Question

Cerebrovascular Accident Simulation Worksheet Outcomes: The student will be able to: 1. Return demonstrate the five components of a Neurologic assessment. 2. Identify diagnostic procedures used in assessment of the client with a CVA. 3. Describe the etiology and pathophysiology of a CVA. 4. Identify clinical manifestations of a client with a CVA. 5. Prioritize treatment and nursing management of a client with a CVA. READINGS: Syllabus: Unit IIb, ATI: Neurological Emergencies REVIEW: NIH Stroke Scale (LeMone) Case Study Clyde Watson is a 58 yr old, African American, male, brought to the emergency room by his wife after collapsing at home. She reports he has complained of headaches and blurred vision that came & went quickly over the past 3-4 weeks. On assessment, Clyde is slightly confused. • What other information do you need about Clyde at this time? • What Labs/diagnostics would be helpful in differential diagnosis of a CVA? What nursing interventions must be taken immediately to prevent further Neurologic deterioration? Describe the difference between an ischemic and a hemorrhagic stroke, include the clinical manifestations of a stroke at different regions of the brain:

Answer 1

1.

• Identify about mental status of patient
• History about pastillness, surgery or on therapy ,secondary illness etc

2.

• CT scan
• CT angiography
• MRI
• Magnetic resonance angiography
• Transcranial doppler ultrasonography
• Carotid duplex scanning
• Blood studies
• Cerebrospinal fluid analysis.

3.

• Maintenance of airway
• Fluid therapy
• Treatment of cerebral eczema
• Drug therapy
• Hemodynamic monitoring
• Monitoring of eye movements and pupil reaction.
• Mental status

4. Ischemic stroke results from inadequate blood flow to brain from occlusion of an artery. It may thrombotic or embolic stroke. Occurs more in men than women.

Hemorrhagic strokes results from bleeding in to the brain tissue itself. It has two types; intracerebral and sub arachnoid hemorrhage.

5.

• Decreased intracranial adaptive capacity related to decreased cerebral perfusion and sustained increase of ICP
• Impaired physical mobility related to. Neuromuscular and cognitive impairment
• Unilateral neglect related to visual field cut
• Impaired urinary elimination related to impaired impulse to void

6.Nursing management

• Maintain airway
• Perform pulse oximetry
• Maintain adequate oxygenation
• IV fluid therapy
• Drug therapy
• Elevate head of 30degree if no symptoms of stroke
• Seizure precautions
• Continuous neurological status
• Safety of patient
• Nutritional therapy according to doctors order