A patient who has recently experienced a stroke presents with worsening right-sided weakness and increased difficulty with speech. Upon assessment, the patient demonstrates right-sided hemiparesis with muscle strength graded at 2/5 and exhibits slurred speech. The patient's fasting blood glucose level is 162 mg/dL, and blood pressure is 158/94 mmHg. What is the priority nursing intervention to address the potential complications in this patient?

C) Monitor neurological status closely and prepare the patient for an urgent CT scan of the brain.

A) Educate the patient on the importance of adhering to antihypertensive and diabetic medication regimens.

B) Initiate a referral to physical therapy to improve muscle strength and mobility.

C) Monitor neurological status closely and prepare the patient for an urgent CT scan of the brain.

D) Provide dietary counseling to help manage diabetes and hypertension.

A patient with a recent history of stroke presents with worsening right-sided weakness and speech difficulties. Laboratory results show hyperglycemia and uncontrolled hypertension. Given these findings, what is the nurse's priority action to address the potential risk for further neurological complications?

C) Notify the healthcare provider immediately and prepare the patient for an urgent CT scan of the brain.

A) Educate the patient on a low-sodium, diabetic-friendly diet to improve blood pressure and glucose control.

B) Administer prescribed antihypertensive medication and reassess blood pressure in one hour.

C) Notify the healthcare provider immediately and prepare the patient for an urgent CT scan of the brain.

D) Initiate a physical therapy consult to begin rehabilitation for motor function improvement.

A patient with a recent lacunar infarct in the left basal ganglia is exhibiting right-sided weakness and speech difficulties. The healthcare team has adjusted the patient's diabetes and hypertension management. As the nurse, which immediate intervention should be prioritized to address the patient's current condition?

B) Begin physical therapy to improve right-sided strength and coordination.

A) Initiate a high-protein diet to promote muscle recovery.

B) Begin physical therapy to improve right-sided strength and coordination.

C) Administer an increased dose of antihypertensive medication to lower blood pressure immediately.

D) Schedule a follow-up CT scan to monitor the progression of the infarct.

A patient with a recent lacunar infarct in the left basal ganglia presents with right-sided weakness and speech difficulties. The clinical team is focusing on managing his hypertension and diabetes to prevent further vascular events. Which of the following nursing interventions is most appropriate to prioritize in this patient's care plan?

D) Schedule regular blood pressure and blood glucose monitoring.

A) Educate the patient on the importance of adhering to a low-sodium diet.

B) Initiate a regimen of daily physical therapy exercises to improve right-sided muscle strength.

C) Collaborate with the dietitian to create a diabetic meal plan.

D) Schedule regular blood pressure and blood glucose monitoring.

A patient in a rehabilitation program is experiencing dysphagia with an increased risk of aspiration. What is the most appropriate initial nursing intervention to minimize this risk during meals?

B) Position the patient in a high Fowler's position during meals.

A) Encourage the patient to drink thin liquids to clear food particles.

B) Position the patient in a high Fowler's position during meals.

C) Suggest the patient take large bites to expedite meal completion.

D) Recommend a fast-paced eating schedule to prevent fatigue.

A patient undergoing an intensified rehabilitation program for right-sided weakness and speech difficulties has developed dysphagia with an increased risk of aspiration. Which nursing intervention should be prioritized to address the patient's nutritional needs and prevent complications?

B) Position the patient in a high Fowler's position during meals.

A) Encourage the patient to drink thin liquids to maintain hydration.

B) Position the patient in a high Fowler's position during meals.

C) Provide large, frequent meals to ensure adequate calorie intake.

D) Instruct the patient to perform chin tuck exercises during swallowing.

A patient with a history of stroke and multiple comorbidities, including hypertension and diabetes, presents with a persistent dry cough and occasional oxygen saturation dips to 92% on room air. The videofluoroscopic swallow study confirms aspiration of thin liquids. What is the priority nursing intervention to prevent complications in this patient?

B) Educate the patient on the importance of thickened liquids and provide a demonstration.

A) Encourage the patient to drink more fluids to stay hydrated.

B) Educate the patient on the importance of thickened liquids and provide a demonstration.

C) Monitor the patient's blood glucose levels closely and adjust diet as needed.

D) Administer prescribed antihypertensive medication to maintain blood pressure within target range.

A patient recovering from a stroke is experiencing persistent dry cough and occasional dips in oxygen saturation to 92% on room air. A videofluoroscopic swallow study shows aspiration of thin liquids. What is the most appropriate nursing action to address these findings?

B) Implement the use of thickened liquids and a mechanical soft diet as recommended by the speech therapist.

A) Encourage the patient to take small sips of water to keep the throat moist.

B) Implement the use of thickened liquids and a mechanical soft diet as recommended by the speech therapist.

C) Position the patient flat in bed to rest after meals to prevent fatigue.

D) Administer a bronchodilator to improve respiratory function.

A patient recovering from recent dietary and medication adjustments reports mild abdominal discomfort and occasional nausea after starting a GLP-1 receptor agonist. Which nursing intervention is most appropriate to help alleviate these gastrointestinal side effects?

