A patient is admitted with a significant cerebral edema following an ischemic stroke and now presents with increased intracranial pressure (ICP). Which nursing intervention is most appropriate to help decrease ICP in this patient?

B) Administer a hypertonic saline solution as prescribed to reduce cerebral edema.

A) Place the patient in a Trendelenburg position to promote cerebral perfusion.

B) Administer a hypertonic saline solution as prescribed to reduce cerebral edema.

C) Restrict fluid intake to prevent fluid overload and decrease ICP.

D) Encourage the patient to perform Valsalva maneuvers to equalize pressure.

A patient admitted with an ischemic stroke is now showing signs of increased intracranial pressure (ICP) with cerebral edema. The patient's blood pressure is 190/115 mmHg, and blood glucose is 250 mg/dL. Which of the following nursing interventions should be prioritized to address the patient's neurological deterioration?

A) Administer mannitol as prescribed to reduce cerebral edema.

B) Increase the dosage of antihypertensive medication to lower blood pressure.

C) Initiate insulin therapy to stabilize blood glucose levels.

D) Obtain a blood culture to check for possible infection.

A patient with a recent stroke is experiencing increased confusion and agitation. Diagnostic tests have ruled out infectious causes, seizure activity, and bacteremia. Which nursing intervention is most appropriate to address the patient's current condition?

B) Implement measures to reduce cerebral edema

A) Administer prescribed antipyretics to reduce fever

B) Implement measures to reduce cerebral edema

C) Initiate seizure precautions immediately

D) Administer broad-spectrum antibiotics as a precaution

A patient with a recent stroke is experiencing confusion and agitation. Diagnostic tests ruled out infections and seizures, and the focus is now on managing cerebral edema. What is the most appropriate nursing intervention to help manage this patient's condition?

C) Elevate the head of the bed to 30 degrees to promote venous drainage

A) Administer prescribed corticosteroids to reduce cerebral edema

B) Encourage the patient to increase fluid intake to maintain hydration

C) Elevate the head of the bed to 30 degrees to promote venous drainage

D) Apply hot packs to the patient's head to reduce intracranial pressure

A patient following a stroke exhibits a fever of 38.2°C, an increased heart rate, and fluctuating blood pressure. Despite no bacterial growth in blood cultures, the medical team considers non-infectious causes of fever. The patient's motor weakness has worsened, and a CT scan shows mild progression of edema. Which nursing intervention is most appropriate to address both the fever and potential cerebral edema?

B) Initiate a cooling blanket and elevate the head of the bed to 30 degrees.

A) Administer scheduled antipyretics and increase intravenous fluid rate.

B) Initiate a cooling blanket and elevate the head of the bed to 30 degrees.

C) Administer low-dose corticosteroids and restrict oral fluids.

D) Encourage ambulation to improve circulation and apply warm compresses to decrease fever.

A patient who recently experienced a stroke is now showing signs of mild fever, increased blood pressure, and worsening motor weakness on the left side. The medical team has initiated a low-dose corticosteroid regimen to address cerebral edema. As a nurse, which of the following actions is most appropriate to prioritize in the care plan to address the patient's current condition?

C) Perform frequent neurological assessments to detect changes.

A) Administer prescribed antipyretics to reduce the fever.

B) Monitor fluid intake and output to prevent fluid overload.

C) Perform frequent neurological assessments to detect changes.

D) Educate the patient and family about stroke rehabilitation.

A patient with a history of recent fluid overload is now experiencing increased respiratory effort, decreased oxygen saturation, and mild metabolic acidosis. Which of the following nursing interventions is the most appropriate to address the patient's current respiratory status?

B) Restrict fluid intake and administer diuretics as prescribed to reduce fluid overload.

A) Increase the rate of intravenous fluid administration to improve circulation.

B) Restrict fluid intake and administer diuretics as prescribed to reduce fluid overload.

C) Discontinue oxygen therapy to prevent potential toxicity from supplemental oxygen.

D) Encourage the patient to perform deep breathing exercises to improve lung function.

A patient with a suspected fluid overload presents with increased respiratory effort, decreased oxygen saturation, and faint crackles on lung auscultation. The nurse notes mild metabolic acidosis and a slight hyponatremia on laboratory tests. Which of the following interventions should the nurse prioritize to address the patient's current respiratory and fluid status while ensuring safety?

B) Elevate the head of the bed and monitor oxygen saturation closely.

A) Increase the rate of intravenous fluid administration to maintain blood pressure.

B) Elevate the head of the bed and monitor oxygen saturation closely.

C) Administer a high-dose diuretic and withhold further fluids.

D) Initiate continuous positive airway pressure (CPAP) therapy immediately.

