Question

Stroke

Patient Profile

B.W. is a 72-year-old white female admitted 2 days ago to the medical unit with a stroke. She has left-sided hemiparesis. A noncontrast CT scan, about 2 hours after the onset of symptoms, was negative. A second CT scan, 12 hours later, was positive for an ischemic area in the right hemisphere.

Objective Data

Physical Examination

• Pupils equal, round, reactive to light and accommodation

• Decreased sensation in left lower extremity, no sensation in left upper extremity, normal sensation to right upper and lower extremity

• 0/5 strength left upper extremity, 1+/5 left lower extremity, 5/5 right upper and lower extremity

• Left facial droop

• Slurred speech

Diagnostic Studies

• A barium swallow study has been ordered for 1:00 PM

Subjective Data

Daughter is at the bedside, she is upset and tearful, stating “Mom doesn’t know where she is and she keeps waving her arm at me and getting upset, trying to tell me something, and I don’t know what she is trying to tell me.”

Discussion Questions

1. Why was the first CT scan negative? What implication did this have on B.W.’s care?

2. What is the difference between an ischemic and a hemorrhagic stroke?

3. What are the different manifestations of right-sided versus left-sided stroke?

4. Why was the barium swallow study ordered?

5. Based on B.W.’s assessment findings, what are the priority nursing diagnoses?

6. Outline a fall risk reduction plan to reduce B.W.’s risk of falling.

7. You acknowledge her daughter’s distress and the difficulties that problems with speech can pose of B.W. and her. Describe nursing interventions to assist B.W. impaired communication.

Answer 1

Answer: The first CT scan was negative as most of the time the results are negative if the CT scan has been done with in 2 -3 hours of the stroke or injury. So, the negative results doesn't mean that the patient does not have stroke but due to this result care given to the patient gets disturbed because of the confusion that whether the patient has stroke or not.

The major difference between the ischemic stroke and hemorrhagic stroke is that in the case of ischemic stroke there is very little supply of blood that goes or provided to the brain parts along with the nutrients and oxygen supply whereas in the case of hemorrhagic stroke there is bleeding within the cranial cavity.

If the stroke occurs left side then all the functions of the right side will get disturbed such as movement of right hand, paralysis on right side etc. Whereas in the case of right side stroke, the paralysis occurs left side and functioning of left side get affected.

Usually barium sulphate is given for the X- Ray image to stud about the abnormalities in the abdomen. Here barium swallow study is done to know about the pain during swallowing, any kind of GIT bleeding etc.