A patient in post-acute stroke rehabilitation is experiencing worsening spasticity and uncontrolled hypertension. Which nursing intervention is most appropriate to address these complications and promote the patient's rehabilitation progress?

B) Administer prescribed baclofen and monitor for side effects such as drowsiness and weakness.

A) Increase the frequency of physical therapy sessions to improve muscle tone.

B) Administer prescribed baclofen and monitor for side effects such as drowsiness and weakness.

C) Encourage the patient to perform independent range of motion exercises without supervision.

D) Recommend reducing antihypertensive medication to prevent hypotension during therapy.

A patient in post-acute stroke rehabilitation is experiencing worsening spasticity in the right upper and lower extremities, persistent hypertension, and elevated glucose levels. Which nursing intervention would most effectively address the patient's spasticity to improve participation in physical therapy?

B) Administer prescribed baclofen to reduce muscle spasticity.

A) Increase the frequency of physical therapy sessions to daily.

B) Administer prescribed baclofen to reduce muscle spasticity.

C) Encourage the patient to perform self-directed range of motion exercises independently.

D) Consult with the dietitian to adjust the patient's diabetic meal plan.

A patient with a history of stroke is receiving baclofen for spasticity and has adjustments made to his antihypertensive and diabetic medications. After a week, his muscle tone improves slightly, and his pain levels decrease, but his range of motion remains limited, and he struggles with fine motor tasks. His blood pressure averages 150/95 mmHg, and fasting glucose is 130 mg/dL. What should the nurse prioritize in the patient's care plan to enhance his rehabilitation outcomes?

B) Focus on intensive physical and occupational therapy to improve mobility and fine motor skills.

A) Increase the dosage of baclofen to further reduce spasticity.

B) Focus on intensive physical and occupational therapy to improve mobility and fine motor skills.

C) Collaborate with the dietitian to optimize the patient's nutritional status for better blood glucose control.

D) Consult with the healthcare provider to add an additional antihypertensive medication.

A patient recovering from a stroke is on baclofen for spasticity and has had his antihypertensive and diabetic regimens adjusted. His blood pressure averages 150/95 mmHg, and fasting blood glucose is 130 mg/dL. Given these findings, which nursing intervention should be prioritized to enhance the patient's recovery?

D) Collaborate with the rehabilitation team to intensify physical and occupational therapy sessions to improve functional independence.

A) Increase the frequency of blood pressure monitoring to evaluate the effectiveness of the antihypertensive regimen.

B) Suggest a change in the antihypertensive medication to the healthcare provider to achieve target blood pressure levels.

C) Focus on implementing dietary modifications to better manage the patient's blood glucose levels.

D) Collaborate with the rehabilitation team to intensify physical and occupational therapy sessions to improve functional independence.

A patient with hypertension and diabetes presents with increased fatigue, new-onset headaches, and signs of cognitive decline. Recent labs show elevated BUN and creatinine levels. Which nursing intervention is most appropriate to address the potential renal impairment in this patient?

B) Monitor the patient's blood pressure closely and collaborate with the healthcare team to adjust antihypertensive medications.

A) Encourage the patient to increase their protein intake to support energy levels.

B) Monitor the patient's blood pressure closely and collaborate with the healthcare team to adjust antihypertensive medications.

C) Instruct the patient to restrict fluid intake to prevent fluid overload.

D) Recommend over-the-counter headache medication to manage the new-onset headaches.

A patient with hypertension and diabetes exhibits increased fatigue, headaches, and cognitive decline. Recent diagnostics reveal elevated BUN and creatinine levels alongside high blood pressure and uncontrolled blood glucose. What should be the primary focus of the nursing care plan to address these complications?

B) Collaborate with the nephrologist to adjust antihypertensive and diabetic medications.

A) Increase fluid intake to enhance renal perfusion.

B) Collaborate with the nephrologist to adjust antihypertensive and diabetic medications.

C) Encourage the patient to engage in more physical activity to improve cognition.

D) Administer a diuretic to reduce blood pressure and alleviate headaches.

A patient with chronic kidney disease is undergoing rehabilitation. His treatment plan includes a medication with a renal-protective profile, a low sodium and controlled protein diet, and cognitive exercises for memory enhancement. Which nursing intervention is most important to prioritize to prevent further renal damage?

A) Encouraging the patient to adhere to the low sodium and controlled protein diet

B) Monitoring the patient's blood pressure to ensure it remains stable

C) Assisting the patient with cognitive exercises to enhance memory

D) Ensuring the patient takes his antihypertensive medication as prescribed

A post-stroke patient with mild, bilateral lower extremity edema and occasional shortness of breath during physical therapy is suspected of having fluid overload. The healthcare team has adjusted his diuretic regimen and emphasized a low-sodium diet. As the nurse, which intervention is the most appropriate to evaluate the effectiveness of these changes in managing the patient's fluid status?

