Mrs. Blossom would need a neurologic assessment done, but not an in depth one. Most importantly focusing on her level of consciousness. Judging by her new onset of A-fib with RVR, if she isn

What nursing assessments should be completed at this time?
Mrs. Blossom would need a neurologic assessment done, but not an in depth one. Most importantly focusing on her level of consciousness. Judging by her new onset of A-fib with RVR, if she isn’t already on telemetry at this time, I would start an EKG on her even though she was converted to normal sinus rhythm. Assessing her vitals would also be important at this time as well.
You assess Mrs. Blossom to find she has a left sided facial droop, slurred speech, and is unable to hold her left arm up for more than 3 seconds.
What is/are your priority nursing action(s) at this time?
If the hospital as a “stroke alert/Code” then absolutely call that team up to assess Mrs. Blossom at well. Notify the Physician and tell the Charge nurse. Obtain suction for emergency purposes.
What may be occurring in Mrs. Blossom?
Mrs. Blossom is having a stroke.
You call a Code Stroke and notify the charge nurse for help. You obtain suction to have at bedside just in case. The neurologist arrives at bedside within 7 minutes to assess Mrs. Blossom. He notes her NIH Stroke Scale

score is 32. He orders a STAT CT scan, which shows there is no obvious bleed in the brain.
What are the possible interventions for Mrs. Blossom at this time?
Obtain and order and administer tPA.
What are the contraindications for thrombolytics like tPA (alteplase)?
tPa is contraindicated in hemorrhagic stroke and recent bleeds such as GI.
You administer tPA per protocol, initiate q15min vital signs and neuro checks. You stay with the patient to continue to monitor her symptoms.
What are possible complications of tPA administration? What should you monitor for?
tPa can cause bruising and bleeding. Monitor for such bruising and bleeding. Monitor to make sure the stroke symptoms are getting better. Monitor vital signs. Monitor LOC.
After 2 hours, Mrs. Blossom is showing signs of improvement. She is able to speak more clearly, though with a slight slur. She is still slightly weak on the left side, but is able to hold her arm up for 10 seconds now. Her NIHSS is now6. Mrs. Blossom’s daughter asks you why this happened.
What would you explain has happened to Mrs. Blossom physiologically?
Mrs. Blossom had a new on-set of A-fib. When the heart goes into A-fib there is a higher chance of clots. When clots are formed in the hear they are most likely to go to the head (heart à head; legs à lungs). Even though she was converted to normal sinus rhythm, she may have formed that clot initially during the A-fib episode. Given that she had a clot in her heart that went to her brain, this could cause a stroke.
Two days later, Mrs. Blossom has recovered fully. She will be discharged today on Clopidogrel and Aspirin, plus a calcium channel blocker, with a follow up appointment in 1 week to see the neurologist.

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