A patient admitted with an ischemic stroke shows signs of right-sided weakness and speech difficulties. The CT scan confirms an ischemic stroke in the left middle cerebral artery territory. Despite initial antihypertensive treatment, the patient's blood pressure remains at 190/110 mmHg, and oxygen saturation is 88% on room air. Which nursing intervention should be prioritized to prevent further complications?

B) Initiating supplemental oxygen therapy to improve oxygen saturation levels.

A) Administering prescribed antihypertensive medication to lower blood pressure.

B) Initiating supplemental oxygen therapy to improve oxygen saturation levels.

C) Conducting frequent neurologic assessments to monitor for signs of increased intracranial pressure.

D) Consulting a speech therapist for a comprehensive swallow evaluation.

A patient with an ischemic stroke confirmed by CT scan is at risk for hemorrhagic transformation due to uncontrolled hypertension. The patient's blood pressure is currently 190/110 mmHg, and there are concerns regarding aspiration pneumonia due to impaired swallowing reflexes. What is the most appropriate initial nursing intervention to address these complications and optimize patient outcomes?

B) Elevate the head of the bed to 30 degrees and provide supplemental oxygen to improve oxygen saturation.

A) Administer an antihypertensive medication to lower the blood pressure immediately.

B) Elevate the head of the bed to 30 degrees and provide supplemental oxygen to improve oxygen saturation.

C) Consult with the healthcare provider to discuss the immediate administration of tPA despite the current blood pressure.

D) Initiate enteral feeding via a nasogastric tube to prevent malnutrition due to dysphagia.

A patient with a history of stroke is experiencing persistent hypertension, elevated WBC counts, and dysphagia. Which intervention should the nurse prioritize to prevent further complications?

C) Monitor blood pressure closely and adjust antihypertensive medications as prescribed.

A) Administer broad-spectrum antibiotics to treat the suspected infection.

B) Implement a modified diet to reduce the risk of aspiration.

C) Monitor blood pressure closely and adjust antihypertensive medications as prescribed.

D) Encourage the patient to perform deep breathing exercises to improve oxygen saturation.

A patient with a recent stroke is being monitored for potential complications. The healthcare team is concerned about the risk of aspiration pneumonia due to the patient's severe dysphagia. Which of the following nursing interventions is most appropriate to help prevent aspiration pneumonia in this patient?

B) Position the patient upright at a 90-degree angle during and after meals.

A) Encourage the patient to drink fluids frequently to maintain hydration.

B) Position the patient upright at a 90-degree angle during and after meals.

C) Advise the patient to use a straw for all liquid intake to control the flow.

D) Limit the patient's fluid intake to prevent aspiration.

A patient with a recent stroke is exhibiting increased confusion, agitation, and new-onset right-sided weakness. Vital signs show a blood pressure of 185/105 mmHg despite antihypertensive therapy. Which nursing intervention is the priority to address the patient's neurological status and prevent further complications?

B) Elevate the head of the bed to 30 degrees to reduce intracranial pressure.

A) Administer a rapid bolus of intravenous fluids to improve cerebral perfusion.

B) Elevate the head of the bed to 30 degrees to reduce intracranial pressure.

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

D) Encourage deep breathing exercises to improve oxygenation and reduce confusion.

A patient with a recent stroke is now experiencing increased confusion, agitation, and right-sided weakness. The blood pressure is 185/105 mmHg, and oxygen saturation occasionally dips to 88% despite supplemental oxygen. Based on these findings, what is the nurse's priority intervention?

B) Increase the frequency of neurological assessments to monitor for further stroke progression.

A) Administer a higher dose of antihypertensive medication to urgently lower blood pressure.

B) Increase the frequency of neurological assessments to monitor for further stroke progression.

C) Initiate high-flow oxygen therapy to improve oxygen saturation levels.

D) Position the patient upright and encourage deep breathing exercises to address possible atelectasis.

A patient with an ischemic stroke in the left hemisphere is showing signs of neurological deterioration and mild cerebral edema. Concurrently, respiratory status is a concern due to intermittent hypoxia and partial resolution of right lower lobe consolidation. As a nurse, which of the following actions is most appropriate to prioritize for this patient?

A) Increase the frequency of neurological assessments to monitor for changes.

B) Administer diuretics to reduce cerebral edema immediately.

C) Escalate respiratory support by initiating non-invasive ventilation.

D) Consult with the nutrition team to adjust the patient's caloric intake to support healing.

A patient with an ischemic stroke and respiratory complications is being monitored closely. Which nursing intervention is most critical to prioritize to prevent further neurological deterioration?

B) Increasing frequency of neurological assessments to detect early signs of changes in the patient's condition.

A) Administering prescribed antihypertensive medication to maintain blood pressure within target range.

B) Increasing frequency of neurological assessments to detect early signs of changes in the patient's condition.

C) Encouraging deep breathing exercises to improve respiratory function and prevent hypoxia.

D) Collaborating with the dietitian to ensure adequate nutritional intake to support recovery.

