Reference no: EM133438615
Case Study 1 Mr. Jones, a 56-year-old retired widow, was admitted to the stroke unit after being diagnosed with a stroke. His poker buddies called 911after Mr. Jones developed arm and face weakness during their weekly game. On assessment, the practical nurse notices he has moderate left-sided weakness and slurred speech. He admits that he hasn't take good care of himself since his wife died last year. His past medical history is limited. He reports the last time he saw a doctor was over 5 years ago and he was told there was some issue with his heart rate but he doesn't recall what it is. He says he is supposed to be taking medication but he hasn't been taking it since he didn't feel sick.
His vital signs are: BP: 160/88 HR 88 irregular, RR 16, O2 Sat 97% on RA, T 37.4C. He has no pain at present.
Questions:
1. What type of stroke would most likely occur based on his manifestations? Ischemic or Hemorrhagic? Explain.
2. What diagnostic test would be needed at this point and why?
3. The ER nurse practitioner told Mr. Jones that his friends did the right thing by calling 911 immediately. What is the rationale behind this comment? Explain from a pathophysiological perspective.
4. The CT Scan confirms a right brain ischemic stroke in the middle cerebral artery region. What subtype of ischemic stroke might this be?
5. Explain the concept of an ischemic penumbra and what consequences this has for cells
. 6. What risk factors does Mr. Jones have for stroke? How do these relate to the pathology of his stroke?
7. Mr. Jones would like to know why the doctor told him he had a right brain stroke, yet his left side is weak. What explanation would the practical nurse give?
8. Mr. Jones will be discharged on Warfarin (an anticoagulant). Why was this prescribed?
Case Study 2
During Mr. Jones' stay, another patient was admitted into the bed next to him. The new patient's name is Mr. Quick, 48 years old. Mr. Quick had a hemorrhagic stroke due to a brain aneurysm.
9. In addition to aneurysms, what other factors can cause a hemorrhagic stroke?
10. Does ischemia occur when a patient has a hemorrhagic stroke? Explain.
11. Where do brain aneurysms typically form?
12. When a brain aneurysm ruptures, where does the blood accumulate?
13. What manifestations would indicate a hemorrhagic stroke has occurred rather than an ischemic stroke?
14. If the hematoma is large, what complications can occur? Why?
15. Mr. Quick developed confusion and drowsiness one week after surgery to repair his brain aneurysms and evacuate the hematoma. Explain what vasospasm is and why it is a concern.