Nursing Care Plan of a Patient with Embolic CVA Essay

Summary of Admission History and Progress Notes 67-year-old young-begetting(prenominal) has a history of non-ischemic cardiomyopathy with ejection factor of 24%, inveterate left ventricle thrombus on anticoagulant, hypertension, metastasis of prostate cancer, chronic kidney disease detail 3. forbearing was admitted to UCSD emergency department on 08/20 after(prenominal) move down stairs. Patient presented confused but conscious. Upon presentation in the ED he had left face, left arm, and left leg weakness. After magnetic resonance imaging and intellectual angiogram, findings were conclusive to a right hand-sided embolic cam stroke. Echocardiogram pick uped apical ventricular thrombus. Patient presented to ED on Coumadin therapy with INR at 3.1.Patient was not a candidate for thrombolytic therapy. He continued on Coumadin and acetylsalicylic acid 81 milligrams was added. Left-sided weakness resolved within one to two days. heart surgeon at UCSD recommends Cardiac Thrombectom y to encumber further knocks. Neurologist recommends endovascular intervention to prevent future embolic strokes though not during an discriminating episode. Patient was held at UCSD ED for permissive hypertension during acute stroke. Patient complained of cough with unripe phlegm over the past few days chest roentgenogram findings of no local infiltrate.PathophysiologyEmbolic cerebral vascular accident (CVA) stroke Etiology/Risk factors Risk factors include a history of flying ischemic attack, hypertension, elevated serum cholesterol, diabetes mellitus, smoking, cardiac valve diseases, anticoagulant therapy, oral incumbrance use, methamphetamine use, aneurysm, or previous stroke (Swearinger, 2012).Pathophysiology A stroke is exampled by disruption of oxygen supply to the foreland by either thrombotic occlusion, embolic occlusion or cerebral hemorrhage. Most thrombotic strokes are the result of atherosclerosis. brass formation builds to the point of blockage in the large blo od vessels that vend blood to the star. Most embolic strokes are caused by a cardiac emboli resulting from cardiac valve disease or atrial fibrillation. The carotid artery feeds the important blood vessels of the brain, therefore cardiogenic emboli have a direct path to the brain (Swearinger, 2012).S&S Signs and symptoms vary depending on severity and side of brain affected. Symptoms may improve within 2 to 3 days as cerebral edema decreases. Patient may appear apathetic, irritable, disoriented, drowsy or comatose incontinence may occur unilateral weakness or paralysis may occur headache, neck stiffness or inflexibleness may be present. The long-suffering may have difficulty jaw or swallowing and may present with unequal or fixated pupils (Swearinger, 2012). diagnostics cadence is critical in diagnosing the type of stroke a patient has experienced. A patient is no longer eligible for rTPA if the critical window of 3 hours from last seen recipe has expired. CBC, electrolyte s, blood glucose and turnting factors should be raddled immediately in order to determine eligibility for rTPA. An MRI leave alone reveal the site of infarction and other brain structure abnormalities related to cause and effect of the CVA. An MRI may take as long as an hour to complete. While a CT scan is generally a diagnostic tool of choice in many emergency situations referable to the rapid process, ischemic areas will not show in the CT imaging until they start to necrose 24 48 hours after the CVA (Swearinger, 2012).Complications Complications include recurrence of CVA, paralysis, aspiration, depression, falls, and coma.Chronic left ventricle thrombus on anticoagulant Anticoagulant therapy is prescribed to prevent increased formation of existing thrombi. extraneous of the hospital environment, the anticoagulant of choice is usually warfarin because it may be taken PO. When the therapeutic range of warfarin is achieved patients INR will be 2.5-3.5. Cardiogenic trombi are t he result of the hearts inability to efficaciously ejecting blood after managed daily living, therefore the blood becomes stagnant and begins to clot (Deglin , Sanoski , & Vallerand, 2013).Chronic kidney disease (CKD) stage 3 is marked by a GFR 30-59 mL per minute (Bladh, et. al., 2013). CKD is a progressive and irreversible disorder. Aggressive direction of Hypertension and Diabetes Mellitus, both of which are common contributing risk factors, may slow progression. Eventually CKD can progress to end-stage renal failure (ESRD). in front development of ESRD, a person with CKD can still manage normal daily living through diet and medication (Swearinger, 2012).Diagnostic Tests, Results and RationalesDiagnostic TestsResultsRationalesMRISeveral areas of restricted diffusion within right MCA sphere consistent with acute embolic infarcts MRI images differentiate between acute and chronic lesions. Ischemic strokes can be identified early. Site of infection, hematoma, and cerebral edema can be viewed through MRI(Swearinger, 2012) Cerebral angiogram decently MCA stroke, right internal artery non-flow limiting dissection with associated pseudo-aneurysm right superior dust M3 occlusion Identify presence of hematoma in stasis of blood vessels after a rupture (Swearinger, 2012) Chest x-rayNegative for infiltrateA presence of infiltrate could indicate pneumonia or heart failure (Swearinger, 2012) Echocardiogram disadvantageously depressed left ventricular ejection factor apical ventricular thrombus Assess ventricular and valvular function of the heart, ejection fraction, and hemodynamic measurements (Swearinger, 2012) Cerebrovascular carotid duplexLow flow right ICA bilateral proximal ICA right 9.5 mm, left 5.5 mm no significant stenosis vertebral arteries evident with antegrade flow Evaluation of carotid arteries to detect occlusions three-dimensional visualization providing data on circumference, length, and thickness of plaque volume (Swearinger, 2012)