Reference no: EM133632495
Case Study
Situation - Rose Nyland is a 75-year-old woman that arrived at the emergency room with expressive aphasia, left facial droop, right sided hemiparesis, and slowness in movement via ambulance. The report the EMT gives is that the patient is a possible stroke alert.
Background - Her husband states that when she awoke that morning at 0500, she complained of a mild headache over the left temple area, was fatigued, and felt slightly weak. Thinking that it was unusual for her to have those complaints, he went to check on her and found that she was having trouble saying words and had a slight left-sided facial droop. When he helped her up from the bedside, he noticed weakness in her right hand and called 911 to bring her to the Emergency Department. Her past medical history includes paroxysmal supraventricular tachycardia, hypertension (HTN), hyperlipidemia, and a history of deep vein thrombosis 15 years ago. A recent cardiac stress test was normal, and her blood pressure was 130/70 and 134/82 on her last two visits to the doctor's office.
Assessment - Mrs. Nyland is awake and alert. When you ask her where she is, she is unable to answer and appears to be frustrated that she cannot answer you. Her lungs are clear bilaterally. You note that the left side of her mouth and eye are drooping. When you ask her to smile, only the right side of her mouth goes up. When you raise her arms in front of her and ask her to hold them in place to a count of 5. Her right arm drifts downward. You ask her to raise her legs and she can only raise her left leg. Her current vital signs are BP 170/90 (117), HR 90 and irregular, RR - 18, T - 98.6º F (37ºC), O2 saturation - 99%
Mrs. Nyland is currently taking flecainide (Tambocor), hormone replacement therapy, amlodipine (Norvasc), aspirin, simvastatin (Zocor), and lisinopril (Zestril). The CT of her head comes back, and no bleeding is noted.
Points to assess: Is this Acute or Chronic? Is the patient Unstable or Stable? Is this Urgent or Nonurgent?
Recommendation(s) - What do you think are the primary alterations in health with this patient (diagnosis)?
What is the pathophysiology related to the patient's problems?
What are the risk factors for this patient, and do they contribute to the current primary problem?
What assessment(s) (expected finding) should be your focus? (Hint: Identify the relevant information first to determine what is most important.)? What signs and symptoms are commonly seen with this diagnosis?
What data should you analyze (laboratory and diagnostic procedures) and report to the health care provider? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.) What lab values may be abnormal?
What would your plan (nursing care) and recommendation(s) be to the health care provider? (Hint: Consider all possibilities and determine their urgency and risk for this client.)
What intervention(s) (therapeutic procedures and/or medications) would be your priority with this patient? (Hint: Determine the desired outcome first to decide which interventions are appropriate and those that should be avoided.) Which intervention would be best for this patient?