Mrs. Smith is a 59-year-old woman who

Mrs. Smith is a 59-year-old woman who was brought to the emergency department by her husband. Mr. Smith noticed that all of a sudden his wife “was slurring her speech and her face was drooping on one side.” Mrs. Smith told her husband that she felt some numbness on the right side of her face and in her right arm. Mr. Smith was afraid his wife was having a stroke so he brought her to the hospital. In the emergency department, Mrs. Smith is alert and oriented. Her vital signs are: temperature 36.7C blood pressure 148/97 pulse 81 respiratory rate 14 An electrocardiogram (ECG, EKG) monitor shows a normal sinus rhythm. Mrs. Smith is still complaining of “numbness” of the right side of her face and down her right arm. Her mouth is noted to divert to the right side with a slight facial droop when she smiles. Her speech is clear. She is able to move all of her extremities and follow commands. Her pupils are round, equal, and reactive to light (4 mm to 2 mm) and accommodation. There is no nystagmus noted. Her right hand grasp is weaker than her left. Mrs. Smith does not have a headache and denies any nausea, vomiting, chest pain, diaphoresis, or visual complaints. She is not experiencing any significant weakness, has a steady gait, and is able to swallow without difficulty. Laboratory blood test results are as follows: white blood cell count (WBC) 8,000 cells/mm hemoglobin (Hgb) 14 g/dL hematocrit (Hct) 44% platelets = 294,000 mm3 erythrocyte sedimentation rate (ESR) 15 mm/hr prothrombin time (PT) 12.9 seconds international normalized ratio (INR) 1.10 sodium (Na2+) 149 mEq/L potassium (K+) 4.5 mEq/L glucose 105 mg/dL calcium (Ca2+) 9.5 mg/dL blood urea nitrogen (BUN) 15 mg/dL creatinine (creat) 0.8 mg/dL. A head computed tomography (CT) scan is done which shows no acute intracranial change and a magnetic resonance imagery (MRI) is within normal limits. Mrs. Smith is started on an intravenous heparin drip of 25,000 units in 500 cc of D5W at 18 mL per hour. She is admitted for a neurology evaluation, magnetic resonance angiography (MRA) of the brain, a fasting serum cholesterol, and blood pressure monitoring. Upon admission to the nursing unit, her symptoms have resolved. There is no facial asymmetry and her complaint of numbness has subsided. Questions: 1. The neurologist’s consult report states, “At no time during the episode of numbness did the client ever develop any scotoma, amaurosis, ataxia, or diplopia.” Explain what these terms mean. 2. Discuss the pathophysiology of a transient ischemic attack (TIA). Include in your discussion what causes a TIA and the natural course of a TIA. 3. Mrs. Smith asks, “How is what I had different from a stroke?” Provide a simple explanation of how a transient ischemic attack (TIA) differs from a cerebrovascular accident (CVA, stroke). 4. Discuss the defining characteristics of a transient ischemic attack (TIA). 5. When told that her cholesterol levels are elevated, Mrs. Smith asks, “I always see commercials on television saying you should lower your cholesterol. What is cholesterol anyway?” How could the nurse explain what cholesterol is and why it increases the risk of heart disease and stroke? 6. Provide a simple rationale for including intravenous heparin in Mrs. Smith’s treatment plan. And calculate how many units she is receiving per hour. 7. Identify the potential life-threatening adverse effects/complications of heparin therapy and the treatment of heparin toxicity or overdose. 8. What is the major complication associated with a TIA? 9. Atorvastatin 10 mg PO per day is prescribed for Mrs. Smith. Explain the therapeutic effects of atorvastatin. 10. What type of lifestyle modifications should the nurse discuss with Mrs. Smith (and her husband) prior to discharge? You also are assigned another patient, Mr. Banks. He is admitted for infection NYD. He rings the call bell and a colleague checks in on him. Your colleague approaches you and says: “Mr. Banks is diaphoretic and is complaining of being SOB. 11. Which patient would you see and assess first and why? On Mr. Banks assessment, he is diaphoretic, SOB, and cool and clammy to touch. His vital signs are: Temp: 38.2 RR: 28 SpO2: 85% BP: 90/70 Pulse: 112 12. Given these findings, what would your interventions be and why? List them in priority sequence. 13. What do you think is happening with Mr. Banks and why?

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