Chapter 9

Stroke Case Study Answers

1. How does the Sandra’s health history put her at risk for a stroke? How can the RN address the client’s concerns and fears regarding the possibility of having another stroke?

• Stroke is more common in women than men.
• Stoke is more common in American Indians.
• Hypertension and high cholesterol put her at risk.
• Has a history of what could have been a TIA.
• The RN can discuss lifestyle changes and teach the client the signs and symptoms of stroke for early recognition to help alleviate fears.

2. What lifestyle modifications may Sandra have to make?

She will need to take her cholesterol and hypertension medications. She may need to change her diet to manage cholesterol.

3. Is Sandra a candidate to receive tPA? Why or why not? Provide the rationale for your response.

She is not a candidate because the requirement is that the client needs to receive the medication within 4.5 hours from when “last seen as normal.” The time of her stroke was unknown.

4. What diagnostic tests and medications can you expect the client to receive?

The client will receive a CT scan upon arrival to the emergency room. They may also receive an MRI or MRA to determine extent of brain injury. They may also receive a carotid ultrasound, PT/INR to assess bleeding times, and a cardiac echocardiogram to look for clots and atrial fibrillation. ABCs are assessed and monitored, as are physical assessments and frequent neurological assessments by the nursing staff. They will also assess swallow function and start anticolagulant medications. 

5. How will homonymous hemianopsia affect Sandra’s hygiene, ability to drive, eat, and participate community activities?

She is missing some of her field of vision in each eye, affecting her ability to see peripherally for driving, and her ability to see for eating, performing hygiene, etc. She will need to move her head more to be sure she is seeing everything when eating, bathing, and doing community activities.

6. What additional assessments can the nurse make to develop interventions to help Sandra and her husband cope with this change in Sandra’s health status?

The nurse will want to assess level of consciousness, physical strength/mobility, swallow ability, communication, and emotional status. Bowel and bladder function may be affected as well, so this will need to be evaluated.

All of the answers to the interactive element are found within the element.