Nursing 135

Critical Thinking Questions

1. What other information would be necessary for evaluating the cause of CVA?

Vital signs, gag or cough reflexes, heart sounds, breath sounds and any respiratory changes, any recent trauma, cholesterol levels, family hx, weight and height, any alcohol consumption, is she a smoker.

2. If her deficits are temporary, how long might it take before they are completely reversed?

No longer than 24 hrs if temporary. However, if s/s are more pronounced than a TIA and last more than 24 hrs, symptoms should resolve in days with no permanent neurologic deficits.

3. Why was N.T placed on clipidogel post CVA?

Clopidogrel is a secondary prevention of MI, stroke, and vascular death in pts with recent MI, stroke, unstable angina or established peripheral arterial disease.

4. Why was the initial CT scan negative for stroke?

A possible reason could have been the inability of the pt to cooperate or remain still during the procedure because of age, significant pain or mental status or incorrect positioning due to lt sided hemiparesis.

5. N.T. is not discharged on estradiol post CVA, why would this medication be discontinued?

Blood clots are an occasional but serious adverse effect of estradiol.

6. Is there any benefit from continuing simvastin after her CVA?

Yes, simvastatin is a cholesterol lowering medicine. Lowering LDL cholesterol levels helps stop progression and may reverse coronary artery disease.

7. Is there treatment that can be initiated in the ED to stop a CVA from progressing?

The penumbra area can be revitalized by administration of tissue plasminogen activator (t-PA) and the influx of calcium can be limited with the use of calcium channel blocker.

8. Which of the following is not a symptom of CVA?

Lumbar pain

9. As you walk to the nursing station, the charge nurse is talking to N.T.'s

doctor. She ordered a modified barium swallow study and referral for speech - language pathologist, OT (occupational therapist), and registered dietician. Give rational for these orders.

Barium swallow-to prep for radiographic