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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N1 Exam 4

Concepts Covered:

  • Oncology Disorders
  • Gastrointestinal Disorders
  • Digestive System
  • Terminology
  • Upper GI Disorders
  • Lower GI Disorders
  • Newborn Complications
  • Noninfectious Respiratory Disorder
  • Nervous System
  • Substance Abuse Disorders
  • Immunological Disorders
  • Respiratory Emergencies
  • Shock
  • Respiratory Disorders
  • Neurological Trauma
  • Neurological Emergencies
  • Respiratory System
  • Emergency Care of the Neurological Patient
  • Central Nervous System Disorders – Brain
  • Musculoskeletal Trauma
  • Liver & Gallbladder Disorders
  • Preoperative Nursing
  • Neurologic and Cognitive Disorders
  • Peripheral Nervous System Disorders
  • Central Nervous System Disorders – Spinal Cord
  • Acute & Chronic Renal Disorders
  • Disorders of the Posterior Pituitary Gland
  • Cognitive Disorders
  • Hematologic Disorders
  • Renal and Urinary Disorders
  • Urinary Disorders
  • Neurological
  • Infectious Respiratory Disorder
  • Musculoskeletal Disorders
  • Emergency Care of the Trauma Patient
  • Pregnancy Risks
  • Prioritization
  • Test Taking Strategies

Study Plan Lessons

Colonoscopy
Colorectal Cancer (colon rectal cancer)
Constipation and Encopresis (Incontinence)
Digestion & Absorption
Digestive Terminology
Endoscopy & EGD
Esophagus
Functional GI Disorders (Obstruction, Ileus, Diabetic Gastroparesis, Gastroesophageal Reflux, Irritable Bowel Syndrome) for Progressive Care Certified Nurse (PCCN)
Gastritis
Gastrointestinal (GI) Course Introduction
GERD (Gastroesophageal Reflux Disease)
Lower Gastrointestinal (GI) Module Intro
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Colorectal Cancer (Colon Cancer)
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)
Nursing Care Plan (NCP) for Ovarian Cancer
Nursing Care Plan (NCP) for Pancreatitis
Nursing Case Study for Colon Cancer
Nursing Care Plan for Liver Cancer
Upper Gastrointestinal (GI) Module Intro
Abdomen (Abdominal) Assessment
Body System Assessments
Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Cranial Nerves
Head to Toe Nursing Assessment (Physical Exam)
Lung Cancer
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Pleural Space Complications (Pneumothorax, Hemothorax, Pleural Effusion, Empyema, Chylothorax) for Progressive Care Certified Nurse (PCCN)
Pneumonia
Stroke Assessment (CVA)
Thorax and Lungs Assessment
Trach Suctioning
Acute Confusion
Adjunct Neuro Assessments
Bladder Cancer
Brain Tumors
Cranial Nerves
General Assessment (Physical assessment)
Head to Toe Nursing Assessment (Physical Exam)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Increased Intracranial Pressure
Intracranial Hemorrhage
Intracranial Pressure ICP
Intro to Health Assessment
Introduction to Health Assessment
Levels of Consciousness (LOC)
Migraines
Miscellaneous Nerve Disorders
Meningitis
Neuro Assessment
Neuro Assessment Module Intro
Neuro Course Introduction
Neuro Terminology
Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)
Neurological Fractures
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Brain Tumors
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Dementia
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Migraines
Nursing Care Plan (NCP) for Multiple Sclerosis (MS)
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Pneumothorax/Hemothorax
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan for Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Case Study for Head Injury
Nursing Case Study for Hepatitis
Nutrition Assessments
Prioritizing Assessments
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Routine Neuro Assessments
Seizures Case Study (45 min)
Spinal Cord Injury
Stomach Cancer (Gastric Cancer)
Stroke Assessment (CVA)
Stroke (CVA) Management in the ER
Stroke Case Study (45 min)
Stroke Concept Map
Vomiting