Case
NUR 2005 CVA Case Study
- Course
- NUR 2005
- Institution
- Laboure College
This is a comprehensive and detailed case study on; CVA for Nur 2005.
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CVA Case StudySudden onset of right-sided weakness, right facial neurologic changes
droop, and difficulty speaking (dysarthric speech)
During transport, he had increased agitation and worsening in status
confusion to place and time
It has been 30 minutes from the onset of candidate for thrombolytic therapy
neurologic symptoms when he presents to the ED
His wife insists on being by his side and talking to Expressive aphasia
John despite John’s frustration in not being able
to answer her questions
Nicotine patch use Should be removed
pain on the right foot for the past week Should perform skin assessment
Indomethacin 25 mg tid Decrease inflammation
Aspirin 81 mg daily Prevent thrombus
Lisinopril 20 mg daily Lower BP
Simvastatin 40 mg daily Lower LDL and elevate HDL chol.
Metformin 500 mg bid Lower blood glucose
Nicotine patch 21 mg transdermal Smoking cessation
DM type II-poorly controlled>>>Metformin/ Hypertension>>>Lisinopril/ ASA
Hyperlipidemia>>>Simvastatin/ Gouty arthritis>>>Indocin/ Smokes 1 ppd>>>Nicotine patch
Interpretation of rhythm= Atrial fibrillation, most common reason for embolic stroke
Relevant VS data
P: 118 (irregular) most common reason for embolic strokes
BP: 198/94 elevated
O2 sats: 99% RA No hypoxia causing neuro symptoms
Relevant Assessment data
appears anxious Anxiety will increase BP.
atrial fibrillation may have precipitated the embolic stroke
Confused to place and why he is in the hospital, is reflecting a left hemisphere CVA
notably anxious, restless, and agitated, speech is
, currently slurred and difficult to understand,
facial droop present on right side, pupils equal
and reactive to light
1. Acute CVA of the left hemisphere
2. An embolic stroke is caused by a thrombus that breaks off from one area of the body
and travels to the arteries that supply blood to the brain. Because the sudden blockage
of blood flow, the onset of symptoms tend to be abrupt and faster.
3. Ineffective tissue perfusion (neurologic)
4. Perform frequent neuro check, monitoring of BP every 15minutes, monitor cardiac
rhythm, NPO
5. Neurologic
6. further deterioration in neuro status
7. frequent neuro checks
Establish peripheral IV IV is a standard of care patent
Labetalol 10-20 mg IV lower BP SBP=160-180 range
prn every 15" to keep
SBP 160- 180
Haldol 2.5-5 mg IV prn decrease agitation Agitation/restlessness
excess agitation controlled
CT head stat confirm that is embolic no hemorrhage
Cardiac monitor Assess AFib HR remains <100
continuous
NPO risk for aspiration No aspiration
tPA IV Thrombolytic therapy Tolerates therapy with no
adverse reactions
Relevant Labs
sodium ACE inhibitors
glucose history of diabetes
creatine May indicate chronic renal insufficiency,
monitor I and O
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