Mrs. Thompson, a patient with an ischemic stroke in the left middle cerebral artery territory, is experiencing decreasing oxygen saturation and increased respiratory rate. Which nursing intervention should be prioritized to address her respiratory status?

B) Initiate aspiration precautions by keeping the head of the bed elevated.

A) Administer a bronchodilator to open airways.

B) Initiate aspiration precautions by keeping the head of the bed elevated.

C) Perform nasopharyngeal suctioning to clear secretions.

D) Increase the flow rate of supplemental oxygen to maintain saturation above 95%.

A nurse is caring for Mrs. Thompson, a patient who recently experienced an ischemic stroke in the left middle cerebral artery territory. Her blood pressure is 185/98 mmHg, and she is receiving tissue plasminogen activator (tPA). Which nursing intervention is most appropriate to prioritize at this time?

C) Elevate the head of the bed to 30 degrees to facilitate venous drainage and reduce intracranial pressure.

A) Administer an antihypertensive medication to rapidly lower her blood pressure.

B) Initiate continuous cardiac monitoring to observe for arrhythmias.

C) Elevate the head of the bed to 30 degrees to facilitate venous drainage and reduce intracranial pressure.

D) Restrict oral intake to prevent aspiration until a swallow evaluation is completed.

A nurse is caring for Mrs. Thompson, who has recently shown signs of increased confusion, garbled speech, and pronounced right-sided weakness. The repeat CT scan shows mild cerebral edema without hemorrhagic transformation. Which of the following nursing interventions is most appropriate to help manage her condition?

C) Elevating the head of the bed to 30 degrees and administering prescribed osmotic diuretics

A) Administering a hypotonic IV solution to reduce cerebral edema

B) Encouraging Mrs. Thompson to perform active range-of-motion exercises with her right arm

C) Elevating the head of the bed to 30 degrees and administering prescribed osmotic diuretics

D) Increasing her oral fluid intake to promote adequate hydration and cerebral perfusion

A nurse is caring for Mrs. Thompson, who has experienced an ischemic stroke and now presents with mild cerebral edema. Which intervention should the nurse implement to effectively manage the cerebral edema while ensuring adequate cerebral perfusion?

C) Elevate the head of the bed to 30 degrees and administer mannitol as prescribed.

A) Administer a hypotonic saline solution to decrease cerebral edema.

B) Position Mrs. Thompson in a flat supine position to improve cerebral perfusion.

C) Elevate the head of the bed to 30 degrees and administer mannitol as prescribed.

D) Restrict all fluid intake to reduce cerebral edema.

A nurse is caring for Mrs. Thompson, who has shown signs of improvement from cerebral edema but has developed a low-grade fever and slight crackles in the right lower lobe. Which nursing intervention should the nurse prioritize to address the current potential complication?

D) Elevate the head of the bed to 30 degrees to reduce aspiration risk.

A) Administer antipyretics to manage low-grade fever.

B) Encourage Mrs. Thompson to perform incentive spirometry every hour.

C) Increase IV fluid rate to maintain hydration.

D) Elevate the head of the bed to 30 degrees to reduce aspiration risk.

Given Mrs. Thompson's current clinical presentation, which nursing intervention is most appropriate to address her new development of a low-grade fever and suspected aspiration pneumonia?

C) Implement aspiration precautions, including elevating the head of the bed to 30-45 degrees during feeding.

A) Position Mrs. Thompson in a supine position to ensure comfort and easier breathing.

B) Encourage oral fluid intake to promote hydration and help reduce fever.

C) Implement aspiration precautions, including elevating the head of the bed to 30-45 degrees during feeding.

D) Discontinue empiric antibiotic therapy until culture results confirm an infection.

Mrs. Thompson is experiencing respiratory compromise likely due to aspiration pneumonia. Which nursing intervention should the nurse prioritize to prevent further respiratory complications?

B) Elevate the head of the bed to 30-45 degrees.

A) Increase the flow rate of oxygen to 4 liters per minute.

B) Elevate the head of the bed to 30-45 degrees.

C) Administer a bronchodilator to improve airflow.

D) Perform chest physiotherapy every 2 hours.

Considering Mrs. Thompson's condition and recent diagnosis of aspiration pneumonia, which nursing intervention is most critical to address her respiratory needs while supporting her ongoing recovery from a stroke?

B) Elevating the head of the bed to 30-45 degrees to reduce the risk of further aspiration.

A) Administering prescribed antibiotics and monitoring for signs of allergic reactions.

B) Elevating the head of the bed to 30-45 degrees to reduce the risk of further aspiration.

C) Encouraging Mrs. Thompson to ambulate frequently to promote lung expansion.

D) Increasing the flow rate of oxygen via nasal cannula to 4 liters per minute to improve oxygen saturation.

Given Mrs. Thompson's current clinical status, which nursing intervention should be prioritized to address her respiratory distress and prevent further complications?

