Assessment One: Short Answer Questions related to a Case Study

Assessment One: Short Answer Questions related to a Case Study

Length: 1000 words

Weighting: 30%

Due:28 August 2023

Aim of this assessmentis to enable you to:

Explain the underlying pathophysiology related to the clinical manifestations of Ischaemic Stroke.

Discuss the importance of reperfusion in the management of a patient presenting with an Ischaemic Stroke.

Identify evidence-based strategies when caring for a patient presenting with Ischaemic Stroke.

Justify and prioritise the nursing care related to the case study.

Promote shared decision-making processes collaborating with family and the health care team.

Case StudyISBAR Handover:

Introduction: Mrs Mary Fenech is a 78-year-old lady with no known allergies (NKA)

Situation: She arrived in the Emergency Department at 09:30 hrs with slurred speech and right sided weakness since 0530 hrs while at home.

Findings from the CT perfusion assessment using Mean Transit Time (MTT) and Time to Peak (TTP) images showed reduced blood flow in the left middle cerebral artery (MCA) vascular territory extending from the medial cerebellum to the deep white matter at the centrum semiovale above the lateral ventricle. A CT angiogram showed an acute left Internal Carotid Artery (ICA) occlusion. Thrombolysis with Alteplase was administered at 11:30hrs

Background: Atrial Fibrillation (AF), Hypertension (HTN), Type 2 Diabetes Mellitus (IDDM), No head trauma, no prior stroke within the previous 3 months

Regular medications-

Atenolol 50mg daily, Aspirin 100mg daily, Lipitor 40mg daily, Magnesium 200mg daily, Amlodipine 5mg daily, Perindopril 5mg daily, NovoRAPID insulin

Assessment:

Airway: slight inspiratory stridor

Breathing: Respiratory rate 24, bilateral air entry, clear sounds. SpO2 90% on room air

Circulation: BP 149/69, irregular rate -80 bpm

Disability: GCS 12 (E 4, V 3, M 5) Pupils equal and reacting to light (PEARL). Sluggish eye gaze. Temp 36.9

Exposure: x2 IVC in Right & Left cubital fossa

Fluid: IV Compound sodium lactate (Hartmans) at 20 mL /hr TKVO

Glucose blood level: 9.5mmol/L

Weight approx. 86kg

Stroke Assessment:

F: Face- Right sided facial droop

A: Arms- Right sided weakness

S: Speech- Aphasia

T: Time of onset 0530hrs, Time of thrombolysis 1130hrs, time of ECR planned at 1300hrs, Door-to-Needle time 150 minutes, Symptom to needle time 390 minutes

Results:A diagnosis of left MCA stroke with totally occluded left Internal Carotid Artery (ICA)

Nursing Interventions:

Initiate Stroke Pathway

Keep in resuscitation bay (Triage category 2)

Connect to continuous cardiac monitoringRecord a 12 lead Electrocardiograph (ECG)

Initiate supplemental oxygen if SpO2 < 93%

Monitor airway patencyRecord Glasgow Coma Scale hourly

Prepare for endovascular clot retrieval (ECR) to restore blood flowArrange for a Speech Pathology consult

Maintain head of the bed elevated to 30 degreesInsert a nasogastric tubeMaintainnil by mouthCollect requested pathologyMonitor for haematemesis, melaena and haematuria

Blood tests:

Coagulation profile and cross match (PT, APTT, INR), FBC, LFT, EUC,

Medications:

Alteplase (IV)

Heparin 5000iu (IV)

Labetalol

Insulin NovoRAPID (SC)

Short Answer Question Format:

Complete your answers for the questions in a Word document.

List each question number and then your answer.

All answers must relate tothe Mrs Mary Fenech case study.

Question 1: (250 words)

Explain the underlying pathophysiology specifically related to the following clinical manifestations:

Aphasia

Right sided facial droop with right sided weakness in upper and lower limbs

Question 2: (500 words)

Select 1 Category only, from the 3 categories listed in the table below.

Provide a rationale for each of the interventions listed for the category that you have selected.

You must critically analyse the available evidence-based literature to support your rationale. Then, concisely explain your rationales in your own words and citing your evidence as in-text references to support your answers.

Category 1

Non-pharmacological interventions Category 2

Pharmacological interventions Category 3

Reperfusion interventions

Continuous cardiac monitoring

12- lead ECG 6th hourly

Monitoring LOC

Supplemental oxygen if SpO2<93%

Monitor for haematemesis, melaena and haematuria

Heparin 5000iu IV

Labetalol

NovoRAPID sub cut supplemental insulin.

Pantoprazole IV Thrombolysis with Alteplase IV

Endovascular clot retrieval (ECR)

Question 3:

As the registered nurse caring for this patient, you will now prioritise 5 of the highest clinical priority related Nursing Interventions (indicated above). Then, list them in the order that you would attend to each one.

Question 4. (250 words)

Concisely, justify the rationale for each of the following nursing care strategies for Mrs Mary Fenech.

Maintain Nil by Mouth

Monitor for haematemesis, melaena and haematuria

Insertion of a nasogastric tube

Collaborating with the family

Health care team collaborations

Please begin by referring to text references provided on vUWS when covering this module and complete a wider search using your online library https://library.westernsydney.edu.au/

Emergency Care Institute NEW SOUTH WALES

https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/strokehttps://vimeo.com/290191822https://strokefoundation.org.au/About-Stroke/Learn/signs-of-strokePrince of Wales Hospital and Community Health Services

The Royal Hospital for Women: Management of patients with acute stroke symptoms

https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/Campusacutestrokesymptoms.pdf