Cerebral Vascular Accident Unfolding Case Study (2 parts)
CONCEPT: PERFUSION NUR 211
You are receiving the following report from the off going nurse:
Cindy Smith is a 72 year old female with history of CAD, HTN, CHF, atrial fibrillation and
Type II DM. She was in a motor vehicle accident 4 days ago, her car was t-boned by a van, but
lucky for her she did not sustain significant injuries in the accident. She came back into the
Emergency Department couple days later with symptoms of a CVA. CT scan confirmed ischemic
stroke of the right parietal/temporal region. Had difficulty with swallow and managing her
secretions. Now she seems to be developing respiratory distress/failure.
Her vital signs are BP 118/72, HR 91 bpm (sinus rhythm with occasional PVC’s), resp.
rate 24/m and temp of 36.8 C. Her sats continue to be in the high 80’s despite oxygen by nonrebreather mask. It appears her blood pressure is trending down…it is normally around 140/80
but on admit it was 180’s/90’s.
The work of breathing is increasing as well. Lungs have crackles bilaterally but more
severe on the right side per auscultation. She has pitting edema in her dependent extremities
and her urine output is decreasing over past 24 hours. WBC’s are climbing.
Patient states she can’t remember if she has been taking her medications since the
accident…she says she has “just been a nervous wreck”. She wonders how her family is doing
and why they never come to visit her. We heard that she has family in the area but have not
seen any visitors since she was admitted. Who knows what the story is there…but the more
anxious she becomes about this, the more difficulty she has with her breathing. The staff has
been trying to do everything possible to keep her off the ventilator.
Answer the following questions:
 Are there any ethical, cultural or age-related issues associated with this patient? If so,
what are they?
 What would you anticipate noticing when you walk into the patient’s room?
 What medical treatment/nursing interventions would you anticipate finding on the
plan of care?
 What medications would you anticipate finding on the patient’s medication
administration record (MAR)?
 If you could ask the off-going nurse only 3 questions, what would they be and why?
 If you were going to do a focused assessment on this patient, what would you
concentrate on and why?
 What issues can you identify as being a priority in caring for this patient?
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com
 What are some potential complications that could occur in this patient that the nurse
needs to be aware of/monitor for?
 What members of the multi-disciplinary team have been/or will be involved in the
care of the patient in the case study and what was their role?
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com
Cerebral Vascular Accident Unfolding Case Study – Part II
1.5 hours later
You go into assess your patient and find that her blood pressure is 258/146, HR of 110/m and
respiratory rate of 28/minute. She is minimally responsive but when she does arouse,
complains of a severe headache. Her lungs have crackles throughout and she is coughing up
light pink frothy sputum. Her oxygen saturation is 88% on 100% non-rebreather mask.
Answer the following questions:

What do you think is going on with this patient? What might have caused this
complication?

What additional assessment do you need to perform for this patient?

What lab/diagnostic tests do you believe will be ordered? What do you anticipate them
showing?

What can an RN initially do for this patient?

What do you need to tell the MD what calling him/her? Utilize the SBAR format to
provide information to the physician.
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com