Mrs. Greene is a 60-year old female who presented to the Emergency Room with new onset Atrial Fibrillation with Rapid Ventricular Response
Mrs. Greene is a 60-year old female who presented to the Emergency Room with new onset Atrial Fibrillation with Rapid Ventricular Response. She is admitted to the cardiac telemetry unit after being converted to normal sinus rhythm with a calcium channel blocker (diltiazem). When you enter the room to assess Mrs. Greene, her daughter looks at you concerned and says “my mom is acting kinda funny.”
1. After completing the readings from this week’s content. What nursing assessments should be completed at this time? Provide rationales from the text book.
You assess Mrs. Greene to find she has left sided facial drop, slurred speech, and is unable to hold her left arm up for more than 3 seconds.
2. What is/are your priority nursing actions at this time? What may be occurring in Mrs. Green Provide rationales from the text book.
You call a Code stroke and notify the charge nurse for help. You obtain suction to have at the bedside. The neurologist arrives at the bedside within 7 minutes to assess Mrs. Greene. He notes her NIH Stroke Scale (NIHSS) is 32. A CT is ordered, which shows no obvious bleed in the brain.
3. What are possible interventions for Mrs. Greene at this time?
4. What are the contraindications for thrombolytics like tPA (alteplase)?
You administer tPA per protocol, initiate q15 min vital signs and neuro checks. You stay with the patient to continue to monitor her symptoms
5. What are possible complications of tPA administration? What should you monitor for?
After two hours, Mrs. Green is showing signs of improvement. She is able to speak more clearly, though with a slight slur. She is still weak on the left side, but is able to hold her arm up for 10 seconds now. Her NIHSS is now 6. Mrs. Greene’s daughter asks you what happened.
6. What would you explain has happened to Mrs. Greene physiologically?
Two days later, Mrs. Greene has fully recovered. She will be discharged today on Clopidogrel and Aspirin, plus a calcium channel blocker with follow-up appointment in 1 week to see the neurologist.
7. What education topics should be included in the discharge teaching for Mrs. Greene and her family?
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