A patient with new-onset expressive aphasia and right-sided spasticity is experiencing consistently elevated blood pressure of 160/95 mmHg. Which nursing intervention is a priority to prevent further neurological compromise?

A) Administer prescribed antihypertensive medication promptly.

B) Increase supplemental oxygen to 4 liters per minute.

C) Encourage the patient to perform passive range-of-motion exercises.

D) Elevate the head of the bed to 45 degrees.

A patient with new-onset expressive aphasia and increased right-sided spasticity has a blood pressure of 160/95 mmHg and mild leukocytosis. Given these findings, what is the most appropriate nursing intervention to prioritize for this patient?

A) Administer antihypertensive medication to reduce blood pressure and prevent further cerebral damage.

B) Provide passive range of motion exercises to the right side to decrease spasticity and prevent contractures.

C) Arrange for a speech therapy evaluation to address expressive aphasia and improve communication.

D) Monitor for signs of infection due to mild leukocytosis and consult with the healthcare provider.

stroke - Nursing Case Study

Pathophysiology

• Primary mechanism: Ischemic stroke occurs when a blood clot obstructs a cerebral artery, leading to reduced blood flow and oxygen deprivation in the brain tissue, causing cell death.

• Secondary mechanism: Hemorrhagic stroke results from the rupture of a blood vessel in the brain, leading to bleeding that increases intracranial pressure and causes further damage to brain tissue.

• Key complication: Both types can lead to neurological deficits, such as paralysis or speech difficulties, due to the affected brain areas losing their function.

Patient Profile

Demographics:

65-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, Type 2 Diabetes, Hyperlipidemia

• Current medications: Lisinopril, Metformin, Atorvastatin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Sudden onset of weakness on the right side of the body

• Key symptoms: Slurred speech, difficulty swallowing, mild confusion, headache, and dizziness

• Vital signs: Blood pressure 180/105 mmHg, heart rate 95 bpm, respiratory rate 22 breaths per minute, temperature 37.5°C, oxygen saturation 92% on room air

Section 1

Following the initial presentation and suspected ischemic stroke, the patient was admitted to the hospital for further evaluation and management. An immediate CT scan was performed to differentiate between ischemic and hemorrhagic stroke. The CT scan confirmed an ischemic stroke, evidenced by an area of hypodensity in the left middle cerebral artery territory. This finding correlated with the patient's right-sided weakness and speech difficulties. Given the time frame since the onset of symptoms, the medical team considered the administration of tissue plasminogen activator (tPA) to dissolve the clot and restore blood flow. However, the elevated blood pressure posed a significant risk, as aggressive management of hypertension would be necessary to safely administer tPA.

As the patient's condition was monitored, new complications arose. The patient's blood pressure remained high despite initial antihypertensive treatment, reaching 190/110 mmHg. This hypertension increased the risk of hemorrhagic transformation. Additionally, the patient's oxygen saturation decreased to 88% on room air, indicating potential respiratory compromise, potentially due to aspiration risks associated with difficulty swallowing. A bedside swallow evaluation suggested impaired swallowing reflexes, raising concerns for aspiration pneumonia. The patient's confusion also persisted, necessitating close neurologic monitoring for any signs of deterioration or increased intracranial pressure.

These developments required the healthcare team to reassess their approach. The risk of hemorrhagic transformation prompted the need for careful blood pressure management while balancing the potential benefits of thrombolytic therapy. The patient was placed on supplemental oxygen to improve saturation levels, and a speech therapist was consulted for further evaluation and management of dysphagia. The nursing team played a crucial role in monitoring vital signs, neurologic status, and respiratory function, while also ensuring the patient remained safe from potential complications such as aspiration. These evolving clinical situations demanded continuous reassessment and adaptation of the treatment plan to optimize the patient's outcomes.

Section 2

As the healthcare team continued to monitor the patient's condition, new diagnostic results provided further insight into the evolving clinical picture. A repeat CT scan was performed 24 hours after admission to assess for any changes in the cerebral vasculature or evidence of hemorrhagic transformation. The scan revealed stable findings with no evidence of bleeding, providing some reassurance regarding the immediate risk of hemorrhagic transformation. However, the patient's persistent hypertension remained a concern, as it could still precipitate complications.

Concurrently, laboratory tests revealed elevated white blood cell counts and C-reactive protein levels, suggestive of an inflammatory process, likely secondary to aspiration pneumonia. Blood cultures were sent to identify any potential pathogens, and broad-spectrum antibiotics were initiated empirically to address the suspected infection. The patient’s oxygen saturation improved to 92% with supplemental oxygen, yet the risk of further respiratory compromise remained due to ongoing dysphagia.

In response to these findings, the medical team intensified their focus on managing the patient's blood pressure with a more aggressive but controlled regimen of antihypertensives, aiming to maintain levels below 180/100 mmHg. The speech therapist’s ongoing assessment confirmed severe dysphagia, necessitating a modified diet and potential consideration for temporary enteral feeding to mitigate the risk of aspiration. The interdisciplinary team’s coordinated efforts were essential in addressing the multifaceted complications, ensuring vigilant monitoring, and adapting the treatment plan to stabilize the patient's condition and improve the overall prognosis.

