CVA Scenario

Read over the CVA scenario below and then use your PDA to find information about this condition so you can provide appropriate nursing care.

CVA Scenario:

Sara Williams, a 78 year old woman, has been brought to the Emergency Department (ED) by ambulance with right-sided weakness. Paramedics report that she was drooping on the right side of her face and her upper extremity hemiplegia. She also has a right visual field loss. Mrs. Williams' granddaughter, with whom she lives, states that she noticed a change in the patient approximately one hour prior to calling emergency medical services (EMS). The patient has a history of transient ischemic attacks (TIA), the last one occurring 6 months ago. At that time, she experienced right-sided weakness,which completely resolved. Prior medical history includes atrial fibrillation, coronary artery disease, hypertension, and hyperlipidemia. Home medications include diltiazem hydrochloride XR 180 mg PO once daily, atorvastatin 10 g PO once daily and warfarin 5 mg PO once daily.

Healthcare Provider's Orders:
Cardiac monitor
Continuous oxygen saturation monitoring
Titrate oxygen to maintain SpO2 greater than  92%
CT of head

  • What do the following terms mean? Use the Tabers software to become familiar with these terms:
    • Hemiplegia
    • Transient ischemic attack
    • Atrial fibrillation
    • Coronary artery disease
    • Hypertension
    • Hyperlipidemia
  • Use MosbyLab software to answer the questions below. Select Test by Name in the drop down box. Type in PT. Read over the information provided. Answer the following questions:
    • What does PT measure? Select Test Explanation (TE). 
    • What are other names for PT? Select Alternate Names (AN).
    • What is the normal PT range? Select Normal Findings (NF).
    • What would be considered a critical PT value? Select Critial Values (CV).
  • What is the normal SpO2? Go to MosbyLab and type oxygen. Select  Oxygen saturation. Click on Normal Findings (NF).
  • Your patient asks you if she can eat breakfast before her blood is drawn for the INR. How would you respond?  Use MosbyLab and select Test by Name and then PT.  Secect Procedure (P). 
  • Whart are possible nursing diagnoses for cerebral vascular accident? Use the RnDxInt software. Select Diseases/Conditions in the drop down area. Type in cerebral and select Cerebrovascular Accident (CVA). 
  • Use the DrugGuide software to answer the following quesitons about  Warfarin.
    • Is the dosage ordered in the scenario within the recommended dose range? Select Route/Dosage (Do).
    • What laboratory test is used to adjust Warfarin dosage? Select RouteDosage (Do).
    • Because Warfarin is a high alert mediation, what needs to be done before Warfarin is administered? Select Implementation (Im).
  • Why is the patient given Atorvastatin and Diltiazem Hydrochloride XR.  Use the DrugGuide software.  Select either Main Index or Generic Index. Type in the name of each medication and select Indications (I).
  • Use your Tabers software and type in cerebrovascular. Select cerebrovascular accident and then stroke. Answer the following questions.
    • How many strokes occur in the United States each year?
    • What are the risk factors for stroke?
    • Which of the risk factors were exhibited by Mrs. Williams?
    • What are the symptoms if a stroke?
    • Which of these stroke symptoms did Mrs. Williams exhibit?
  • How can you assess Mrs. Williams ability to swallow? Use the RnDxInt software. Select Main Index and look for Swallowing Impairment. Then access Actions (A)
  • Why do you think that a CT of the head was ordered? Go to MosbyLab and then type in CT and then select CT Scan of Brain. From the menu on the right read the Text Explanation (TE).