A) Encourage the patient to eat small, frequent meals throughout the day

B) Advise the patient to lie down immediately after taking the medication

C) Suggest the patient drink a glass of water before medication administration

D) Recommend the patient skip doses if symptoms occur

A patient recovering from a recent illness is on a GLP-1 receptor agonist and a calcium channel blocker. The patient reports mild abdominal discomfort and occasional nausea, suspected to be related to the GLP-1 receptor agonist. The endocrinologist has adjusted the dosing schedule. Which nursing action is most important to address the patient's current symptoms and medication management concerns?

A) Educate the patient on proper administration techniques for the GLP-1 receptor agonist to minimize side effects.

B) Encourage the patient to increase fluid intake to alleviate abdominal discomfort.

C) Advise the patient to take the calcium channel blocker with meals to reduce gastrointestinal distress.

D) Suggest the patient keep a symptom diary to identify potential triggers and patterns of discomfort.

post stroke complications - Nursing Case Study

Pathophysiology

• Primary mechanism: Ischemic injury leads to neuronal cell death due to oxygen and glucose deprivation, initiating an inflammatory cascade that exacerbates brain tissue damage.

• Secondary mechanism: Disrupted blood-brain barrier permits infiltration of inflammatory cells and molecules, promoting edema and further neuronal injury.

• Key complication: These processes can result in increased intracranial pressure, which may cause additional neurological deficits and complicate recovery efforts.

Patient Profile

Demographics:

68, male, retired school teacher

History:

• Key past medical history: Ischemic stroke 6 months ago, hypertension, type 2 diabetes

• Current medications: Aspirin 81 mg daily, Lisinopril 20 mg daily, Metformin 500 mg twice daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Difficulty with coordination and speech

• Key symptoms: Right-sided weakness, slurred speech, mild facial droop, occasional headaches

• Vital signs: Blood pressure 154/92 mmHg, heart rate 88 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, oxygen saturation 94% on room air

Section 1

New Complications:

During the follow-up appointment, the patient presents with worsening right-sided weakness and increased difficulty with speech, raising concerns about further complications post-stroke. Upon assessment, the neurological examination reveals an exacerbation of the right-sided hemiparesis, characterized by decreased muscle strength graded 2/5 in the right upper and lower extremities. The patient exhibits increased slurred speech and an inability to articulate words clearly, suggesting possible aphasia progression. Additionally, there is a noticeable decline in his ability to perform daily activities independently, such as dressing and using utensils.

Recent laboratory results reveal hyperglycemia with a fasting blood glucose level of 162 mg/dL, indicating suboptimal control of his type 2 diabetes, which could be contributing to endothelial dysfunction and further vascular complications. The patient's blood pressure remains elevated at 158/94 mmHg despite adherence to antihypertensive therapy, highlighting the need for reassessment of his current medication regimen and potential lifestyle modifications. The combination of uncontrolled hypertension and diabetes poses a risk for recurrent cerebrovascular events, and the possibility of a silent lacunar infarct, which could explain the new neurological deficits, cannot be ruled out without further imaging.

Given these findings, it is crucial to consider the potential development of post-stroke complications such as increased intracranial pressure or a new ischemic event. The clinical team decides to order an urgent CT scan of the brain to evaluate for any acute changes in intracranial structures. Meanwhile, the patient is monitored closely for signs of neurological deterioration, and a multidisciplinary approach involving neurology, endocrinology, and physical therapy is initiated to address the complex interplay of factors contributing to his current status. This comprehensive evaluation and intervention plan aim to stabilize the patient’s condition and prevent further decline, emphasizing the importance of coordinated care in managing chronic post-stroke complications.

Section 2

New Diagnostic Results:

Following the urgent CT scan, the imaging results reveal a new lacunar infarct in the left basal ganglia, correlating with the patient's exacerbated right-sided weakness and speech difficulties. This finding confirms the suspicion of a recurrent ischemic event, likely exacerbated by the patient's poorly controlled hypertension and diabetes. The infarct, although small, significantly impacts the delicate neural networks responsible for motor coordination and speech articulation, explaining the new neurological deficits observed during the examination.

In light of these diagnostic results, the clinical team focuses on refining the patient’s management plan. First, they address the suboptimal control of his diabetes by consulting endocrinology to adjust his insulin regimen and reinforce dietary modifications aimed at stabilizing blood glucose levels. Additionally, the patient's antihypertensive therapy is reassessed, with considerations for adding a calcium channel blocker to better manage his elevated blood pressure. The integration of these interventions is critical in reducing the risk of further vascular events and promoting neural recovery.

The confirmation of a new lacunar infarct underscores the urgency of a comprehensive rehabilitation program, tailored to the patient's current capabilities and aimed at enhancing his functional independence. Physical therapy sessions are intensified, focusing on strengthening the right-sided musculature and improving coordination. Speech therapy is also prioritized to address the deteriorating language skills, employing strategies to aid in clearer articulation and communication. This multidisciplinary approach not only targets the immediate complications but also proactively supports the patient's long-term recovery and quality of life, setting the stage for ongoing monitoring and adjustment of care as necessary.

