Case Study: Cerebral Vascular Accident (CVA)

Scenario: At 0645 John Jacobs, a 65 year old African American male, is admitted to Miami University Hospital. He was seen in the Emergency Department with the following symptoms: right sided hemiparesis, homonymous hemianopia, expressive aphasia. He is drowsy, his weight is 230 lbs. and he is 5 ft. 11 in. tall with BP 200/120. He has a history of cocaine abuse in his past and drinks alcohol on a regular basis. He is scheduled for a CT scan and cerebral angiogram prior to admission to the floor to rule out cerebral vascular accident (CVA). His wife accompanies him and states, “I found him unconscious on the floor in the bathroom.”
Focus Questions:

1. What are the risk factors in this case? Describe how they might contribute to the development of cerebral vascular accident (CVA).
2. What other data would you want to collect related to possible risk factors?
3. Describe what hemiparesis, homonymous hemianopia, and expressive aphasia will mean in relationship to nursing care.
4. How should the nurse prepare John and his wife now for the CT scan and later for the angiogram?

Scenario: John has had all of his tests completed. He has a blockage of the middle cerebral artery. He is started on Vasotec, Heparin, and Dilantin
Focus Questions:

1. What are the nursing diagnoses (NANDA) for John and what interventions does he need to improve his status?
2. What are the rational for John receiving each of the medications listed above?
   Scenario: Day of discharge. Medications for discharge include: Dilantin 300mg daily, Vasotec 10 mg daily, Plavix 75 mg daily and all medications are given orally, and Tylenol 1000mg q4h prn for headache. Continue with PT/OT 3x/week. His wife seems overwhelmed with the thought of taking care of John at home. She is especially concerned about his dysphagia.
   Focused Questions:
3. How would the nurse explain the medications to John and his wife at discharge?
4. What is dysphagia? Explain interventions the wife could use to help with his eating.
5. As a coordinator of care, how might the nurse plan for John’s discharge?
6. what recommendations do you think this patient needs?

Sample Solution