PNH301 Exploring Stroke: Beyond the Case Study
1. How would you differentiate a stroke from a TIA?
2. What risk factors would the nurse assess for?
3. What are the expected nursing diagnoses for a patient who has had a stroke?
Identify the highest priority diagnoses by labeling them HP.
4. What nursing interventions would the nurse implement for a patient with an
acute stroke? What about a patient engaged in stroke rehabilitation? Identify
each intervention as
A=acute,
R=rehab or
AR=both acute and rehab.
Neuro: CV:
Resp: GI:
GU: Skin:
EENT: Psychosocial:
5. Explore the discussions between the nurse/family/physician and options related
to Advanced Directives. What are the Advanced Directives from your current
clinical placement? What is the process for initiating ADs? What does the CNO
say about the nurses role in Advanced Directives?
6. Discuss the changes in anticoagulation therapy that have occurred over the past
few years.
S.B. is a 17 year-old male who lost control of his car and struck a tree. Witnesses
reported that he was not restrained, and his face hit the windshield on impact. When
paramedics arrived, S.B. was responsive but confused, has significant facial swelling, and
reported pain in his right wrist and left forearm. The paramedics initiated cervical spine
(C-spine) precautions, strapped him to a backboard, started oxygen (O2) at 15L/min via
nonrebreather mask, and started a 16 gauge IV with 0.9% normal saline (NS). His vital
signs (VS) were 120/75, 125, 36, SaO2 94%. On arrival to the ED 5 minutes later his VS
were 110/62, 110 (reg), 28-32 and shallow, SaO2 99%. An additional 16 gauge IV was
inserted and the following labs were drawn: CBC, type and crossmatch, (T &C), complete
metabolic panel (CMP), PT/PTT INR, and alcohol (ETOH) level.
The trauma physician completed a head-to-toe assessment and found the following:
obeys commands, responds to voice but not oriented to time or place. Generalized
facial edema with full-thickness 2-cm cheek laceration and bilateral mandibular
depressed fractures. Blood behind left tympanic membrane (TM), edema with slight
discolouration over left mastoid process. Clear drainage coming from the left nare. Mid
to upper chest contusions without crepitus, breath sounds clear. Abdomen slightly firm,
but not tender. Catheterized for 500ml clear yellow urine; negative for blood, glucose,
ketones. Positive deformity of right wrist and diffuse tenderness of left lower forearm.
Questions
1. On arrival, S.B. had slight discolouration over the left mastoid process, blood behind
the left tympanic membrane, and drainage from the nose. What is the significance of
these findings?
2. What are the typical signs and symptoms (S/S) of a BSF?
3. Identify two complications associated with BSF.
4. The term raccoon eyes is frequently used when describing someone who has a BSF.
Explain the term raccoon eyes.