CONCEPT: INTRACRANIAL REGULATION TOPIC: Stroke Ms. A is a… CONCEPT: INTRACRANIAL REGULATIONTOPIC: Stroke  Ms. A is a 64-year-old woman, arrives at the emergency department (ED) with expressive aphasia, left facial droop, left-sided hemiparesis, and mild dysphagia. Her husband states that when she awoke that morning at 0730, she stayed in bed, saying she had a mild headache over the right temple and was feeling weak. He went and got coffee, then thinking it was unusual for her to stay in bed, went back to check on her. He found she was having trouble saying words and had a left-sided facial droop. When he helped her up from the bedside, he noticed weakness in her left hand and leg and brought her to the ED. Her medical history includes atrial fibrillation (Afib), hypertension (HTN), and hyperlipidemia. A recent cardiac stress test was normal, and her blood pressure is under good control. Ms. A is currently taking amiodarone, amlodipine, aspirin, simvastatin, and lisinopril. The provider suspects Ms. A is having a stroke.  1. What diagnostic procedure would most likely be ordered by the provider and why? 2, Identify the two major types of stroke and a brief description.  3. What factors could contribute to the development of stroke?A.B.C.D.E.F.G.H. 4. What are the common manifestations of stroke?A.B.C.D.E.  5. Outline the focused assessment that you need to obtain.A.B.C.D.E. Your assessment findings are as follows: VS: 168/102, 99, 23, 97.8oF, SaO2 93% on room air. Her lungs are clear, and she is alert and oriented. She is able to follow simple commands, has PERRL with intact extraocular movements, and no vision loss. Her facial movements are asymmetrical, with left-sided drooping. Speech is slightly slurred, although it remains intelligible. She is unable to move her left arm and leg; sensation is intact. There is no ataxia; however she is experiencing some visual and tactile neglect of the left side. 6. Complete the National Institutes of Health Stroke Scale (NIHSS) scores for each of Ms. A’s symptoms.alert knows months and age able to follow commands no visual loss left-sided facial paralysis left-leg no movement left arm no movement no ataxia sensation intact moderate aphasia neglect of left side  7. Describe the following manifestations that can occur to a client with stroke.aphasia dysarthria alexia agnosia apraxia agraphia anosognosia  A noncontrast CT scan confirms the diagnosis of a cardioembolic stroke. The provider writes the order shown below:Physician’s Orders IV 0.9% normal saline at 75 mL/hr   Activase (tPA) per protocol                                                                                                                   stat CBCD, coagulation panel, cardiac panel                                                                                                                         neuro-VS every hour                                                                                                                       obtain patient’s weight                                                                                                               O2 at 2 L per nasal cannula                                                                                                               NPO until swallowing evaluation                                                                                                                                                                                          8. Give some interventions that you can delegate to your assistive personnel (AP) when caring for Ms. AA.B.C.D.E.  9. What are the contraindications when giving tPA?A.B.C.D.E.F.G. 10. What are your nursing responsibilities during the administration of tPA?A.B.C.D. 11. What signs and symptoms would alert you to the possible presence of an intracerebral hemorrhage as an adverse effect of tPA infusion?A.B.C.  Ms. A is admitted to the stroke unit. A second CT scan 24 hours later reveals a small CVA in the right hemisphere. She is placed on aspirin, amiodarone, amlodipine, clopidogrel, simvastatin, and lisinopril. 12. Why was Ms. A placed on clopidogrel post-CVA?  13. What is the importance of continuing simvastatin for Ms. A?  14. Ms. A was referred to speech pathologist, physical therapist, and occupational therapist. Which of the following problems or issues post-stroke needs to be addressed by the following healthcare team members:A. social workerB. speech pathologistC. dietitianD. physical therapistE. occupational therapistHealth Science Science Nursing NUR MISC

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