Stroke case study: Joe (54 years old) is a carpenter who presents to the emergency room at the local emergency department with acute aphasia, right facial droop, and right-sided weakness.
Onset of the symptoms was sudden and occurred at work. One of his co-workers called 9-1-1. The Emergency Medical Team evaluated Joe’s neurologic deficits and glucose on the way to the hospital. Glucose was 85. The EMS notified the emergency department of a possible stroke patient. Continue: Upon arrival in the emergency department (ED), the nurse gather the patient’s medical history from his wife who met him at the hospital. The wife report his history of uncontrolled hypertension (often non-compliant with anti-hypertensive medications), diabetes (diagnosed 2 years previously, taking oral medications). Joe is reported to smoke 2 packs per day for at least 20 years and although he has attempted to stop smoking several times, none of the attempts were successful. Joe’s parents both died in their early 60’s from heart attacks. His wife expresses concern that Joe spends most of his free time watching TV and is not physically active when not at work.
Following review of the CT scan and lab test the ED physician advises the patient, his wife, and the nurse that the evidence indicates Joe is having in the early stages of an ischemic stroke. Once informed consent is obtained, the patient receives thrombolytic therapy. Although Joe continues to report right sided hemiparesis, the treatment is considered successful and the patient is admitted to the nursing unit for further monitoring of his condition. On admit to the nursing unit Joe’s vital signs are as follows: blood pressure-150/62; heart rate-72; respiratory rate 15; temperature-98.9 degrees F. Physical assessment reveals no facial drooping, tongue protrudes midline, PERRL, Glasgow coma scale 15. Right arm and leg are slightly weaker than the left. Joe denies any numbness or tingling. Questions: 1. What are the priority nursing diagnoses and interventions for Joe? 2. What risk factors does Joe have for a stroke? 3.What are priorities for educating the patient regarding prevention of another stroke? Three hours later the nurse enters the room to for an hourly neurological assessment and finds Joe snoring very loudly. His wife state this is unusual for him. The nurse is not able to arouse Joe from his sleep. Questions: 4. What should the nurse’s priority action be at this time? 5. What do you think is the number one priority test the patient needs at this time? 6. Please write out the SBAR report for this patient at this time? Situation:Background: Assessment:Recommendation: