Stroke - Nursing Case Study

Pathophysiology

• Primary mechanism: Stroke occurs when blood supply to the brain is interrupted or reduced. This can be due to a blockage in a blood vessel (Ischemic stroke) or a blood vessel rupture (Hemorrhagic stroke).

• Secondary mechanism: In Ischemic stroke, the lack of blood flow deprives the brain of oxygen and nutrients, causing brain cells to die. In Hemorrhagic stroke, blood spills into or around the brain, creating swelling and pressure, damaging cells and tissue in the brain.

• Key complication: After a stroke, the affected area of the brain cannot function properly. This can lead to paralysis, speech difficulties, memory loss, and understanding problems. Prompt medical treatment is essential to minimize brain damage and potential complications.

Patient Profile

Demographics:

68, male, retired teacher

History:

• Treated for hypertension and high cholesterol in the past

• Currently on medication for blood pressure (Lisinopril) and cholesterol (Atorvastatin)

• No known allergies

Current Presentation:

• Chief complaint of sudden onset weakness in the right arm

• Experiencing mild difficulty in speaking and slight facial drooping on the right side

• Vital signs: Blood pressure 135/85 mmHg, Pulse 75 bpm, Respiratory rate 18 breaths per minute, Temperature 98.6 F, Oxygen saturation 98% on room air.

Section 1

New Diagnostic Results:

The patient was immediately sent for a CT scan as per the hospital's stroke protocol. Preliminary findings revealed an ischemic stroke on the left side of the brain, which correlates with the patient's right-sided weakness, facial drooping, and speech difficulties. His NIH Stroke Scale score was recorded as a 4, indicating a minor stroke. Laboratory results were also received, showing a slightly elevated cholesterol level at 220 mg/dL and a blood glucose level of 100 mg/dL, which is within the normal range. His INR was 1.0, indicating that his blood was not overly thin which could have increased the risk of a hemorrhagic stroke. EKG showed normal sinus rhythm.

These findings indicate that the patient's current medication regimen for his hypertension and high cholesterol may not be entirely effective. High cholesterol can contribute to the formation of plaques in the arteries, which can lead to ischemic strokes like the one the patient is experiencing. The patient's high blood pressure can also contribute to the development of these plaicues and increase the risk of a stroke. The patient's normal INR and blood glucose levels show that he does not have any additional risk factors for stroke, such as diabetes or blood clotting disorders.

The next step in the patient's journey will be to manage his symptoms and prevent further brain damage. This will likely involve administering clot-busting drugs, assessing the effectiveness of his current medications, and implementing lifestyle changes to reduce his stroke risk factors. Specific clinical data, such as his vital signs, cholesterol level, and NIH Stroke Scale score, will be vital in guiding these interventions.

Section 2

Response to Interventions:

After administering a thrombolytic agent to dissolve the clot and restore blood flow to the brain, the patient's right-sided weakness slightly improved. His facial drooping was also less noticeable, however, his speech remained slurred, albeit comprehensible. The NIH Stroke Scale score was reassessed and found to be reduced to 3, indicating a minor improvement. Additionally, the patient was started on a statin medication to manage his elevated cholesterol level.

The patient was also referred to a dietician who provided dietary recommendations to help manage his cholesterol and hypertension. He was advised to limit saturated and trans fats, reduce sodium intake, and increase fruits, vegetables, and whole grains in his diet. The patient was receptive to these suggested dietary changes, demonstrating motivation to improve his health. Further assessments will continue to monitor his progress and response to these interventions over the coming days. The patient's vital signs remained stable with a blood pressure reading of 130/80 mmHg and heart rate of 72 bpm.

Section 3

New Diagnostic Results:

On the third day of admission, the patient's cholesterol values returned from the lab. The total cholesterol was 260 mg/dL, LDL cholesterol was 170 mg/dL, and HDL cholesterol was 35 mg/dL, indicative of hyperlipidemia. His fasting blood sugar was also slightly elevated at 110 mg/dL.

The healthcare team decided to increase the dosage of his statin medication and added a low-dose aspirin to his treatment plan to reduce the risk of recurrent stroke. The patient was also scheduled for a follow-up appointment with the dietician to discuss a more targeted dietary plan to manage both his elevated cholesterol and blood sugar levels. The team also decided to incorporate a gentle exercise routine, as tolerated by the patient, to aid in weight management and overall cardiovascular health. The patient's vital signs remained stable with a blood pressure reading of 130/80 mmHg and heart rate of 72 bpm.

Section 4

Change in Patient Status:

Over the next couple of days, the patient reported a noticeable improvement in his symptoms. He stated that he felt less dizzy and his balance seemed to have improved. He also reported that his headache was less severe than before. These improvements were likely due to the increased dosage of statin medication and the introduction of low-dose aspirin in his treatment regimen.

Despite these improvements, the patient still struggled with fatigue and had difficulty performing the new exercise routine. His nurse observed him becoming breathless and needing frequent rest periods. His blood pressure readings also fluctuated slightly, with readings ranging between 120/80 mmHg and 140/90 mmHg. His heart rate remained stable at 72 bpm. Given these observations, the healthcare team decided to monitor his blood pressure more closely and adjust his exercise routine to a level that was more comfortable for him. The team also reinforced the importance of adhering to the new dietary plan to help manage his cholesterol and blood sugar levels.

Section 5

New Diagnostic Results:

Several days into the patient's stay, new diagnostic results were received. His lipid panel showed elevated cholesterol levels with total cholesterol at 230 mg/dL, LDL (bad cholesterol) at 160 mg/dL, and HDL (good cholesterol) at 35 mg/dL. His fasting glucose level was also slightly high at 105 mg/dL, indicating a need for further management of his diet and medication.

These results confirmed the healthcare team's suspicion of dyslipidemia and prediabetes, conditions that increased his risk for recurrent strokes. The team decided to adjust his medication regimen, adding metformin to help control his blood sugar levels. They also reinforced the need for dietary changes, especially the reduction of saturated fats and simple carbohydrates. The patient's fatigue and breathlessness were noted and considered in adjusting his physical therapy plan. The plan was to gradually increase his activity level as his strength and endurance improved, with frequent monitoring to avoid overexertion.