1. What role do diagnostic tests play in evaluating N.T. for a suspected CVA?

It assists in testing if the brains have been damaged in the incident of body changes. It also

checks if there are bleeding in the brain due to cerebrovascular accident (CVA). Diagnostic

tests make the doctor know the pressure level of the patient.

Noncontrast computed tomography (CT) scan is the primary test used to diagnose a stroke.

CT can indicate the size and location of the lesion and differentiate between ischemic and

hemorrhagic stroke.

2. Explain how knowing the type of CVA is an important factor in planning care.
Knowing the type of CVA is an important factor in planning care to the patient because knowing

the type of stroke the patient had will determine the medical treatment for the patient. For

example, the drug therapy for Ischemic Stroke is the administration of tPA (recombinant tissue

plasminogen activator) to reestablish blood flow through a blocked artery to prevent cell death in

patients with the acute onset of ischemic stroke. tPA must be administered within 3 to 4.5 hours

of the onset of clinical signs of ischemic stroke. In the other hand, anticoagulants and platelet

inhibitors are

3. Which factor in N.T.'s history is the most likely contributor to her having experienced a

CVA?

Her age and high blood pressure is the biggest risk factor for CVA. The risk of CVA varies

directly with blood pressure. The more the heart pumps blood, the higher the pressure the blood

forces upon the walls of the artery, In N.T.’s case, she had other contributing factors, like the

hyperlipidemia, which increases fat in the blood, and atrial fibrillation, which makes the heart

beat fast and irregularly. The cholesterol in the blood could have causes atherosclerosis, causing
blood clotting in the artery. The atrial fibrillation could have formed the clot with the slow blood

flow and caused the clot to travel to the brain.

 
4. Outline a plan of care for implementing these orders.

   Inform N.T that the doctor diagnosed her with Thrombolytic CVA and the course of

treatment the doctor has ordered.

Ensure that N.T understands her diagnosis and is comfortable with the procedures.

 Inform N.T that a neurologic assessment will be done every hour and to find out

symptoms of her thrombolytic stroke.

4  Have suction equipment available at bedside, as a safety precaution.

5. Which interventions can you delegate to the nursing assistive personnel (NAP)? Select all

that apply.

a. Obtaining N.T.'s weight

b. Assisting N.T. in repositioning every 2 hours

e. Obtaining a manual BP per protocol

The NAP cannot perform a neurologic check or set up oxygen therapy.

6. What is the purpose of monitoring the CPK isoenzyme levels?

Creatine phosphokinase (CPK) is an important enzyme for muscle function. The CPK

isoenzymes test is a way to measure the levels of this enzyme in the bloodstream. CPK can be

broken down into three separate parts: CPK-1 is mainly found in the brain and lungs, CPK-2 is

mostly found in the heart, CPK-3 is found in the skeletal muscle. When these parts of the body

become damaged due to injury or disease, CPK enzymes can be released in the blood. This can

help the health care provider to identify the areas of the body that have been damaged.
6 Neurologic Disorders
7. Complete the National Institutes of Health Stroke Scale (NIHSS) scores for each of
N.T.'s symptoms.

TOTAL SCORE 12

[Link] on your scoring, what level of CVA did N.T. experience?

[Link] instructions on the tPA vials read to reconstitute with 50 mL of sterile water to make
a total of 50 mg/50 mL (1 mg/mL). The hospital protocol is to infuse 0.9 mg/kg over 60
minutes with 10% of the dose given as a bolus over 1 minute. N.T. weighs 143 pounds.
What is the amount of the bolus dose, in both milligrams and milliliters, you will
administer in the first minute? What is the amount of the remaining dose that you will
need to administer?
Amount of the bolus dose is 5.84 mg and 5.84 mL.

Remaining dose of the drug to be administered is 52.26 mg.

10. Contraindications for beginning fibrinolytic therapy include which of the following?
Select all that apply.

a. Currently on Coumadin with an INR of 2.4

b. Major surgery in the last 14 days

d. Platelet count of less than 100,000

e. Blood glucose of less than 50 mg/dL

f. History of myocardial infarction 1 year ago

g. Improving neurologic status

6 Neurologic Disorders
11. What are your responsibilities during the administration of Activase (tPA)?

Monitoring the patient is critical when administering Activase (tPA). The nurse should:

 Proper dosage administration based on patient’s weight

 Restrict use of sodium nitroprusside as it can increase intracranial pressure.

 Monitor B/P and vital signs

 Check for major and minor bleeding--including occult blood

 Notify MD to discontinue infusion and obtain an emergency CT scan when patient

develops severe headache, acute hypertension, nausea, vomiting, or worsening neurologic

examination

 Monitor for signs of orolingual angioedema - therapy should be discontinued if

angioedema is present

 Some other precautions include: cholesterol embolization, unreliable coagulation tests,

and adverse allergic type reactions.

12. If N.T.'s deficits are temporary, how long might it take before they completely reverse?

Recovery time depends on the severity of the stroke. If blood circulation is restored in minutes to hours,

the deficits will reverse within hours to a day. Small thrombotic stroke deficits resolve within a few days.

If the blood circulation is interrupted for more than a few hours, it may be necessary to have physical

rehabilitation When there is permanent brain damage causes permanent disability.

In N.T’s case of Thrombotic CVA, temporary mild deficits usually take up to 6 months to one year to

completely reverse.

13. During the first 24 hours after receipt of Activase (tPA), the primary concern is
controlling N.T.'s:

BP

14. While assessing N.T., you note the following findings. Which one is unrelated to the
CVA?

Lumbar pain

15. Why was N.T. placed on clopidogrel (Plavix) post-CVA? 

of stokes. Secondary prevention of MI, stroke, and vascular death in patients with recent MI,

stroke, unstable angina or established peripheral arterial disease.

16. Because N.T. had a thrombolytic infusion, how many hours should you wait before
beginning administration of any anticoagulant or antiplatelet medications?

The thrombolytic agent dissolves the clot; the anticoagulant prevents any more clots from

forming. In a condition with thrombolytic infusion, one should wait for 24 hours before

administering any anticoagulant or antiplatelet medications, as there is a risk for bleeding. The

use of anticoagulant will delay the treatment.

17. Is there any benefit from continuing simvastatin (Zocor) after her CVA?

There are benefits to continuing simvastatin (Zocor) after her CVA. The indication for Zocor is

adjunctive management of primary hypercholesterolemia and mixed dyslipidemias. Zocor will

reduce liver cholesterol formation and lower lipid content on the arteries. Patients with a

risk/history of stroke should be prescribed this medication to prevent future occurrences of CVA.

It is for a patient to continue using simvastatin (Zocor) after her CVA since it contributes much

to reduce the risk of stroke to patients who are a high risk of attaining vascular attack.

18. As you walk into the nurse's' station, the charge nurse is coordinating the swallowing
evaluation, including a modified barium swallow study and referral for a speech-language
pathologist (SLP). Give the rationale for these orders.

The importance of SLP is to make the diagnosis of dysphagia, recommend the optimal food texture and

also recommend the safest position in eating. Additionally, it assists to determine the liquid consistency in

preventing aspirations.
A modified barium swallow study is to evaluate the swallowing process of a patient who has difficulty

speaking or swallowing food  (dysphagia) and that are risk for aspiration. The patient will swallow a

barium containing meal (foods or liquids).