Reference no: EM133382578

Assignment:

Case Study:

Mr. Dover is a 63-year-old African American male taken to the ED by his wife when he complains of chest palpitations and lightheadedness when sitting down for dinner. He has a medical history of hypertension, hypercholesterolemia, and Type II Diabetes Mellitus controlled by diet. Mr. Dover is a 20-pack year smoker.

When in the ED, he is placed on the continuous cardiac monitor which shows a new onset of atrial fibrillation with a rapid ventricular response of 180. He was treated with Diltiazem 25 mg IV push and started on a continuous infusion at 5 mg/Hr. He remains in atrial fibrillation with a ventricular response of 90-100 bpm.

Mr. Dover is admitted to the inpatient cardiac telemetry unit from the ED to the. When you walk into the room, you notice the patient has a left sided gaze and a facial droop. When you ask Mr. Dover his name and date of birth, his speech is garbled and incomprehensible. He does not follow commands; you raise his arm and notice it is flaccid. This is a significant change in condition from the report provided by the ED nurse an hour ago. A Code Stroke is called, and within 5-minutes the Stroke Team.

The hospitalist orders a STAT non-contrast head CT scan which shows no signs of a hemorrhagic stroke. Mr. Dover is suspected of having an ischemic stroke. After discussion and consent from the patient's wife, the physician orders alteplase (tPA) 0.9mg/kg with 10% of the dose being administered as a bolus, and the remainder of the drip over 60-minutes. Prior to administering the bolus, the patient's vital signs are 140/85, HR 100, RR 24, SaO2 94%.

In a well-developed robust manner, fully answer and address the following questions and content.

1. Based upon the information provided in the case study, describe the precipitating factors that resulted in Mr. Dover's having an ischemic CVA?

2. Mr. Dover was administered tPA. Identify the inclusion criteria for the administration of tPA? Identify ten exclusion criteria points the provider needed to review prior to ordering the alteplase. Why was administering tPA appropriate for Mr. Dover?

3. With rationale, identify a priority nursing diagnosis, this cannot be an "at risk" for diagnosis. The nursing diagnosis must include "related to" and "as evidenced by".

• Identify a SMART nursing outcome for the chosen diagnosis.

4. With supporting evidence, describe four nursing interventions focusing on safety that can improve patient outcomes for the patient suffering an acute ischemic stroke.

• Lastly, identify three (3) interprofessional team members, and the role they will play, in caring for Mr. Dover, and who will lead him to your expected outcome and a positive patient outcome. Interprofessional team members are considered healthcare professionals other than a nurse, and physician, of any type and not UAPs.