Posted: September 15th, 2015

Cerebrovascular Accident (CVA)

During the early hours of the morning, Jocelyn Maldrin experiences a mild headache over the right temple, is fatigued and feels slightly weak. Jocelyn is a 68 year old woman who is usually in good health. Jocelyn calls her husband for help. When her husband approaches her he finds her experiencing difficulty in saying words and she has a slight left-sided facial droop. When her husband tries to help her up from the bedside he notices weakness in her left hand. Her husband immediately drives her to the local emergency department.
Upon assessment in the emergency department, it is confirmed that Jocelyn has had a CVA. Jocelyn’s past medical history consists of Hypertension and Deep Vein Thrombosis. Her medications prior to the CVA included HRT (hormone replacement therapy), Aspirin, Zocor and Plavix. The physician in the emergency room reviews her medications and sends Jocelyn to your medical unit where you are her nurse.
QUESTIONS
1. What other information would be important to collect for evaluating the cause for the CVA?
2, If Jocelyn’s deficits are temporary, how long might it take before they are completely reversed?
3. The physician prescribes Plavix post CVA? Why do you think he prescribed this for Jocelyn?
(4).Jocelyn is not placed on HRT post CVA. Why would this medication be discontinued?
(5),What treatment that can be initiated in the emergency department to stop a CVA from progressing?
(6) Jocelyn has been on your unit for 3 days and has now stabilized. She is starting to regain some strength to her left-sided limbs. The physician orders a modified barium swallow study and a referral to the speech language pathologist. She has also been referred to the OT (occupational therapist) and RD (registered dietitian). Provide rationales for each of these orders/referrals.
(7). As part of discharge planning, you are asked to advise Jocelyn of local resources and community centres in her area. What type of resources and community centres are available for people who are discharged and need a controlled exercise program?

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