Case StudyStroke

Case Study Stroke

 

Patient Profile

A.J., a 66-yr-old white woman, awoke in the middle of the night and fell when she tried to get up and go to the bathroom (see Chapter 56 case study on p. 1344). She fell because she was not able to control her left leg. Her husband took her to the hospital, where she was diagnosed with an acute ischemic stroke. Because she had awakened with symptoms, the actual time of onset was unknown and she was not a candidate for tPA.

Subjective Data

• Left arm and leg are weak and feel numb
• Feeling depressed and fearful
• Requires help with ADLs
• Concerned about having another stroke
• Says she has not taken her medications for high cholesterol and high blood pressure for several weeks
• History of a brief episode of left-sided weakness and tingling of the face, arm, and hand 3 mo earlier, which totally resolved and for which she did not seek treatment

Objective Data

• BP 180/110 mm Hg
• ECG is as follows:
• Left-sided arm weakness (3/5) and leg weakness (4/5)
• Decreased sensation on the left side, particularly the hand
• Left homonymous hemianopsia
• Height 5 ft, 3 in, weight 160 lb
• Alert, oriented, and able to answer questions appropriately but mild slowness in responding

Past Medical History

• Migraines
• Hypertension
• Hyperlipidemia

Discussion Questions

• How do A.J.’s prior health history and current findings put her at risk for another stroke?
• How can you address A.J.’s concerns regarding having another stroke?
• How can A.J. and her family address activity issues such as driving after the stroke?
• What strategies can you use to help A.J. and her family cope with her depression?
• Priority Decision: What are the priority lifestyle changes that A.J. should make to reduce the likelihood of another stroke?
• How will homonymous hemianopsia affect A.J.’s hygiene, eating, driving, and community activities?
• What factors should you assess for related to outpatient rehabilitation for A.J.?
• Priority Decision: What are the priority nursing interventions for A.J.?
• Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? Are there any collaborative problems?
• Delegation Decision: What nursing interventions for A.J. can the RN delegate to unlicensed assistive personnel (UAP)?
• Evidence-Based Practice: A.J.’s family wants to know if her atrial flutter caused her stroke and, if so, what she can do to prevent additional problems with her atrial flutter.