Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

CASE SCENARIO:
ACUTE ISCHEMIC STROKE

Patient Information:
Name: Patient M
Age: 61 y/o
Sex: Male
Civil Status: Married
Religion: Roman Catholic
Nationality: Filipino
Birthdate: September 5, 1959
Blood Type: AB+

History of Presenting Condition

Patient M is a 61-year-old Senior Partner in a Law Firm. While eating his breakfast Patient M
experienced sudden onset of slurred speech, had facial drooping, with weakness in his left side upper
and lower limbs. His wife witnessed the onset of symptoms and immediately called for an ambulance.

Past Medical History

Asthma – Diagnosed Aged 8
Hypertension Grade 1 – Diagnosed 5 years ago
Prediabetes – Diagnosed 3 years ago

Medication History
Seretide Accuhaler
Ventolin (As Required - Not Required for over 1 Year)
Thiazide Diuretic
Amlodipine, Losartan and Atorvastatin however with poor compliance
Oral Hypoglycemic Agent (Metformin) non-compliance

Social History
• 61-Year-Old Senior Partner at a Law Firm recently reduced working hours 20 -
30 hours per week, previously worked 50 - 60 Hours.
• Planning on retirement in 1 - 2 years
• Living with his wife who is a retired teacher.
• 2 Adult Children both married and now with their own family - 1 lives close by, the other lives
overseas.
• Lifestyle changes implemented over the past 2-3 years following Diagnosis of Prediabetes.
• Outside work he enjoys golf, usually playing at least 2-3 per week. Also enjoys playing Casino
with Friends.
• History of Smoking 30 Years x 10 – 15sticks/day – Stopped smoking 3 Years ago when
diagnosed with prediabetes.
• Occasionally drinks alcohol.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

❖ Pre-Hospital Assessment/Assessment by Emergency Response Team:

Vital Sign:
BP: 140/90mmHg
Pulse: 75 bpm

Physical Exam:
⮚ Left Facial Drooping
⮚ Left Motor Weakness: Upper Limb 0/5, Lower Limb 2/5 (Unilateral Weakness)
⮚ Slurred Speech

Immediately transported to the nearest hospital for admission.

Patient M was accompanied by his daughter and provided information to the triage team. She
said her father had an episode of sudden-onset numbness and tingling in the left limb, with slight
confusion and slurred speech.

Upon arrival to Emergency Room at 8:30 AM, as a nurse receiving the patient, you
performed a head to toe assessment and vital signs checking.

Vitals:
BP 145/90 mmHg
Pulse 82
RR-20
Temp. 37.8
O2 sat. 97%

Physical Exam:
⮚ Confused
⮚ Left Facial Droop
⮚ Slurred Speech
⮚ Left Motor Weakness Upper Limb 0/5, Lower Limb 2/5
⮚ Decreased Tone
⮚ Altered Sensation
⮚ Mild Left Sided Neglect
⮚ Slight carotid bruits on the right

Respiratory: with bouts of productive cough 3 days ago, according to wife;

+ rales, + ronchi

At 8:45 AM, seen and examined by Dr. Martha Velasco, ER resident and ordered for
Medical Intensive Care Unit admission however MICU is full, no available bed at the moment;
advised for transfer to other facility but insisted to stay and wait till bed is available in MICU.
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

Doctor’s Order:

⮚ Admit patient to Medical Intensive Care Unit

⮚ Secure consent for admission
⮚ Diet: NPO temporarily
⮚ Dx:
• CBC with platelet count
• Serum Electrolytes ( Na, K, Cl, Mg )
• BUN Crea
• FBS. Lipid Profile
• SGOT,SGPT
• HbA1C
• Urine Analysis
• 12 L ECG
• CXR-PA
• Plain Cranial CT-scan
• Rapid Antigen for SARCov2
⮚ For CBG monitoring
⮚ Treatment: IVF- PNSS1L X 8 hours
⮚ O2 support via nasal cannula at 2-3 LPM
⮚ Monitor vital signs q1 hour
⮚ Monitor I&O q shift and record
⮚ Refer once CT scan result is available
⮚ Refer to Dr. Steve Arcellana (neurology) for evaluation.

Medications:
⮚ Omeprazole 40 mg IV now then OD
⮚ Piperacillin-Tazobactam 1.5gm IV q 8 hours ANST (-)
⮚ Paracetamol 300 mg IV q 4 hours PRN for temp. ≥38 oC
⮚ Losartan 50 mg/tab 1 tab OD PO
⮚ Atorvastatin 40 mg tab 1 tab OD PO

Dr. Martha Velasco

ER-Resident
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

ACTIVITY:
A. Critical Thinking Exercise
1. Differentiate ischemic stroke from hemorrhagic stroke.
2. What are the step-by-step nursing interventions upon receiving the patient in the Emergency
Department?

B. Application:
1. Formulate (2) priority nursing care plan for the patient.