COMPETENCY APPRAISAL 2 CASE ANALYSIS

ISCHEMIC STROKE

A 52-year-old police officer, with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. The family noted that the symptoms began just as the evening news was starting. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next ten minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the patient in a chair and calls Iloilo Mission Hospital Emergency Department for help.

Case Details PMHX : + HTN No history of migraines, seizures, prior stroke, diabetes MEDS: ACE inhibitor VS: PA: BP 150/80 P 89 R 20 T 98.9 SaO2 95% Well appearing, awake middle-aged male, in no acute distress.

HEENT: NC/AT (normocephatic/atraumatic), no contusions Neck supple, NT. No JVD or bruits Abd: Soft, non-tender.

Extremities: Warm and dry. No clubbing, cyanosis, or edema Neuro: Mental status Awake, responsive, and appropriate. Patients answers correctly, and follows commands Cranial nerves Mild left facial droop. Forehead moves symmetrically PERRL / EOMI except for slight difficulty crossing midline to left Visual fields Intact bilaterally but difficult to assess Motor Right arm and leg extremity with 5/5 strength Left arm cannot resist gravity, left leg with mild drift Sensation Intact bilaterally to fine touch. Neglect Mild neglect to left side of body however can be corrected. Ataxia None with heal to shin and finger to nose Language Expressive and receptive language intact Mild to moderate dysarthria. Able to protect airway

Laboratory Evaluation CBC, renal, and ECG unremarkable. Glucose 100

Noncontrast head CT (performed 1.5 hours from symptom onset) No intracranial hemorrhage or mass lesions. Suggestion of early ischemic changes in right hemisphere (mild loss of insular ribbon and subtle loss of gray-white matter interface) but no large areas of hypodensity or mass effect.

Impression/Diagnosis

Right middle cerebral artery distribution ischemic stroke, now 2 hours from symptom onset. As the nurse assigned to this client what will be you nursing intervention? Do you think this patient is a candidate for thrombolytic therapy? What admitting orders would you consider for this patient?

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