Case Study 1

Endorsement to ER: “I am signing out Adobo Gisado Paminta,62 yo male, Birthday, Dec 25,
1960, with weight of 75kg. with known hypertension and atrial fibrillation who is not on
anticoagulation”. “He was found down on the floor at 7:10 am by his wife. He was last seen
normal at 10 pm last night. He is aphasic with right-sided weakness, GCS of 11, HR of
130/minute and BP of 200/110 mmHg. IV Metoprolol 5 mg given and his follow up HR was
94/minute and BP was 182/90 mmHg” ER to ICU: “Upon arrival to the ER at 9:10 am his
NIHSS was 21 - global aphasia, left gaze preference, right hemiplegia and neglect.” “CT
completed at 9:26 am showed a left dense MCA sign. CTA showed a left M1 occlusion. CTP
showed a core of 38 ml, penumbra of 140 ml, mismatch volume 102 ml, mismatch ratio 3.7.”
“He swas out of the IV tPA window. Endovascular team was notified at 9:38 am”. “He was
taken to the cath lab at 9:50 am. His HR was 106/minute and BP was 190/106 mmHg. Groin
puncture was attained at 10:06 am. TICI3 revascularization was achieved. He had started
moving his right arm and leg few minutes after the procedure”. “His target post procedural BP
should be <140/80mmHg”. MRI brain is pending.

Patient’ Name: Adobo Gisado Paminta Date of Birth: Age:62 Sex:Male Room No.:
Dec,25,1960

Last First Middle Name MM DD YY Weight: 75

Name Name Dec 25 1960
Time last seen before current symptoms started: Day: Time: 9:10 am

Objective: Confirm diagnosis of stroke and perform initial physical evaluation in less than 10 minutes

Symptom onset <4 hours Symptom onset >4 hours Time of onset unknown
ago ago
7:10AM 9:10AM
He is aphasic with right sided  No anticoagulant use Patient's NIHSSwas 21 - global
weakness  Global aphasia aphasia, left gaze preference, right
GCS of 11  Left gaze preference hemiplegia and neglect
HR of 130/minute  Right Hemiplegia
BP of 200/110 mmHg  Neglect
 Left den se MCA sign
9:50PM
HR was 106/minute
BP was 190/106 mmHg
Patient history and physical examination:
Not on an anti-coagulation -GCS 11
NIH was 21 - global aphasia, left qaze preference, right hemiplegia and neglect
Hypertension and atrial fibrillation
Initial Vital Signs:
BP• 200/110 mmHq
HR: 130/mins
Given Metoprolol Vital Signs:
BP: 182/90 mmHg
HR: 94/mins
Vital Signs:
BP: 190/106 mmHa
HR: 106/mins

NIHSS score 21

Absolute contraindications for rt- No tPA unless BP is reduced

 PA

Significant lab results/ CT Scan

Diagnostics

Current medication (if any)

IV metroprolol 5mg

Category (Mild/Mod/High Risk): Moderate

Pending Diagnostics MRI brain is pending

Basing on the weigh, if to give tPA, what
should be the dose to give to the patient?
(give the computation)
For the computation:
Total dose= 0,9mg x 75kg= 67.5mg
The total dose of Pa needed is=67.5mg
Computation:
Bolus= 10% of total dose
67.5 x 0.10 mq= 6.75 rounded off it will
Equivalent to 6.8

• Administer 6.75/6.8 mg (10%) in a 1 min

bolus
Computation:
Infusion Dose= 90% of total dose 67.5 x 0 90
mg= 60mg which will be rounded off to
60 80mg
Administer the remaining 60.75/60.8 mg
(90%) in a 60 minute infusion.
What is the possible Diagnosis of the Hypertension and Atrial Fibrillation
patient?

Patient’ Name: Date of Birth: Age: Sex: Room

No.:

Last Name First Middle MM DD YY Weight:

Name Name
Time/Date FOCUS F.D.A.R.
Prepared by: K.A. San Joaquin- Delos Reyes, RN, MN