NUR241-Contexts of Practice Health Alteration

Scenario:

N.T., a 79-year-old woman, arrives at the emergency room with expressive aphasia, left facial droop, left-sided hemiparesis, and mild dysphagia. Her husband states that when she awoke that morning at 0600, she stayed in bed, complaining of a mild headache over the right temple and feeling slightly weak. He went and got coffee, then thinking it was unusual for her to have those complaints, went back to check on her. He found she was having some trouble saying words and had developed a left-sided facial droop. When he helped her up from the bedside, he noticed weakness in her left hand and leg and brought her to the emergency department. Her past medical history includes paroxysmal atrial fibrillation (PAF), hypertension (HTN), and hyperlipidemia. A recent cardiac stress test had normal findings, and her blood pressure (BP) has been well controlled. N.T. is currently taking flecainide (Tambocor), hormone replacement therapy, amlodipine (Norvasc), aspirin, simvastatin (Zocor), and lisinopril (Zestril). The physician suspects N.T. has experienced an acute cerebrovascular accident (CVA).

Questions:

1.What role do diagnostic tests play in evaluating N.T. for a suspected CVA?

2.Explain how knowing the type of CVA is an important factor in planning care.

3.Which factor in N.T.'s history is the most likely contributor to her having experienced a CVA?

4.Which interventions can you delegate to the nursing assistive personnel (NAP)? Select all that apply.

a. Obtaining N.T.'s weight

b. Assisting N.T. in repositioning every 2 hours

c. Initiating oxygen therapy by nasal cannula

d. Performing N.T.'s neurologic checks every hour

e. Obtaining a manual BP per protocol

Complete the National Institutes of Health Stroke Scale (NIHSS) scores for each of N.T.'s symptoms