Case Study, Chapter 67, Management of Patients With Cerebrovascular Disorders

1. Penny Williams, a 74-year-old patient, is admitted to the telemetry unit with the diagnosis of acute ischemic stroke. The patient is experiencing paroxysmal atrial fibrillation with a controlled ventricular rate on the monitor. A CT of the head without contrast reveals no evidence of hemorrhage. The transesophageal echocardiogram reveals moderate mitral valve insufficiency and embolism as a primary cause of the stroke. The patient is on a weight-based heparin protocol. The patient received digitalis to keep the ventricular rate of the atrial fibrillation controlled. The patient has right-sided paralysis and global aphasia. The patient has unilateral neglect of her right side and has right field homonymous hemianopsia. Papilla edema is present bilaterally. The patient is drooling from the right side of her mouth and coughs periodically. The patient was found by her daughter when she got home from work. The daughter stated her mother was normal before she left for work, and 10 hours later the mother exhibited the symptoms described above. The time of onset for the stroke could not be safely determined so no interventions could be used to treat the stroke. (Learning Objective 4)

What principles of nursing management should the nurse provide the patient during the acute stage of the ischemic stroke based on the assessment findings from the case study?

 Place the assessment findings that are supported by the nursing principle(s) in parenthesis.

2. John Green, a 71-year-old patient, is being discharged from the rehabilitation unit 8 weeks after an ischemic stroke. The patient’s spouse stated that they used to enjoy going to golf outings with their friends, but the patient has not played golf since he had the stroke, and she does not want to try to golf once her husband is discharged home because he has to use a walker and can barely ambulate. She also states that her husband still has trouble speaking, and his short-term memory is not very astute so it would be embarrassing to be on a golf outing with him. The patient’s spouse has worn the same outfit to the rehabilitation unit the past 3 days, and the nurse notices the patient’s hair is unkempt and his affect is flat. The rehab nurse has made arrangements with the social worker for a physical therapist, speech therapist, and occupational therapist to provide three sessions of therapy at the patient’s home for the next 4 weeks, and then a reevaluation will follow to determine if the patient will need further therapy. The patient is able to sit independently, stand independently, and use a walker. The patient is able to ambulate 30 feet with the walker, and then he requires a short rest before he is able to ambulate another 30 feet. The patient slurs words occasionally and has hesitant speech. The patient has problems with short-term speech. (Learning Objective 7)

What educational topics should the nurse provide the family about home care for the patient after stroke?

What assessment of the spouse does the nurse need to make, and what should the nurse suggest?