B) Monitor the patient's daily weight.

A) Measure the patient's blood pressure every 4 hours.

B) Monitor the patient's daily weight.

C) Check the patient's urine output every shift.

D) Assess the patient's skin turgor daily.

Post acute stroke inpatient rehabilitation - Nursing Case Study

Pathophysiology

• Primary mechanism: Neuroplasticity - After a stroke, the brain's ability to reorganize and form new neural connections is crucial for recovery. Rehabilitation therapies aim to enhance neuroplasticity, promoting the re-learning of lost skills as other parts of the brain compensate for damaged areas.

• Secondary mechanism: Motor recovery - Stroke often impairs muscle strength and coordination. Intensive rehabilitation focuses on repetitive, task-specific exercises to improve motor function and facilitate the reconnection between the brain and muscles, enhancing movement and reducing disability.

• Key complication: Spasticity - As a frequent post-stroke condition, spasticity involves increased muscle tone and stiffness, which can hinder rehabilitation efforts. Addressing spasticity through physical therapy and possibly medication is essential to improve mobility and overall recovery outcomes.

Patient Profile

Demographics:

65-year-old male, retired construction worker

History:

• Key past medical history: Hypertension, Type 2 Diabetes Mellitus, Ischemic Stroke 3 weeks ago

• Current medications: Aspirin 81 mg daily, Lisinopril 20 mg daily, Metformin 500 mg twice daily, Atorvastatin 40 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Weakness on the right side and difficulty speaking

• Key symptoms: Right-sided hemiparesis, expressive aphasia, mild dysphagia, occasional confusion

• Vital signs: Blood pressure 150/95 mmHg, heart rate 105 bpm, respiratory rate 22 breaths per minute, temperature 37.8°C, oxygen saturation 92% on room air

Section 1

New Complications:

During the second week of post-acute stroke rehabilitation, the patient begins to exhibit signs of worsening spasticity in the right upper and lower extremities. This increase in muscle tone and stiffness is making it more difficult for him to participate effectively in physical therapy sessions. The rehabilitation team notes a marked decrease in his range of motion, particularly in the elbow and knee joints, which complicates efforts to improve his functional mobility. Additionally, the patient reports increased discomfort and pain associated with the spasticity, further hindering his participation in therapeutic exercises.

The patient's vital signs show persistent hypertension despite adherence to his medication regimen, with blood pressure readings averaging 160/100 mmHg. This uncontrolled blood pressure may be contributing to the exacerbation of his spasticity and poses a risk for further vascular complications. A review of his laboratory results reveals slightly elevated glucose levels, indicating suboptimal control of his Type 2 Diabetes, which could be impacting his overall recovery and contributing to his current complications.

The rehabilitation team convenes to evaluate the patient's current treatment plan. They consider the introduction of an antispasmodic medication, such as baclofen, to help manage the spasticity, alongside adjustments to his antihypertensive and diabetic regimens. The team also emphasizes the importance of continuing range of motion exercises to prevent contractures and improve joint mobility. These interventions aim to enhance the patient's participation in rehabilitation and improve his quality of life, setting the stage for further recovery and assessment of his response to these new strategies.

Section 2

Response to Interventions:

Following the implementation of the revised treatment plan, the patient begins receiving baclofen to manage his spasticity, alongside adjustments to his antihypertensive and diabetic regimens. Within a week, the rehabilitation team notes some initial improvements. The patient's muscle tone in the right upper and lower extremities shows a slight reduction, which eases the intensity of physical therapy sessions. He reports a mild decrease in pain levels, allowing for better participation in therapeutic exercises. Despite these positive changes, the team observes that his range of motion remains limited, and he continues to experience difficulty with fine motor tasks involving the right hand.

Concurrently, the patient's vital signs indicate a modest improvement in blood pressure control, with readings now averaging 150/95 mmHg. This reduction suggests a partial response to the antihypertensive regimen adjustments, though not yet at the desired target levels for optimal stroke recovery. His glucose levels also show a minor improvement, with fasting blood glucose now at 130 mg/dL, indicating better, but still suboptimal, diabetes management.

The rehabilitation team identifies these changes as an encouraging step forward but recognizes the need for ongoing adjustments and monitoring. They decide to maintain the current pharmacological approach while intensifying the focus on non-pharmacological interventions, such as enhanced physical and occupational therapy, to further improve joint mobility and functional independence. The team remains vigilant for any new complications, understanding that the patient's journey to recovery will require continuous evaluation and adaptation of his care plan.