A patient has developed pneumonia characterized by a productive cough with yellowish sputum, low-grade fever, and increased respiratory rate. The interdisciplinary team has started broad-spectrum antibiotics while awaiting sensitivity results. Which nursing intervention is most appropriate to help manage the patient's respiratory status at this time?

A) Encourage the patient to perform deep breathing and coughing exercises regularly.

B) Restrict fluid intake to reduce pulmonary congestion.

C) Position the patient in a supine position to promote comfort.

D) Administer oxygen via nasal cannula to maintain oxygen saturation levels above 95%.

A patient with a recent diagnosis of pneumonia shows bilateral infiltrates on a chest X-ray and is started on broad-spectrum antibiotics. Considering the patient's decreased immune function and the risk of multi-drug resistant organisms, which nursing intervention is most critical at this time?

C) Implementing strict infection control measures to prevent cross-contamination

A) Encouraging the patient to increase fluid intake to thin secretions

B) Scheduling regular deep breathing exercises to improve lung expansion

C) Implementing strict infection control measures to prevent cross-contamination

D) Monitoring the patient’s neurological status for signs of increased intracranial pressure

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 supply to brain tissue, causing cell death and loss of neurological function.

• Secondary mechanism: Hemorrhagic stroke results from the rupture of a blood vessel in the brain, leading to bleeding, increased intracranial pressure, and subsequent damage to neural tissue.

• Key complication: Both types of stroke can lead to cerebral edema, exacerbating brain injury and increasing the risk of long-term disability or death due to further compression of brain structures.

Patient Profile

Demographics:

67-year-old male, retired construction worker

History:

• Key past medical history

Hypertension, Type 2 Diabetes, Hyperlipidemia

• Current medications

Lisinopril, Metformin, Atorvastatin, Aspirin

• Allergies

Penicillin

Current Presentation:

• Chief complaint

Sudden weakness on the right side of the body

• Key symptoms

Slurred speech, facial droop on the right side, difficulty walking, headache

• Vital signs

Blood pressure: 185/110 mmHg, Heart rate: 98 bpm, Respiratory rate: 22 breaths per minute, Temperature: 37.8°C (100°F), Oxygen saturation: 92% on room air

Section 1

New Complications:

As the medical team continues to monitor the patient, new complications arise two days post-admission. The patient's neurological status deteriorates, evidenced by increased confusion, agitation, and a marked decrease in responsiveness to verbal stimuli. A repeat CT scan of the brain reveals significant cerebral edema, particularly in the region affected by the ischemic stroke, with a midline shift indicating increased intracranial pressure (ICP). This development suggests a worsening of the patient's condition and an urgent need for intervention to prevent further neurological compromise.

Laboratory results show a rising white blood cell count, currently at 15,000/mm³, suggestive of a possible infection or inflammatory response. The patient's blood glucose levels are also elevated at 250 mg/dL, complicating his diabetes management and potentially exacerbating cerebral edema. Blood pressure remains persistently high at 190/115 mmHg despite medication adjustments, indicating the need for more aggressive hypertension management to prevent further vascular injury.

The healthcare team must now prioritize interventions to manage the increased ICP and address the underlying causes of these complications. This includes considering osmotic diuretics like mannitol to reduce cerebral edema, optimizing glucose control with insulin therapy, and revisiting antihypertensive strategies. Close monitoring for signs of infection is also essential, given the elevated white cell count. The team must balance these interventions with the patient's overall clinical stability, evaluating the risks and benefits of each treatment option while preparing for potential further deterioration.

Section 2

New Diagnostic Results:

In response to the patient's deteriorating neurological status, the medical team orders a series of diagnostic tests to further elucidate the underlying causes of the complications. A lumbar puncture is performed to rule out meningitis or encephalitis as potential contributors to the patient’s increased confusion and agitation. The cerebrospinal fluid (CSF) analysis shows a slightly elevated protein level, but no white blood cells, bacteria, or viruses are detected, effectively ruling out these infectious causes.

Meanwhile, an electroencephalogram (EEG) is conducted to assess for any seizure activity that might explain the patient's altered mental state. The results reveal intermittent focal slowing over the region affected by the stroke, but no epileptiform activity, suggesting that seizures are not contributing to the current confusion and agitation. This finding shifts the focus back to managing cerebral edema and optimizing intracranial dynamics as the primary concern.

Additionally, repeat blood cultures are drawn to investigate any occult infection that might be driving the elevated white blood cell count. Preliminary results show no bacterial growth at 24 hours, though cultures will be monitored for the full 48-hour period to confirm the absence of bacteremia. This prompts the healthcare team to re-evaluate other sources of inflammation, such as the stress response related to the stroke itself, and to continue close surveillance for any new signs of infection. With these diagnostic insights, the team remains vigilant in balancing aggressive management of cerebral edema and hypertension with supportive measures to stabilize the patient's overall condition.

