9.13 Learning Activities

Stroke Case Study (Case Study answers are located in the Answer Key at the end of the book.)^[1]

Sandra is a 66-year-old, Native American female brought to the emergency department by her husband. She awoke in the middle of the night and fell when she tried to walk to the bathroom because she could not control her left leg. In the Emergency Department, she was diagnosed with an acute ischemic stroke, but the actual time of the stroke was unknown.

Subjective Data:

• States left arm and left leg feel weak and numb
• Reports feeling depressed and anxious
• Concerned about having another stroke
• States she has not taken her medications for high cholesterol for many weeks and forgets to take her hypertension medications every day
• Reports a brief episode of left-sided weakness and tingling of the face, arm, and hand three months earlier, which she verbalizes “totally resolved” and for which she did not seek treatment

Objective Data:

• 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
• BMI of 29
• Alert and oriented and able to verbally respond to questions appropriately but noticeable delay with verbal responses
• Appears tearful and anxious
• Requires help to perform ADLs

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?
2. What lifestyle modifications may Sandra have to make?
3. Is Sandra a candidate to receive tPA? Why or why not?  Provide the rationale for your response.
4. What diagnostic tests and medications can you expect the client to receive?
5. How will homonymous hemianopsia affect Sandra’s hygiene, ability to drive, eat, and participate 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?