Section 3

As the patient undergoes the newly intensified rehabilitation program, an initial assessment by the physical and speech therapists highlights some promising yet complex findings. During physical therapy sessions, the patient demonstrates slight improvements in his right-sided strength, managing to lift his right arm halfway with assistance. However, his gait remains unsteady, necessitating the use of a walker for safety. The patient's blood pressure remains a concern, with readings consistently hovering around 160/95 mmHg despite the adjusted antihypertensive regimen, indicating that further pharmacological adjustments may be necessary to achieve optimal control. Laboratory results show a moderately elevated HbA1c of 8.2%, suggesting that tighter glycemic control is still needed to mitigate the risk of further complications.

In speech therapy, the patient exhibits modest progress with articulation exercises, showing improved clarity with single syllable words but continuing to struggle with fluency in longer phrases. His speech is slow and labored, and he exhibits signs of frustration, which affects his overall mood and motivation. This observation prompts the clinical team to consider a holistic approach, integrating psychological support to address underlying emotional challenges that may impede his rehabilitation progress.

Despite the initial improvements in therapy sessions, a new complication emerges. The patient begins to exhibit signs of dysphagia, evidenced by coughing and choking during meals. A bedside swallow evaluation by the speech therapist reveals aspiration risk, prompting a referral for a formal videofluoroscopic swallow study. This development highlights the need for a reassessment of the patient's nutritional plan, including possible modifications to food consistency and the introduction of swallowing exercises to prevent further respiratory complications. The team remains vigilant, closely monitoring the patient's respiratory status and adjusting the care plan to ensure comprehensive support as he navigates these new challenges on his recovery journey.

Section 4

In the ensuing weeks, the patient's condition presents a mixed picture of progress and new challenges. During a follow-up with the interdisciplinary team, the patient is noted to have developed a persistent dry cough, and his oxygen saturation occasionally dips to 92% on room air. These respiratory changes prompt further investigation, as they could be indicative of silent aspiration or early pulmonary complications secondary to his dysphagia. The videofluoroscopic swallow study confirms that the patient is aspirating thin liquids, necessitating immediate modifications to his diet. The speech therapist recommends thickened liquids and a mechanical soft diet to minimize the risk of aspiration pneumonia. The team collaborates with the dietitian to ensure adequate caloric intake while adhering to the new dietary restrictions.

Concurrently, the patient's blood pressure remains elevated, with readings now fluctuating between 165/100 mmHg, pointing to the need for a reevaluation of his antihypertensive regimen. The cardiologist is consulted to optimize his medication plan, introducing a calcium channel blocker to complement his current therapy. This adjustment aims to achieve tighter blood pressure control, which is crucial in reducing the risk of recurrent strokes. The patient's HbA1c remains a concern at 8.0%, despite dietary interventions and oral hypoglycemic agents. The endocrinologist suggests the addition of a GLP-1 receptor agonist to his regimen, hoping to improve glycemic control and subsequently decrease the risk of vascular complications.

These developments underscore the complexity of managing post-stroke rehabilitation in a patient with multiple comorbidities. The clinical team emphasizes the importance of regular monitoring, patient education, and a tailored, multidisciplinary approach to address the evolving needs of the patient. As they implement these changes, the team remains hopeful yet cautious, knowing that vigilant assessment and timely intervention are crucial to navigating the patient's recovery journey successfully.

Section 5

As the patient continues his recovery journey, the team closely monitors his response to the dietary and medication adjustments. Within two weeks of implementing the thickened liquids and mechanical soft diet, the patient reports fewer coughing episodes during meals, suggesting a positive response to the dietary modifications. However, a new challenge arises: the patient begins to experience mild abdominal discomfort and occasional nausea, which the team suspects may be related to the introduction of the GLP-1 receptor agonist. To address these gastrointestinal side effects, the endocrinologist adjusts the dosing schedule, dividing the dose throughout the day to improve tolerability.

Simultaneously, the patient's blood pressure begins to show signs of improvement, with readings now averaging 150/90 mmHg, indicating a favorable initial response to the addition of the calcium channel blocker. The patient reports feeling less fatigued, and his energy levels appear to be gradually increasing. Despite these positive signs, the team remains vigilant, aware that fluctuations in blood pressure can still pose a risk for further complications. They emphasize the importance of medication adherence and regular blood pressure monitoring to the patient and his family.

Meanwhile, the patient's HbA1c has decreased slightly to 7.6%, marking a step towards better glycemic control. The team is encouraged by this progress but remains focused on achieving even tighter control to reduce long-term vascular risks. During a follow-up visit, the patient expresses concerns about the complexity of his medication regimen and the challenges of managing his dietary restrictions. In response, the team organizes a medication management session with the pharmacist and a nutritional counseling session with the dietitian to support the patient and his family in navigating these complexities. Through these coordinated efforts, the interdisciplinary team continues to work towards optimizing the patient's recovery while anticipating and addressing potential complications.