Find and read the article: Thompson, R. & George, L.E. (2016). Preparing new nurses to address bullying: The effect of an online educational module on learner self-efficacy. MedSurg Nursing,26(5), 412-432
* Identify the/a main dependent variable.
*How was this dependent variable measured?
* What evidence is provided of the reliability and validity of this measure? If none provided, state this, and give ONE EXAMPLE of how reliability validity for the main DV measure may be demonstrated.
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 mild headache over the right temple and feeling slightly weak. He went and get coffee, then thinking it was unusual forher to have those complaints, went back to check on her. He found she was having some trouble saying words and had develped 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 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).
Question: What factor in N.T's history is the most likely contributor to her having experienced a CVA
Case Study progress
After a noncontrast CT scan, she is diagnosed with a thrombolytic CVA. The physician writes the orders shown in chart
Chart View
physician'sorders
IV 0.9% NACI at 75 ml/hr
Activase (tPA) per protocol
Stat CBC, PT/INR, CPK isoenzymes
Neurologic assessment
Obtain patiet weight
Vital signs every hour
Oxygen at 2 L per nasal cannula(NC)
Question: Outline a plan of care for implementing these orders
The instruction on tPA vials read to reconstitute with 50 ml of sterile water to make a total of 50 mg/50 ml. (1 mg/ml) . The hospital protocol is to infuse 0.9 mg/kg over 60 minutes with 10% of the dose given as a bolus ver 1 minutes. N.T. weighs 143 pounds. What is the amount of the bolus dose, in both milligram and mililitres, you will administer in the first minute? What is the amount of the remaining dose that you will need to administer?
Case study progress
N.T is admitted to the neurology unit. A second CT scan (18 ours later reveal a small CVA in the right hemisphere. She is placed on flecainide (Tambocor), Amlodipine (Norvasc, clopidogrel (plavix), Aspirin , simvastatin ( Zocor) and Lisinopril (Zestril,.
Question: If N.T"s deficits are temporary, how long might it take before completely reverse
Why was N.T placed on clopidogel (Plavix) post- CVA?
Is there any benefit from the continuing simvastatin (Zocor) after her CVA
As you walk into the nurses' station, the charge nurse is coordinating the swallowing evaluation, including a modified barium swallowing study and refferal for speech -language pathologist.(SLP) GIve the rationale for these order?
1. Common risk factors of CVA including hypertension, hyperlipidemia and other cardiovascular diseases. In this case the client has all three risk factors. The most likely contributor in her case is history of paroxysmal atrial fibrillation or PAF. It is a condition in which an irregular often rapid heart rate that commonly cause poor blood flow.
2. 0.9mg /kg over 60 minutes
Weight in kg is 65kg (143 pound converted into kg)
So over 60 minutes the client will get 0.9mg X65 kg= 58.5mg
10% of the dose given as bolus
So 10% of 58.5= 5.85 mg
1mg/1ml
Hence, 5.85mg in 5.85 ml is the bolus dose of first minute.
3.plan of care
*Assess the general condition of the patient
*Check vital signs and body weight
*Check oxygen saturation and arrange articles for oxygen therapy
*Start oxygen 2litres per minute
*Prepare the articles for IV cannulation,blood collection and IV fluid therapy
*Prick once with cannula collect blood for laboratory investigations and send it as soon as possible.
*Start IV fluid therapy 75ml/hour
*Patient weight and vital sign need to be monitored hourly
4.As patient is at risk of developing further complications a the duration for a complete recovery can not be predicted.
* Clopidogrel is an antiplatelet which reduce blood clotting.
*Simvastatin is a lipid lowering medication which decreases blood cholesterol levels.
*These both medication reduce the risk of heart attack and stroke.
5. Post CVA there are chances to develop dysphagia and there by aspiration. A barrium swallow test can assess for silent aspiration chances.
*Speech language pathologist are trained to test swallowing as well as they can train the patients to correct their speech.
Find and read the article: Thompson, R. & George, L.E. (2016). Preparing new nurses to address...
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 mild headache over the right temple and feeling slightly weak. He went and get 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...
Neurology Consult Note Admission Date: 9/28/2015 LOS: 0 days Reason for Consult: stroke activation Consult type: Opinion with orders Assessment/Plan 51 year old male with PMH of DM, HTN, HLD, and CVA 3 months ago presents to the ED with sudden onset of left sided weakness. Last known normal was 23:30 and presented to the ED around 01:15am. NIHSS 12 for left sided weakness, sensory changes and extinction and mild dysarthria. Head CT showed right thalamic and corona radiata hemorrhage....