Adult Health 2

A 47 y/o executive is speaking with his secretary about a meeting  scheduled for the next day and suddenly slumps in his chair and is  unable to speak.  The secretary immediately calls 911 and the patient is  transported immediately to the ED.  He is having trouble speaking and  is also having some visual irregularities.  He has recently been told he  has high cholesterol and is also being treated for high blood pressure  and GERD.

Patient history includes:
Works 16 hours a day and last vacation was 3 years ago
Drinks 4-6 cups of coffee daily
Smokes 10-20 cigarettes a day depending on how stressful his day is
Used to exercise, but “now is too busy”
Eats most meals out daily.

The  ED physician suspects that the patient The nurse is teaching the  patient about the following tests and the patient is asking why each one  is ordered.  Using your book, explain to the patient  why each of these  diagnostic tests has been ordered.  Which one should be completed first  and why?

CT scan of the head without contrast


MRI of the brain

MRA of the brain

2. Identify the patient’s risk for stroke and how each increases his risk

3.  The patient is being considered for fibrinolytic therapy.  What is  fibrinolytic therapy and what are the major concerns and  contraindications?  What must be known before fibrinolytic therapy can be considered?

4. The patient has been diagnosed with an ischemic stroke and received the  fibrinolytic TPA and spendt the first 24 hours in the ICU and is now  transferred to the stroke unit.  The patient has some residual weakness  on the R side, but is otherwise free of long-term disability.  The  patient has been told he has uncontrolled hypertension and  hypercholesteremia and will be discharged home with some outpatient  physical therapy.

The nurse is teaching the patient about the  medications he will go home on.  Explain why the patient is being  discharged on the following medications

An antihypertensive

A statin

Low dose Aspirin

5.  The nurse is completing discharge teaching and plans to teach the  patient how to reduce the risk of having another stroke  Considering the  risk factors of this patient, what should the nurse teach the patient?

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