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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Dysrhythmias

Concepts Covered:

  • Circulatory System
  • Emergency Care of the Cardiac Patient
  • Disorders of the Posterior Pituitary Gland
  • Endocrine
  • Multisystem
  • Cardiac Disorders
  • Renal
  • Fundamentals of Emergency Nursing
  • Adult
  • Medication Administration
  • Disorders of the Adrenal Gland
  • Disorders of the Thyroid & Parathyroid Glands
  • Central Nervous System Disorders – Brain
  • Vascular Disorders
  • Depressive Disorders
  • Urinary System
  • Eating Disorders
  • Shock
  • Emergency Care of the Trauma Patient
  • Communication
  • Basics of NCLEX
  • Renal Disorders
  • Upper GI Disorders
  • Intraoperative Nursing
  • EENT Disorders
  • Labor Complications
  • Bipolar Disorders
  • Acute & Chronic Renal Disorders
  • Substance Abuse Disorders
  • Anxiety Disorders
  • Cardiovascular Disorders
  • Musculoskeletal Disorders
  • Trauma-Stress Disorders
  • Postpartum Complications
  • Emergency Care of the Respiratory Patient
  • Respiratory Emergencies
  • Noninfectious Respiratory Disorder
  • Somatoform Disorders
  • Emergency Care of the Neurological Patient
  • Neurological Emergencies
  • Respiratory Disorders

Study Plan Lessons

02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
02.11 12 Lead EKG- Injuries for CCRN Review
03.02 Diabetes Insipidus for CCRN Review
06.03 Multi-System CCRN Important Points for CCRN Review
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
09.05 Chronic Renal Failure 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 and Neglect for Certified Emergency Nursing (CEN)
ACLS (Advanced cardiac life support) Drugs
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Advanced Cardiovascular Life Support (ACLS)
Amiodarone (Pacerone) Nursing Considerations
Amitriptyline (Elavil) Nursing Considerations
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Antidepressants
Antidepressants
Arterial Pressure Monitoring
Atrial Fibrillation (A Fib)
Atrial Flutter
Calcium and Magnesium Imbalance for Certified Emergency Nursing (CEN)
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Calculating Heart Rate
Cardiac (Heart) Enzymes
Cardiac Anatomy
Cardiac Stress Test
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiopulmonary Arrest
Cardiovascular Trauma for Certified Emergency Nursing (CEN)
Communicating with Providers
Congestive Heart Failure Concept Map
Critical Thinking
Cushing’s Syndrome Case Study (60 min)
Dialysis & Other Renal Points
Diltiazem (Cardizem) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Dysrhythmia Emergencies
Dysrhythmias Labs
EKG (ECG) Course Introduction
EKG (ECG) Waveforms
EKG Basics – Live Tutoring Archive
Electrical A&P of the Heart
Electrical Activity in the Heart
Electrolytes Involved in Cardiac (Heart) Conduction
Enteral & Parenteral Nutrition (Diet, TPN)
General Anesthesia
Heart (Cardiac) Failure Therapeutic Management
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Hypertension for Certified Emergency Nursing (CEN)
Hypertensive Emergency
Hyperthyroidism Case Study (75 min)
Increased Intraocular Pressure for Certified Emergency Nursing (CEN)
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Mood Stabilizers
Mood Stabilizers
Myocardial Infarction (MI) Case Study (45 min)
Nitroprusside (Nitropress) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Normal Sinus Rhythm
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Cardiogenic Shock
Nursing Case Study for Head Injury
Nursing Case Study for Rheumatic Heart Disease
Obstetric Trauma for Certified Emergency Nursing (CEN)
Pacemakers
Peptic Ulcer Disease Case Study (60 min)
Performing Cardiac (Heart) Monitoring
Pericardial Tamponade for Certified Emergency Nursing (CEN)
Potassium-K (Hyperkalemia, Hypokalemia)
Premature Atrial Contraction (PAC)
Premature Ventricular Contraction (PVC)
Procainamide (Pronestyl) Nursing Considerations
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Pulmonary Hypertension for Certified Emergency Nursing (CEN)
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Rheumatic Fever
Sinus Bradycardia
Sinus Tachycardia
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Somatoform Disorder Case Study (30 min)
Stroke Case Study (45 min)
Stroke for Progressive Care Certified Nurse (PCCN)
Supraventricular Tachycardia (SVT)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
The EKG (ECG) Graph
Thoracic Surgery (Lobectomy, Pneumonectomy) for Progressive Care Certified Nurse (PCCN)
Troponin I (cTNL) Lab Values
Vasopressin (Pitressin) Nursing Considerations
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)