Section 3

As the medical team continued their efforts to stabilize the patient, new complications emerged, demanding swift clinical reasoning and intervention. The patient began exhibiting increased confusion and agitation, prompting a thorough neurological assessment. Vital signs were closely monitored, revealing a blood pressure of 185/105 mmHg despite ongoing antihypertensive therapy, raising concerns about cerebral perfusion and potential further ischemic damage. Neurological examination showed a decrease in responsiveness and new-onset right-sided weakness, indicating possible progression of the stroke. In response, an urgent MRI was ordered to evaluate for any new ischemic areas or complications such as cerebral edema.

Simultaneously, the patient’s respiratory status showed signs of decline. Despite supplemental oxygen, oxygen saturation occasionally dipped to 88%, suggesting worsening pulmonary function. Auscultation of the lungs revealed diminished breath sounds and coarse crackles in the right lower lobe, consistent with atelectasis or consolidation, aligning with the initial suspicion of aspiration pneumonia. Repeat laboratory tests confirmed persistent leukocytosis and elevated inflammatory markers, but blood cultures remained pending.

In light of these findings, the healthcare team adjusted the treatment plan. They intensified respiratory support with increased frequency of chest physiotherapy and optimized antibiotic therapy based on evolving clinical evidence. Neurological management focused on carefully balancing blood pressure control to prevent further cerebral damage while ensuring adequate perfusion. The interdisciplinary team also prioritized reassessing the patient’s nutritional status and the potential need for enteral feeding, recognizing the critical role of nutrition in recovery. These coordinated efforts aimed to address both the immediate complications and the underlying conditions contributing to the patient's complex clinical picture, setting the stage for continued monitoring and potential reevaluation of the treatment strategy.

Section 4

As the clinical team continued to address the patient's multifaceted condition, the new MRI results provided crucial insights into the neurological status. The imaging revealed an extension of the ischemic area in the left hemisphere, with evidence of mild cerebral edema. These findings corroborated the observed neurological deterioration, including the decreased responsiveness and right-sided weakness. The MRI also showed signs of early subcortical involvement, which could explain the increased confusion and agitation. This necessitated a delicate balance in managing the patient's blood pressure to optimize cerebral perfusion while minimizing the risk of exacerbating the edema.

In parallel, the patient's respiratory status remained a significant concern. The intensified chest physiotherapy and adjusted antibiotic regimen began showing initial signs of stabilization. Repeat chest X-rays indicated partial resolution of the right lower lobe consolidation, consistent with improving atelectasis or infection resolution. However, intermittent hypoxia persisted, and the patient required close monitoring with the possibility of escalating respiratory support if necessary. The interdisciplinary team discussed the need for further diagnostic testing, such as a sputum culture, to tailor antibiotic therapy more precisely, considering the pending blood culture results.

These developments emphasized the critical need for an integrated approach, reinforcing the importance of regular reevaluation of the patient's overall condition. The team recognized that ongoing adjustments to the treatment plan were essential to address the evolving complications effectively. By coordinating efforts across specialties, including neurology, pulmonology, and nutrition, the healthcare team aimed to stabilize the current situation while anticipating potential future challenges, thereby ensuring a comprehensive and adaptable care strategy for the patient.

Section 5

Change in Patient Status:

In the following days, the patient's condition exhibited a notable shift, prompting an immediate reassessment by the clinical team. The patient developed new-onset expressive aphasia, a concerning sign indicating further compromise in the left hemisphere. Neurological observations revealed an increase in right-sided spasticity, further complicating efforts to manage mobility and prevent contractures. Vital signs showed a hypertensive trend, with blood pressure readings consistently elevated at 160/95 mmHg, heightening concerns about cerebral perfusion pressure and the potential impact on the ischemic area and surrounding edema.

Concurrently, the respiratory status exhibited subtle improvements. Oxygen saturation levels stabilized at around 94% on 2 liters of supplemental oxygen, and the patient demonstrated a more effective cough, aiding in the clearance of secretions. Despite these positive respiratory signs, the patient's overall condition remained precarious due to the neurological complications. Blood tests revealed a mild leukocytosis, with a white blood cell count of 11,500/mm³, which, combined with the respiratory symptoms, suggested ongoing inflammatory processes.

These developments necessitated a recalibration of the care strategy. The team deliberated on the need for aggressive blood pressure management to protect the brain from further ischemic damage while avoiding exacerbation of cerebral edema. Neurological consultation was sought to evaluate the potential benefits of initiating corticosteroids to address the cerebral edema, weighing the risks of infection exacerbation. In light of the patient's fluctuating status, the clinical team emphasized the importance of continuous monitoring and timely interventions, ensuring each specialty's insights contributed to a cohesive and dynamic treatment approach.