STROKE 1 Case Study
By: Hannah Campo & Alexys
Carballea
s
Suzanne, a 66-year-old white
woman, awoke in the middle
of the night and fell when she
tried to get up and go to the
bathroom. She fell because
she was not able to control
her left leg. Her husband took
her to the hospital, where she
was diagnosed with an acute
ischemic stroke. Because she
woke up with symptoms, the
actual time of onset was
unknown and she was not a
candidate for tPA.
Objective Data
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BP: 180/110
Left sided arm weakness (3/5) and leg weakness (4/5)
Decreased sensation on the left side, particularly the hand
Left homonymous hemianopsia
Overweight
Alert, oriented, and able to answer questions appropriately but
mild slowness in responding
Subjective Data
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Left arm and leg are weak and feel numb
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Feeling depressed and fearful
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Requires help with ADLs
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Concerned regarding having another stroke
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Says she has not taken her medication for
high cholesterol
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History of a brief episode of left-sided
weakness and tingling of the face, arm, and
hand 3 months earlier, which totally resolved
and for which she did not seek treatment
1.
How does Suzanne’s prior health history put her at risk for a stroke?
Suzanne is overweight and has high blood pressure. These are both
predisposing factors to CVA.
2.
How can the nurse address Suzanne’s concerns regarding having
another stroke?
Reassure Suzanne that, while another CVA it is a possibility, with diet exercise
and close monitoring by her doctor the odds are in her favor of not having
another one. Also, if a colt does become apparent it can be treated promptly
tPN.
3. How can Suzanne and her family address activity issues such as
driving after the stroke?
Let her know that it will take time to heal, she will have physical
therapy to help with strengthening and OT to help her regain her
ability to drive. Time of treatment and evaluation as to the extent of
her injuries is the first step. Do not give false hope and allow time for
her to voice her fears and expectations so that misinformation can be
addressed.
4. What strategies might the home health nurse use to help Suzanne
and her family cope with her feeling depressed?
Home health can help to ease caregiver role strain. By helping with
ADL’s. They also can evaluate the home for hazards and give advice
for assistive devices in order to promote self care and independence.
5. What lifestyle changes should Suzanne make to reduce the
likelihood of another stroke?
Suzanne is advised to lose weight, incorporate regular
exercise, at least 3 times a week, into her routine. Diet
changes will most likely need to be made in order for
weightless to take place, a diet consult should be put in.
6. How will homonymous hemianopsia affect Suzanne’s
hygiene, eating, driving, and community activities?
7. What factors should the nurse assess for related to outpatient rehabilitation
for Suzanne?
This nurse needs to asses Susan’s ability to care for herself. is she able to
feed herself when meals are delivered, or does she need food to be set up for
her, or even fed? She she able to use and assistive device to ambulate to the
bathroom? Can she use a grab bar to sit, or does she need help? If Suzanne
isn’t able to do basics with little help then a rehab facility may be needed till
she is. the family may be willing to help with meal prep and assistance with
ambulation during the day but, the families ability and willingness should be
assessed. We want to prevent care giver role strain and help Suzanne get the
care she deserves and needs in order to fully heal. the ability for the daily to
afford such care should be assessed as well.
8.
Based on the assessment data provided, write one or more nursing
diagnoses. Are there any collaborative problems?
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Self care deficit related to CVA
Risk for depression related to loss of ability to unexpected loss of
ability to care for self
Risk for caregiver role strain related to extensive assistance with
ADL’s