Question

A 62-year-old woman with a history of hypertension and hyperlipidemia presented to a primary stroke center with sudden onset of weakness of the right side. On examination, she had a global aphasia, left gaze preference, right homonymous hemianopsia (field cut), right facial droop, dysarthria, and right hemiplegia (NIH Stroke Scale = 22). Head CT showed only equivocal hypodensity in the left middle cerebral artery territory. CT angiography showed a left middle cerebral artery. She was given Alteplase intravenous tPA at 2 hours from symptom onset and transferred to a comprehensive stroke center, where digital subtraction angiography confirmed left middle cerebral artery occlusion. She underwent mechanical thrombectomy with recanalization of the MCA. The next day, she had only a very mild expressive aphasia and right facial droop (NIHSS = 2). Three months later she had no neurological deficits (NIHSS=0). 1. The NIH stroke scale is used to describe the severity of a stroke. Describe the different components evaluated in this tool. Click here to enter text. 2. Thrombolytic drugs are considered a high-risk medication. Describe both inclusion and exclusion criteria for these drugs. In your own words, describe why it is important to consider these criteria. Click here to enter text. 3. Describe 3 nursing priorities and interventions when caring for an acute stroke patient. Click here to enter text. 4. Describe modifiable risks that put a patient at risk for a stroke. What teaching would you provide to a patient that has modifiable risk factors? Click here to enter text.

Answer 1

1. The NIH stroke scale is used to describe the severity of a stroke. Describe the different components evaluated in this tool. The NIH stroke is a diagnostic tool used to assess the severity of the stroke. It assesses the eleven different elements in the stroke patients and each score between 0 and 4. It has a total score of 42.

1. Level of consciousness: Level of consciousness is assessed by asking simple questions to the patients and is responses are assessed.

2. Best Gaze: It is assessed by moving the object horizontally and the patient ability to move eyes.

3. Visual: Ability of the person to visualize the object by using upper and lower quadrant.

4. Facial Palsy: the ability of the person to raise the eyebrows or to show the teeth or the person assessed by facial expression.

5. Motor arm: The ability of a person to hold the arm at 45 degrees and a 90-degree angle for 10 seconds are assessed.

6. Motor Leg: The ability of the patient to hold the leg at 30 degrees for 5 seconds.

7. Limb ataxia: This test is used to assess the motor center of the brain by using a finger -nose finger, and heel-shin test to assess motor ability.

8. Sensory: The sensory part of the patient is assessed by stimuli.

9. Best Language: The level of aphasia is assessing with the level of fluency, expression of words and language abilities.

10. Dysarthria: Level of slurred speech is assessed.

11. Extinction and inattention: Level of attention of the patient towards the environment.

The score 0 denotes No stroke symptoms and score between 21 to 42 denotes severe stroke.

2. Thrombolitic Drugs:

Inclusion criteria:

• Ischemic stroke with neurological deficit.
• Age greater than 18 years.
• Initial treatment and presence of blood clots.

Exclusion Criteria:

• head trauma prior to 3 months.
• Previous intracranial hemorrhage.
• intracranial neoplasm or aneurysm.
• uncontrolled blood pressure

These criteria are necessary to consider before administering any thrombolytic drug to dissolve blood clots in the brain and to reduce possible risk on patients.

3. Three Nursing priorities and nursing Intervention:

• assess the level of mental status and sensory perception of the patient. Determine the cerebral perfusion and monitor the intracranial pressure.
• Control blood pressure. Increased blood pressure and fluctuation lead to further cerebral injury.
• Assess the physical mobility and daily activities of the patient. It helps to assess the recurrence of symptoms and to prevent it.

4. Modifiable risk factor for stroke:

• Hypertension
• Hyperlipidemia
• Obesity
• diabetes
• Smoking
• Atrial fibrillation

Patient teaching:

Educate the patient to exercise regularly and to eat a healthy diet to control the chronic diseases of hypertension, hyperlipidemia, and diabetes. Engage the patient in a quit smoking program. Educate the patient about the importance of maintaining a healthy weight in order to prevent the risk of stroke.