Question Answered step-by-step Presentation 78-year-old White woman Medical History: – Diabetes… Presentation 78-year-old White woman Medical History: – Diabetes mellitus Type II – Hypertension – Hyperlipidemia – Mild ischemic stroke (2 years ago) with full recovery Medications: – Metformin, Hydrochlorothiazide, Simvastatin History & Symptoms: • At 2:30 pm, the patient’s spouse returned home to find his wife on the floor. He last saw her normal when he left for the store at 1:00 pm. • The patient showed signs of slurred speech, aphasia and paralysis of the right arm and leg. There were no signs of trauma to the patient. • EMS was contacted and arrived on scene at 2:40 pm. EMS personnel suspected stroke and took the patient to the nearest hospital NIHSS Score: Symptom NIHSS score Symptom NIHSS score Awake & alert 0 Mixed aphasia and unable to follow any commands or make intelligible speech 7 Dysarthric 2 Right facial droop and right hemiplegia (arm and leg) 10 TOTAL NIHSS 19 Physical exam & lab results BP=190/110Pulse =regularVitals & physical exam are otherwise unremarkableINR=1.1PTT=29.3 secsGlucose =200 mg/dL Diagnosis & treatment considerations Diagnosis: Ischemic stroke with left hyperdense MCA sign Lab values within normal limitsBP 190/110 mm Hg NIHSS score = 19 2 hours and 30 minutes have elapsed since this patient was last seen normal Treatment Patient has no contraindication to tPA – Blood pressure was controlled with an appropriate IV antihypertensive After discussion of the risks and benefits, the patient’s spouse agrees to treatment with tPA tPA administered 3 hours after the patient was last seen normal tPA Rx (0.9 mg/kg – not to exceed 90 mg total dose)Weight :61 kgTotal Dose :55 mg Treatment outcome: Day 1: ❖ _Approximately 70 minutes after tPA administration, the patient develops acute hypertension, vomiting and decreased level of consciousness ❖ _A clinical diagnosis of symptomatic ICH is made and confirmed on CT ❖ _The patient is treated with 5U random donor platelets and 12U cryoprecipitate and stabilizes ❖ _The BP is treated with labetalol to keep the SBP <185 mmHg The patient is transferred to the ICU 6 hours later, the patient's NIHSS is 24 but she is stable Day 14: Patient is transferred to inpatient rehabilitation with an NIHSS of 16. She requires short-term placement of a percutaneous enteral gastrostomy (PEG) tube. Day 14: CT scan indicates a moderate to large left hemisphere ischemic stroke with associated encephalomalacia. There is expected interval resolution of the ICH. Day 14: The cause of stroke is found to be paroxysmal atrial fibrillation, and the patient is anticoagulated with warfarin, aiming for a target INR of 2.5. Day 90: NIHSS = 11 List 2-3 priorities for each patient (priorities on day 90). I do not need a reference. Can you please provide rationales? Thank you Health Science Science Nursing NURSING 102 Share QuestionEmailCopy link Comments (0)
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