Case Study Of Action: Code Stroke In Action

2124 Words 9 Pages
Code Stroke in Action
Kathryn Sheehy
University of San Diego
MEPN 560 April 6,2015

Code Stroke in Action The clock just struck 0752 in room five of the Emergency Department when the medics called in. They reported that they had an eighty-two year-old female, who had initials K.R., demonstrating left sided facial droop and aphasia. According to the ACLS stroke scale, if one has facial droop, difficulty speaking or arm drift they are 72% likely to have a stroke (Carl). Her last known time of baseline was at 1920 the previous night. Because strokes can lead to permanent damage of the brain it is vital that quick and smart action is taken. Delaying emergency care for the patient could lead to lifetime disability and possibly
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She was an elderly female, which increased her risk, but she also had atrial fibrillation, which is an irregular heartbeat, that is often not effective for cardiac function ((Urden, Stacy & Lough 649). Because of her heart condition, she was on Warfarin, an anticoagulant prescription medication, which was intended to prevent clots from forming and causing complications like pulmonary embolism or stroke (Fiumara & Goldhaber, 2009). Warfarin does not work by thinning the blood, but simply prolongs the time it takes for the blood to clot. When patients are taking Warfarin it is important to educate them and their caretaker about consistency of their Warfarin dosage as well as the benefit of regularly checking their international normalized ratio (INR) to insure that the patient’s INR is within it’s goal range. The INR informs the patient and the doctor about the effectiveness of the medication dosage. K.R’s INR levels resulted as 1. For someone who is not on Warfarin, the INR levels are supposed to be controlled below 1, but for those who are taking Warfarin, their INR levels are to be kept between 2-3. The patient’s husband informed the nurse and doctor that he has not strictly adhered to the patient’s medicine regimen over the past week due to her disinterest in taking her pills. This is most likely the cause of the stroke. Her past medical history of smoking and high blood pressure were …show more content…
Ischemic stroke protocol involves t-PA to obliterate the clot and return blood to the brain. Early management of ischemic strokes may include interventional radiology, which may perform an intra-arterial thrombolysis and mechanically remove the clot form the artery. After any procedure is completed, it is vital that anticoagulant therapy, hypertension, blood glucose and intracranial pressure is controlled and monitored. Patient K.R. had an ischemic stroke, but as previously stated, her symptoms began more than four hours ago; therefore, she was excluded from the t-PA procedure. Since she was not eligible, her stroke management protocol was different. The nurse insured that the patient’s systolic pressure was under 220mm Hg and that the diastolic pressure was between 121-140mm Hg (American Heart Association). She received isotonic fluids to fluid resuscitate her, adequate airway and SpO2 was maintained, adequate circulation and perfusion was maintained, and neurological assessments were completed every 30 minutes (American Heart Association). The patient’s other symptoms such as headache, pain and nauseas were treated (Carl). The patient’s family was kept in close communication with the emergency room doctors and with the nurses to insure that they were well acquainted with the plan of care. The patient’s family was also re-educated about

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