Section 3

In the days following the initial diagnostics, the patient begins to exhibit further changes in their clinical status. Notably, the patient develops a mild fever, with body temperature rising to 38.2°C (100.8°F), accompanied by a heart rate of 105 beats per minute and blood pressure fluctuations, which now range between 160/90 mmHg and 175/95 mmHg. Despite the absence of bacterial growth in initial blood cultures, this new febrile episode prompts the medical team to expand their differential diagnosis to consider non-infectious causes of fever, such as drug fever or neurogenic fever secondary to the stroke.

In parallel, the patient's neurological assessment reveals a slight increase in motor weakness on the left side, now graded at 2/5 strength compared to the previous 3/5. This decline in motor function, coupled with the persistent confusion and agitation, raises concerns about worsening cerebral edema or further ischemic changes. A repeat CT scan of the brain is ordered, which shows no significant hemorrhagic transformation or new ischemic lesions, but does indicate mild progression of edema in the vicinity of the original stroke site.

The team, now focused on optimizing cerebral perfusion and managing the fever, adjusts the treatment plan to include antipyretics for fever control and titration of intravenous fluids to maintain adequate hydration without exacerbating cerebral edema. Concurrently, they initiate a low-dose corticosteroid regimen aimed at reducing inflammation and edema. Nursing staff intensify monitoring, ensuring frequent neurological checks and vital sign assessments to detect any further deterioration. This comprehensive approach underscores the importance of clinical vigilance and adaptability as the team strives to stabilize the patient amidst evolving complications.

Section 4

After initiating the revised treatment plan, the patient's fever shows a modest response to antipyretics, with temperatures fluctuating between 37.8°C (100.0°F) and 38.0°C (100.4°F). However, over the next 24 hours, the nursing staff notes a new development: the patient begins to exhibit increased respiratory effort and a respiratory rate climbing to 24 breaths per minute. Oxygen saturation, previously stable at 95% on room air, drops to 90%, prompting the team to administer supplemental oxygen via nasal cannula. Auscultation of the lungs reveals faint crackles at the bases, raising the suspicion of fluid overload or early pulmonary edema as a complication of the increased intravenous fluid administration.

Laboratory tests are ordered to further evaluate the patient’s respiratory status. The results reveal a mild metabolic acidosis with a bicarbonate level of 20 mEq/L and a compensatory respiratory alkalosis evidenced by a slightly decreased PaCO2. Serum electrolytes show a slight hyponatremia, with sodium levels at 133 mEq/L. These findings suggest that the fluid management strategy may need to be recalibrated to prevent further complications. The medical team decides to adjust the IV fluid rate, and diuretics are cautiously introduced to manage the potential fluid overload while closely monitoring electrolyte balance.

The patient's neurological status remains a paramount concern with little improvement in strength on the left side. The persistent confusion and agitation are addressed with non-pharmacological strategies to ensure patient safety. As the team reflects on these developments, they recognize the delicate balance required to optimize cerebral perfusion while managing systemic complications. Continued interdisciplinary collaboration and vigilant monitoring are prioritized to navigate the complexities of this evolving clinical scenario.

Section 5

As the team continues to manage the patient's fluid status and respiratory complications, a new complication arises: the patient develops a productive cough with yellowish sputum, and a low-grade fever persists despite antipyretic treatment. The nursing staff notes an increased respiratory rate of 28 breaths per minute and auscultation now reveals more pronounced crackles throughout the lung fields. These findings raise the suspicion of an infectious process, prompting the medical team to obtain a chest X-ray and sputum culture to evaluate for possible pneumonia.

The chest X-ray reveals bilateral infiltrates consistent with an infectious process, and the sputum culture confirms the presence of a bacterial pathogen. In light of these findings, the interdisciplinary team initiates broad-spectrum antibiotics while awaiting antibiotic sensitivity results to tailor therapy. This development underscores the importance of vigilant monitoring and reassessment, as the patient's susceptibility to infection may be heightened due to compromised immune function and hospital-related factors.

Throughout this period, the patient's neurological status remains a critical focus. While the left-sided weakness persists, there is a slight improvement in cognitive function with a decrease in confusion, allowing for more effective communication and cooperation with care strategies. The team emphasizes the need for continued interdisciplinary collaboration, balancing the management of the new infectious complication with the ongoing optimization of cerebral perfusion and respiratory support. This scenario highlights the dynamic nature of patient care, requiring continuous evaluation and adjustment of the treatment plan to address evolving challenges effectively.