Patient Background
What was Marco's chief complaint when he arrived at the hospital?
Slurred speech and memory loss while at work
What abnormal neurological findings were noted on Marco’s exam
Left-sided facial droop and weakness
What imaging test is first used to rule out a hemorrhagic stroke?
CT scan of the head
What is the main “clot-busting” drug used in Marco’s treatment?
Tissue Plasminogen Activator (tPA)
What does the “F” in the FAST acronym stand for?
Face - look for drooping on one side when smiling
What are TWO key risk factors in Marco’s history that increase his stroke risk?
Hypertension and high cholesterol
What was Marco’s blood pressure reading upon arrival
170/88 mmHg
What is the purpose of the NH Stroke Scale?
To assess the severity and progression of the stroke
Within how many hours from symptom onset should tPA be administered?
Within 3-4 hours (goal 60 minutes upon hospital arrival)
What lifestyle changes should Marco make to prevent another stroke?
Quit smoking, eat a heart-healthy diet, and exercise regularly
What type of stroke did Marco experience based on his symptoms and diagnostics?
Embolic (ischemic) stroke
Which body systems were primarily affected by Marco’s stroke
Cardiovascular, Musculoskeletal, and nervous system
Why is blood glucose checked during stroke evaluation?
To rule out hypoglycemia, which can mimic stroke symptoms
Name one adverse effect and one nursing precaution for tPA administration
A/E: Bleeding
Precaution: implement bleeding precautions and monitor coagulation
What are common complications after a stroke that Marco should monitor for?
Weakness, speech problems, confusion, and vision changes
Describe one social determinant of health that may positively influence Marco’s recovery
Economic stability and strong family support
Why is it important to check for pupil equality and reactivity in a stroke patient?
It helps assess neurological function and detect possible brain injury
What is the rationale for performing a CT angiogram or carotid ultrasound?
To identify blockages or clothes in blood vessels supplying the brain
What secondary medication was started after tPA to prevent further clot formation?
Aspirin (anti-platelet)
Why are follow-up appointments with physical and speech therapy important?
Regain strength, coordination, and communication skills post-stroke
Explain how Marco’s lifestyle (smoking and diet) may have contributed to the pathophysiology of his stroke
Smoking damages blood vessels, which increases clotting and a high-fat diet raises cholesterol and plaque buildup
Marco’s O2 saturation was 94%, explain the significance of this finding?
It indicates slightly decreased oxygenation, which can worsen cerebral ischemia if not monitored
Based on Marco’s case, differentiate between embolic and thrombotic ischemic strokes
Embolic strokes are caused by a clot traveling from another site (heart in a-fib)
Thrombotic strokes are caused by local plaque buildup and clot formation within cerebral arteries
What medication would you anticipate if Marco had A-Fib
Warfarin
*Warfarin reduces clots from forming therefore prevents a stroke
Create a SMART goal for Marco’s stroke recovery related to blood pressure management
Marco will maintain his BP below 130/88 mmHg within 3 months by taking prescribed medications
Follow a low-sodium diet