A) Increase the flow of supplemental oxygen to improve oxygen saturation levels.

C) Administer antipyretics to manage her low-grade fever and prevent further respiratory compromise.

D) Schedule frequent neurological assessments to monitor her stroke recovery.

Mrs. Thompson is experiencing respiratory distress with fluctuating oxygen saturation levels and increased respiratory rate despite supplemental oxygen. Which of the following interventions should the nurse prioritize to address her current respiratory status?

B) Elevate the head of the bed to at least 45 degrees and encourage the use of incentive spirometry.

A) Increase the supplemental oxygen flow rate to 4 liters per minute via nasal cannula.

B) Elevate the head of the bed to at least 45 degrees and encourage the use of incentive spirometry.

C) Administer a dose of bronchodilator to improve her airflow and reduce labored breathing.

D) Prepare for intubation and mechanical ventilation due to worsening respiratory distress.

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 to brain tissue, causing cell injury and death.

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

• Key complication: Both types can cause localized brain damage, resulting in neurological deficits such as paralysis, speech difficulties, and cognitive impairment, which are crucial for understanding patient care and rehabilitation strategies.

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, 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, mild headache

• Vital signs: Blood Pressure: 180/100 mmHg, Heart Rate: 95 bpm, Respiratory Rate: 22 breaths/min, Temperature: 98.6°F, Oxygen Saturation: 93% on room air

Section 1

As the medical team initiates the initial assessment, the patient, Mrs. Thompson, undergoes a detailed neurological evaluation and imaging studies. A CT scan of the head is performed promptly, revealing an ischemic stroke in the left middle cerebral artery territory. The stroke team is consulted immediately, and tissue plasminogen activator (tPA) is considered within the treatment window to dissolve the clot. Blood glucose levels are assessed given her history of Type 2 Diabetes, showing a level of 160 mg/dL, slightly elevated but not critically high. The team ensures her glucose is managed to prevent further neurological damage. Her blood pressure remains elevated at 185/98 mmHg, a critical factor that requires careful, gradual reduction to avoid further cerebral perfusion issues.

Shortly after the initial intervention, Mrs. Thompson's condition shows signs of change. Her oxygen saturation drops to 89% on room air, prompting supplemental oxygen administration via nasal cannula. Her respiratory rate increases to 26 breaths per minute, indicating possible respiratory compromise. Auscultation of lung sounds reveals fine crackles at the bases, suggesting the development of pulmonary congestion, potentially secondary to heart strain or aspiration risk due to dysphagia associated with her stroke. The nursing team implements aspiration precautions, elevating the head of the bed and preparing for a possible swallow evaluation.

These developments necessitate a coordinated response from the healthcare team. The primary focus is on stabilizing Mrs. Thompson's cardiovascular and respiratory status while monitoring for signs of neurological deterioration. The team establishes a plan for frequent vital sign monitoring, neurological checks, and strict blood glucose control. Mrs. Thompson's case highlights the complexity of stroke management, requiring astute clinical reasoning as her condition evolves. The team remains vigilant for potential new complications, including cardiac events and infection risks, as they adjust her care plan to optimize recovery and prevent further deterioration.

Section 2

As the healthcare team continues to monitor Mrs. Thompson's condition, they note a change in her neurological status. During a routine neurological check, Mrs. Thompson exhibits increased confusion and difficulty speaking, with her speech becoming garbled and less coherent than during the initial assessment. Her right-sided weakness appears more pronounced, and she is unable to lift her right arm against gravity. These findings raise concerns about potential expansion of the ischemic stroke or new complications, such as hemorrhagic transformation. The nurse immediately reports these observations to the stroke team, prompting an urgent repeat CT scan to assess for any changes in cerebral pathology.

The repeat CT scan reveals no evidence of hemorrhagic transformation; however, it does show mild cerebral edema around the ischemic area, contributing to her altered mental status. This finding necessitates careful management to reduce intracranial pressure while maintaining adequate cerebral perfusion. The medical team considers the administration of osmotic diuretics such as mannitol and elevates the head of the bed to 30 degrees to optimize venous drainage. Additionally, the team continues to monitor her blood pressure closely to ensure it remains at a level that supports adequate cerebral perfusion without exacerbating the edema.

In parallel, Mrs. Thompson's blood glucose levels are monitored rigorously, as hyperglycemia could worsen her neurological status. The nursing team administers insulin as needed to maintain her glucose levels within a target range. As the team implements these interventions, they remain vigilant for signs of further deterioration or new complications, such as aspiration pneumonia, given her increased risk due to dysphagia. The focus is on stabilizing Mrs. Thompson's condition and optimizing her recovery through coordinated, multidisciplinary care tailored to her evolving clinical needs. This phase of her treatment underscores the importance of dynamic clinical reasoning and timely intervention in managing complex stroke cases.

