Your client is a 63 year old female patient who arrived via…
Your client is a 63 year old female patient who arrived via EMS with right sided arm weakness, right facial droop and slurred speech. History and Physical History and Physical The client is a 63-year-old, African-American female with a history of Diabetes Mellitus type II, hypertension, and rheumatoid arthritis. Due to aphasia, her spouse is answering questions for her at the bedside. Husband states that the client was in her usual health the night prior and went to bed around 2200. They woke around 0500, the client walked her dog and came back inside. She then poured 2 cups of coffee and carried one in each hand to the table and sat with him to watch the 6:00AM news. She was able to converse normally and he did not notice any slurred speech or facial drooping. At approximately 0630 the client noticed that she could not hold her makeup brush with her right hand. Her spouse noticed that her face was drooping. The spouse called 911 and she was transported to the Emergency Department. Nurses Note: Client assessed quickly at the ambulance bay doors and stroke alert initiated. Client is alert and oriented x 3 with slurred speech and some word finding difficulty. The client is unable to lift or maintain gravity in right arm or and right leg. Drooping to the right side of the face noted and is tearful. Healthcare provider at bedside. 07/05/20XX 0712: Client assessed quickly at the ambulance bay doors and stroke alert initiated. Client is alert and oriented x 3 with slurred speech and some word finding difficulty. The client is unable to lift or maintain gravity in right arm or and right leg. Drooping to the right side of the face noted and is tearful. Healthcare provider at bedside. Vitals Reference Range Vitals 07/05/20XX 0712: Temp: 98.6*F Pulse: 99 Respirations: 22 Blood Pressure: 180/118 O2 Saturation: 98% on Room Air NIHSS 07/05/20XX 0712: 10 After the healthcare provider leaves the room, the client is able to speak a few words and states that she has a history of atrial fibrillation and also had her gallbladder removed 4 months ago. The client begins to moan, hold her head, and complains of extreme pain in the back of her head. The pharmacy called to state that they will be mixing the thrombolytic and sending it. The lab has called with the stat laboratory results: Lab Result Reference Range White blood cell 6.4 Hemoglobin 13.3 Hematocrit 39 Platelet 180,000 PT 11 INR 1.1 Nurses Notes: 07/05/20XX 0810 – Client to radiology for repeat CT without contrast to rule out hemorrhage due to reported sudden onset of headache. CT results: no evidence of hemorrhage. 07/05/20XX 0820: Client returns from Radiology and placed on bedside telemetry monitoring. Client remains in Atrial fibrillation Vitals Reference Range Vitals 07/05/20XX 0820: Temp: 98.6*F Pulse: 99 Respirations: 22 Blood Pressure: 180/118 O2 Saturation: 98% on Room Air NIHSS 07/05/20XX 0820: 10 Heathcare provider at the bedside and orders to lower the blood pressure before administering thrombolytic to reduce the risk of hemorrhage. Nurses Note: 07/05/25 0830 – Client resting quietly. Right side remains weak, unable to maintain gravity in right arm and right leg, speech is slurred with some word finding difficulty. Client remains in A-fib on the monitor with a rate of 90. Healthcare provider orders to administer thrombolytic – Tenecteplase 20 mg IV. Telemetry monitor to cycle every 15 minutes. Vitals Reference Range Vitals 07/05/20XX 0830: Temp: 98.6 Pulse: 90 Respirations: 20 Blood Pressure: 141/89 O2 Saturation: 98% on Room Air Nurses Note: 07/05/25 0910 – Client is improving and now able to maintain gravity in all extremities, slurred speech continues with dysarthria noted. Client denies pain or discomfort, lungs are clear with no shortness of breath, has urinated with assistance on bedpan, urine clear and yellow. The health care provider has ordered admission to ICU for further monitoring. Vitals Reference Range Vitals 07/05/20XX 0910: Temp: 98.6 Pulse: 88 Respirations: 20 Blood Pressure: 138/82 O2 Saturation: 98% on Room Air NIHSS 4 Your client is steadily improving and will likely stay for 3-4 days depending upon her continued improvement. During her hospital stay, which diagnostic tests do you anticipate will be ordered in effort to determine the cause of the stroke? Select all that apply.
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