Contributing factors involved in this

hospitalization such as lifestyle, PMH, FH,

etc:
Not diagnosed with DM but A1C shows prediabetes, Hx of HTN, Tobacco use

Pre-Diabetic

Medications for this condition

(name, route, dose, action)
Humalog SubQ Sliding Scale
lower blood glucose

Hypertension is a modifiable risk

for stroke. HTN is one of the most
common risk factors associated
with stroke and controlling HTN
should be the #1 goal

DM is a modifiable risk for

stroke. Screenings and control
of glucose levels is a goal for
stroke prevention.

Pertinent Physical Examination findings:

Slurred speech
Right facial drooping
RUE weakness
A&O x 3 (disoriented to time)
Trending elevated BP btwn 180-130/92-80
Delayed verbal responses
GCS = 14

Priority Nursing Diagnosis (3 parts)

Impaired mobility r/t ischemic stroke aeb
RUE weakness, decreased muscle
strength, decreased coordination.
Measurable outcome w/ timeframe:
Increased mobility through PT/OT therapy
and inpatient rehabilitation within 2 days.
Nursing interventions you used with
rationales:
1) changed position every 2 hrs
2) Assisted in active & passive range of
motion
3) Assisted in self care
Evaluation: patient was able to turn self, push
up in bed and sit up independently by end of
shift.

Hypertension

Medications for this condition

(name, route, dose, action)
Lisinopril Oral 5mg
Daily - antihypertensive

(D.F. 67 y/o M)

Stroke
Pathograph of this condition
(with pg# from Lewis)
Thrombotic stroke results from the
formation of a blood clot that causes
narrowing of the lumen of a blood vessel
with eventual occlusion and infarction. It
is the most common cause of stroke.

Psychosocial / Spiritual issues

and discharge needs:
Support for change in ALD
Tobacco cessation support

Anticipated patient teaching

required:
Signs & symptoms of stroke
Preventative medications (Aspirin/
Anticoagulant)
Dangers of tobacco use

Medications for this condition

(name, route, dose, action)
Aspirin Oral 325mg Daily anticoagulant
Plavix Oral 75mg Daily -antiplatelet
Keppra Oral 1000mg bid anticonvulsant

Recent laboratory/diagnostic tests results with

significance (i.e. why are they high/low?)
CT scan upon admission showed ischemia damage
to the brain related to stroke
MRI/MRA confirmed bilateral medial occipital lobes
and cerebellar infarct with occlusion of the posterior
circulation indicative of ischemic stroke
CTA day 2 showed basilar artery occlusion stent
placed to correct.
INR = 1 WNL
Glucose = 87 in am,
A1C = 6.2 - indicative of diabetes
1
LDL = slightly above optimal (100) level = elevated
cholesterol level

Guide for Reflection

Guide for Reflection Using Tanners (2006) Clinical Judgment Model
Program Thread: Safe, Quality, Evidence-based practice
Introduction
Patient came into the ED 8 days ago with extremity weakness and trouble swallowing.
Background
Patient has no history of TIA, he has a history of HTN, hyperlipidemia, tobacco use and his A1C upon
admission was 6.2 indicating pre-diabetes/DM.
Noticing
Patient has right sided weakness, right sided facial drooping, slowed verbal response, and is alert and
oriented to person, place, and situation but not time. He is aware of whats going on around him,
sometimes difficult to arouse from sleep, he is tired and wants to rest.
Interpreting
This patients history of hypertension and tobacco use are number #1 modifiable risks for stroke. He
could have had a TIA in the past and been unaware. His increased A1C also indicates that he should
probably be on anti-diabetic medications, he is currently on a sliding scale corrective insulin q6h. He
also has hyperlipidemia which can also contribute to an ischemic stroke.
Responding
This patient has a number of modifiable risks for stroke, in which this stroke could have possibly been
avoided if proper education was given and monitoring of labs were done regularly.
Reflection-on-Action and Clinical Learning
I believe that patient teaching about better controlling his HTN and glucose monitoring is essential to
change these modifiable risks of stroke and to decrease the likelihood of a reoccurring stroke. As well
as tobacco cessation is going to be essential as the patient was unaware of the dangers of tobacco use.

List two goals for the next practicum experience:

1. Relate medical history to current patient conditions
2. Assist with patient discharge teaching, etc.