Penny Williams, a 74-year-old patient, is admitted to the telemetry unit with the diagnosis of acute ischemic stroke. The patient is experiencing paroxysmal atrial fibrillation with a controlled ventricular rate on the monitor. The CT of the head without contrast reveals no evidence of hemorrhage. The transesophageal echocardiogram reveals moderate mitral valve insufficiency and embolism as a primary cause of the stroke. The patient is on a weight-based heparin protocol. The patient received digitalis to keep the ventricular rate of the atrial fibrillation controlled. The patient has right-sided paralysis and global aphasia. The patient has unilateral neglect of her right side and has right field homonymous hemianopsia. There is papilla edema present bilaterally.

Question

The patient is drooling from the right side of her mouth and coughs periodically. The patient was found by her daughter after her daughter had gotten out of work and arrived at her mother’s home. The daughter stated her mother was normal before she left for work, and 10 hours later the mother exhibited the symptoms described above. The time of onset for the stroke could not be safely determined so no interventions could be used to treat the stroke. What principles of nursing management should the nurse provide the patient during the acute stage of the ischemic stroke based on the assessment findings from the case study? Place the assessment findings that are supported by the nursing principle(s) in parenthesis.

Answer 1

Anawer :

Acute ischemic stroke : ischemic stroke is caused from a lack of blood flow to the part of the brain due to inadequate perfusion caused by a partial or complete block of the artery
Embolic stroke : embolic stroke caused by the formation of clot circulating in the vasculature .the clot wedges into a narrowing of an artery due to atherosclerotic plaque or the clot diameter is larger than the artery .
Risk factors :
Risk factors that are specially associated with emboluc stroke are :
Dysrhythmias .
Bacterial endo carditis .
Enlarged heart .
Heart failure with ejection fraction less than 30%.
Myocardial infarction with in 30 days .
Rheumatic mitral and aortic valve disease.
Symptoms :
Patient may feel sudden weakness or numbness in the face ,arm or legs ,especially on one side of body .
Confusion.
Severe headache.
Sudden trouble seeing in eye.
Timely management :
In the first 48 hours ,it is important to start addressing other factors that can impact the patient recovery .the following conditions and their nursing interventions will be discussed includes :
Intra cranial pressure .
Vital signs .
Oxygenation.
Blood pressure management .
Hypo hyperglycemia .
Maintaining normal temperature.
Deep vein thrombosis
Nutrition.
Constipation.
Risk For infection.
Immobility .
The first 48 hours : intra cranial pressure : due to the swelling and edema cause by ischemia ,intracranial pressure may rise .
We should corticosteroids in the treatment of acute cerebral edema in stroke patient .
Vital signs and dysrhythmias :
Vital signs should be taken every 1-2 hours For the first 8 hours .vital signs may need to be taken more frequently if the patient becomes unstable .
Regular ,intermittent neurological checks are an important assessment tool .neuro checks should be dobe every 15 minutes on admission and after 30 minutes once further every 2 hours .
Cardiac rhythm should be monitored For 24 hours to assess For any new dysrhythmias .
Oxygenation :
O2 very much important.and nurse should check the lung sounds frequently
Position changing to prevent bed sores .
Physiotherapy to right side of patient .
Blood pressure management .
Glycemic control .
Medication administration such as digitalis to control irregular heart beat .
Nurse need to be proactive For their patient to ensure specialised therapies such as speech ,occupational and physical therapy are consulted.