A 47 y/o executive is speaking with his secretary about a meeting scheduled for the next day and suddenly slumps in his chair and is unable to speak.  The secretary immediately calls 911 and the patient is transported immediately to the ED

CASE STUDY 1

A 47 y/o executive is speaking with his secretary about a meeting scheduled for the next day and suddenly slumps in his chair and is unable to speak.  The secretary immediately calls 911 and the patient is transported immediately to the ED.  He is having trouble speaking and is also having some visual irregularities.  He has recently been told he has high cholesterol and is also being treated for high blood pressure and GERD.

Patient history includes:
Works 16 hours a day and last vacation was 3 years ago
Drinks 4-6 cups of coffee daily
Smokes 10-20 cigarettes a day depending on how stressful his day is
Used to exercise, but “now is too busy”
Eats most meals out daily.

The ED physician suspects that the patient The nurse is teaching the patient about the following tests and the patient is asking why each one is ordered.  Using your book, explain to the patient  why each of these diagnostic tests has been ordered.  Which one should be completed first and why?

CT scan of the head without contrast

Echocardiogram

MRI of the brain

MRA of the brain

2. Identify the patient’s risk for stroke and howeach increases his risk

3. The patient is being considered for fibrinolytic therapy.  What is fibrinolytic therapy and what are the major concerns and contraindications?  What must be knownbefore fibrinolytic therapy can be considered?

4. The patient has been diagnosed with an ischemic stroke and received the fibrinolytic TPA and spendt the first 24 hours in the ICU and is now transferred to the stroke unit.  The patient has some residual weakness on the R side, but is otherwise free of long-term disability.  The patient has been told he has uncontrolled hypertension and hypercholesteremia and will be discharged home with some outpatient physical therapy.

The nurse is teaching the patient about the medications he will go home on.  Explain why the patient is being discharged on the following medications

An antihypertensive

A statin

Low dose Aspirin

5. The nurse is completing discharge teaching and plans to teach the patient how to reduce the risk of having another stroke Considering the risk factors of this patient, what should the nurse teach the patient?