Section 3

Two weeks into the revised treatment plan, the patient exhibits a change in status that prompts the rehabilitation team to re-evaluate his care strategy. During a routine assessment, he reports increased fatigue and new-onset headaches, which he rates as moderate and persistent throughout the day. The rehabilitation team also notices a subtle decline in his cognitive function; he appears more forgetful and struggles with following multi-step instructions during therapy sessions. Concerned about these developments, the team conducts a series of diagnostic tests to uncover the underlying cause.

New diagnostic results reveal an elevated blood urea nitrogen (BUN) level of 28 mg/dL and a serum creatinine level of 1.8 mg/dL, indicating a potential decline in renal function. These findings are concerning in the context of his antihypertensive and diabetic regimens, which are known to impact kidney health. The patient's blood pressure remains higher than desired, averaging 155/98 mmHg, which may be contributing to the headaches and cognitive symptoms. Additionally, a repeat fasting blood glucose test shows a reading of 142 mg/dL, suggesting that his diabetes is still not adequately controlled.

Faced with these new complications, the rehabilitation team must employ clinical reasoning to adjust the patient's treatment plan. They consider the possibility of medication side effects or interactions contributing to the renal impairment and decide to collaborate with a nephrologist to refine the patient's antihypertensive and diabetic management. Furthermore, they emphasize the importance of closely monitoring the patient's fluid intake and dietary habits to support kidney function. The team also plans to integrate cognitive rehabilitation strategies into his therapy regimen to address the cognitive decline and enhance his overall recovery process. This comprehensive approach aims to stabilize the patient's condition and pave the way for further improvements in his rehabilitation journey.

Section 4

In the days following the adjustment of the patient's treatment plan, the rehabilitation team closely monitors his response to the interventions. The nephrologist recommends modifying his antihypertensive regimen to include a medication with a renal-protective profile, while also adjusting his diuretic dosage to prevent further renal strain. The patient's dietary plan is revised to emphasize low sodium and controlled protein intake, aiming to reduce the burden on his kidneys. As part of the multidisciplinary approach, a dietitian collaborates with the patient to ensure he understands these dietary changes and their importance.

Within a week, the patient shows signs of improvement. His headaches become less frequent and severe, and his blood pressure starts to stabilize, with readings averaging 140/88 mmHg. However, his cognitive symptoms require ongoing attention. The occupational therapist integrates targeted cognitive exercises into his rehabilitation sessions, focusing on memory enhancement and step-by-step task execution. The patient's adherence to the revised diabetic management plan is also reinforced, with regular monitoring of his blood glucose levels, which show a gradual trend towards better control, averaging around 125 mg/dL.

Despite these positive developments, the team remains vigilant for any new complications. They schedule regular follow-ups to assess his renal function, as the initial improvement in lab results — with BUN levels decreasing to 24 mg/dL and serum creatinine stabilizing at 1.5 mg/dL — provides cautious optimism. The team understands that the patient's path to recovery is multifaceted, requiring continuous adjustments and close coordination across disciplines to ensure his successful rehabilitation and long-term health outcomes.

Section 5

A few days after the initial improvements, the patient begins to exhibit signs of a potential new complication. During a routine assessment, the nurse notes that the patient has developed mild, bilateral lower extremity edema and reports experiencing occasional shortness of breath during physical therapy sessions. His vital signs remain stable with a blood pressure reading of 138/86 mmHg and a heart rate of 78 bpm, but his oxygen saturation occasionally dips to 92% during exertion. Given these findings, the team suspects the possibility of fluid overload, which could compromise both his cardiovascular and renal function.

The interdisciplinary team convenes to reassess the patient's condition. They decide to perform additional diagnostic tests, including a chest X-ray and an echocardiogram, to evaluate cardiac function and rule out any signs of heart failure. Blood tests reveal a slight increase in BNP levels, rising to 145 pg/mL, which further suggests the need for careful management of fluid balance. The nephrologist and cardiologist collaborate to adjust the patient's diuretic regimen, reducing the dosage to mitigate renal strain while ensuring effective fluid removal. This adjustment is complemented by the dietitian's reinforcement of a low-sodium diet, aiming to prevent further fluid retention.

The team continues to monitor the patient's response to these interventions. They emphasize the importance of daily weight monitoring, checking for any significant fluctuations that could indicate worsening fluid retention. The patient's care plan is adjusted to include more frequent respiratory assessments and shorter, more frequent physical therapy sessions to minimize exertional dyspnea. This careful coordination across disciplines highlights the complexity of managing multiple comorbidities in a post-stroke patient and underscores the need for ongoing vigilance to optimize his rehabilitation outcomes.