCRN Review
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Abuse
Abuse and Neglect for Certified Emergency Nursing (CEN)
Acute Confusion
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS) Module Intro
Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Acute Respiratory Distress
Adenosine (Adenocard) Nursing Considerations
Aggressive & Violent Patients
Amiodarone (Pacerone) Nursing Considerations
Aneurysm & Dissection
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Bleeding for Certified Emergency Nursing (CEN)
Blunt Abdominal Trauma
Blunt Thoracic Trauma
Calling for RRT, Code Blue
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiopulmonary Arrest
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Cardiovascular Trauma for Certified Emergency Nursing (CEN)
Combative: IV Insertion
Conflict Management (Patient, Perioperative Team, Family) for Certified Perioperative Nurse (CNOR)
Crash Cart
Critical Incident Management
Crush Injuries
Day in the Life of an ICU (Intensive Care Unit) Nurse
Delegation of Tasks to Assistive Personnel for Certified Emergency Nursing (CEN)
Discharge Planning for Certified Emergency Nursing (CEN)
Drugs for Bradycardia & Low Blood Pressure Nursing Mnemonic (IDEA)
Dysrhythmia Emergencies
Dysrhythmias for Certified Emergency Nursing (CEN)
EKG Basics – Live Tutoring Archive
Emergency Drugs Nursing Mnemonic (LEAN)
Emergency Nursing Course Introduction
EMTALA & Transfers
Ethical Dilemmas for Certified Emergency Nursing (CEN)
Fall and Injury Prevention
Flight Nurse
Forensic Nurse
Gastrointestinal Trauma for Certified Emergency Nursing (CEN)
Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)
Head Trauma & Traumatic Brain Injury
Heart (Heart) Failure Exacerbation
Hypertension (HTN) Concept Map
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertension for Certified Emergency Nursing (CEN)
Hypertensive Emergency
Increased Intracranial Pressure
Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)
Injection Injuries for Certified Emergency Nursing (CEN)
Intracranial Hemorrhage
Ischemic (CVA) Stroke Labs
Joint Commission
Lacerations for Certified Emergency Nursing (CEN)
Legal & Ethical Issues in ER
Massive Transfusion Protocol
Maxillofacial Trauma for Certified Emergency Nursing (CEN)
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Seizures
Nursing Case Study for Head Injury
Nursing Skills (Clinical) Safety Video
Patient and Healthcare Team Safety (Disasters, Environmental Hazards) for Certified Perioperative Nurse (CNOR)
Patient Safety for Certified Emergency Nursing (CEN)
Patient Satisfaction for Certified Emergency Nursing (CEN)
Penetrating Abdominal Trauma
Penetrating Injuries for Certified Emergency Nursing (CEN)
Penetrating Thoracic Trauma
Premature Atrial Contraction (PAC)
Premature Ventricular Contraction (PVC)
Procainamide (Pronestyl) Nursing Considerations
Pulmonary Embolism
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Rapid Sequence Intubation
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Trauma for Certified Emergency Nursing (CEN)
Restraints
Restraints 101
Risk Management for Certified Emergency Nursing (CEN)
Safety Check Nursing Mnemonic (MADLE)
Safety Checks
Seizure Assessment
Seizure Causes (Epilepsy, Generalized)
Seizure Management in the ER
Seizure Therapeutic Management
Seizures Case Study (45 min)
Seizures Module Intro
Sexual Assault and Battery for Certified Emergency Nursing (CEN)
Sinus Bradycardia
Sinus Tachycardia
Stress and Crisis
Stroke (CVA) Management in the ER
Stroke (CVA) Module Intro
Stroke Case Study (45 min)
Supraventricular Tachycardia (SVT)
Transfer and Stabilization for Certified Emergency Nursing (CEN)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Nursing Interventions for Certified Perioperative Nurse (CNOR)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Trauma Survey
Triage
Triage in the ER
Triage Nursing Mnemonic (START)
Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Verapamil (Calan) Nursing Considerations
Wound Bleeding (Uncontrolled External Hemorrhage) for Certified Emergency Nursing (CEN)