Section 3

As the healthcare team continues to monitor Mrs. Thompson closely, her response to the interventions implemented for cerebral edema begins to unfold. Over the next several hours, the nursing team observes a gradual improvement in her neurological status. Her speech, while still impaired, becomes slightly more coherent, and she exhibits a mild reduction in confusion. Her right-sided weakness remains, but she is now able to move her right arm slightly against gravity, suggesting a positive response to the current management strategy. Vital signs are stable, with her blood pressure maintained at 140/85 mmHg, supporting adequate cerebral perfusion.

However, despite these encouraging signs, Mrs. Thompson begins to develop a low-grade fever, with her temperature rising to 38.2°C (100.8°F). This prompts the team to investigate potential sources of infection, given her increased risk for aspiration pneumonia due to her dysphagia. A chest X-ray is ordered to assess for any signs of pulmonary complications. Additionally, the nursing team performs a comprehensive assessment, including auscultation of lung sounds, which reveal slight crackles in the right lower lobe, raising suspicion of potential aspiration.

Laboratory results reveal a white blood cell count of 13,000/mm³, further supporting the possibility of infection. The team initiates empiric antibiotic therapy while awaiting culture results, recognizing the importance of early intervention in preventing further deterioration. This new development underscores the complexity of Mrs. Thompson's case, as the team balances the management of her stroke-related complications with the emerging need to address potential infectious processes. The multidisciplinary team remains vigilant, adjusting the care plan as needed to optimize her recovery and prevent further setbacks.

Section 4

As the healthcare team continues to monitor Mrs. Thompson, they note a change in her respiratory status. Her respiratory rate increases to 24 breaths per minute, and she appears to be working harder to breathe. Oxygen saturation levels have decreased slightly, now reading at 91% on room air. Given these changes, the team decides to initiate supplemental oxygen therapy to maintain adequate oxygenation, starting with a nasal cannula at 2 liters per minute and monitoring her response closely. The crackles in her right lower lobe persist, and the team considers the possibility of evolving pneumonia, likely secondary to aspiration, as the primary cause of her respiratory compromise.

Concurrent with these respiratory observations, the results of Mrs. Thompson's chest X-ray are made available. The imaging confirms the presence of an infiltrate in her right lower lobe, consistent with aspiration pneumonia. This finding corroborates the earlier clinical suspicion and guides the refinement of her antibiotic regimen to target the most likely pathogens effectively. The healthcare team also emphasizes the importance of preventative measures, such as elevating the head of her bed and implementing meticulous oral care to reduce further aspiration risks.

Despite these setbacks, Mrs. Thompson continues to show improvement in her neurological status. Her speech becomes increasingly coherent, and she demonstrates the ability to follow simple commands. This simultaneous progression in her neurological recovery and development of mild respiratory complications presents a complex clinical picture requiring careful prioritization and adjustment of her care plan. The team remains proactive, maintaining a delicate balance between addressing her current respiratory needs and supporting her ongoing recovery from the stroke. As they await culture results to further tailor her treatment, the focus remains on preventing additional complications and promoting Mrs. Thompson's overall recovery trajectory.

Section 5

As the healthcare team continues to monitor Mrs. Thompson, they observe a new complication in her clinical status. Over the course of the next 24 hours, Mrs. Thompson's respiratory effort remains labored despite the supplemental oxygen, and her oxygen saturation levels fluctuate, occasionally dipping to 89% on 2 liters per minute via nasal cannula. Her respiratory rate increases further to 28 breaths per minute, and she exhibits signs of accessory muscle use, indicating increased respiratory distress. Additionally, Mrs. Thompson begins to exhibit a low-grade fever, with her body temperature rising to 100.4°F (38°C), further suggesting an inflammatory or infectious process.

In parallel, the laboratory results from her blood work reveal a slight increase in her white blood cell count to 12,500/mm³, supporting the diagnosis of an infection, likely related to her confirmed aspiration pneumonia. The team also notes a mild elevation in her C-reactive protein (CRP) levels, signaling an acute inflammatory response. Given these findings, the healthcare team decides to escalate her antibiotic therapy to a broader spectrum regimen while awaiting specific culture results to ensure coverage of possible resistant organisms. Additionally, they implement more aggressive pulmonary hygiene measures, including physiotherapy and incentive spirometry, to aid in clearing her lung secretions and enhance her respiratory function.

Throughout this period, Mrs. Thompson's neurological status continues to improve, though her respiratory compromise poses a significant challenge. Her ability to communicate and follow commands remains a positive indicator of her stroke recovery, but the team must maintain vigilance to prevent further deterioration in her respiratory status. The interdisciplinary team collaborates closely, ensuring that each intervention is carefully balanced to support Mrs. Thompson's overall recovery journey, emphasizing the importance of ongoing assessment and timely adjustment of her treatment plan to accommodate her evolving clinical needs.