Case Study:

Acute Ischemic
Stroke
Student Name: Nabaa Almurouhn
ID: 13381

Coordinator Name: Ms. Fatimah Aldossary

Outline:
- Demographic data.
- History on Admission.
- Medical Diagnosis.
- Overview.
- Risk factors.
- Signs and symptoms.
- Physical Examination.
- Laboratory and Diagnostic Study.
- Medications.
- Nursing Care Plan.
Demographic data:
 Age: 71 years old

 Sex: Female

 Nationality: Saudi

 Date of Admission: 28\07\21

 History on Admission
(chief complain, present, past)

A 71 years old Saudi female

admitted on 28th of July she is a
known case of Hypertension,
Diabetes, CAD (Coronary
Artery Disease) post PCI
(percutaneous coronary
intervention) since 2017.
In Qatif Central
Hospital
She was presented to QCH. Patient
was well until Fajr prayer she started
to have convulsion in form of (GTC)
then followed by sudden weakness of
the Lt side of her body and dysarthria.
CTA head scan was done and it turned
out that she needs Thrombectomy.
 In KFSH
(reason for admission)

Patient was referred from QCH

as life saving for thrombectomy
as a case of Rt MCA stroke
since it is not available there.
Medical Diagnosis:
Iinitia
l
Acute Ischemic Stroke

Final
Acute Ischemic stroke of right
MCA (middle cerebral artery)
 Overview
:
Ischemic stroke: happens when the brain's
blood vessels become narrowed or blocked,
causing severely reduced blood flow to the
brain. Blocked or narrowed blood vessels are
caused by fatty deposits that build up in blood
vessels (thrombotic) or blood clots or other
debris that travel through the bloodstream and
lodge in the blood vessels in the brain
(embolic).
Risk Factors:
- Age over 60
- Hypertension
- Diabetes mellitus
- Obesity
- Hypercholesterolemia
- Cardiac disease: Atrial fibrillation, heart failure, valvular
disease.
- Family history of stroke or transient ischemic attack (TIA)
Physical Examination
- Mental status: unconscious, GCS: 3/15
- Head: cataract in both eyes, upper & lower lip with
mucosal injury due intubation.
- Integumentary: the skin is dry and pale, blanchable
redness on sacral area.
- Respiratory: with ETT and on ventilator.
- Cardiovascular: capillary refill within normal range, with
CVC.
- Gastrointestinal: feeding through NGT, good bowel
movement.
- Genitourinary: with urinary catheter.
Diagnostic
Studies
1. Computerized tomography (CT) scan & CT
Angiography:
2. Magnetic
to detect anyresonance imagingof extra or intracranial arteries.
stenosis or occlusion
(MRI):
using radio waves and magnets to create
detailed view of the brain which can detect
brain tissue damaged by ischemic stroke.
3. Carotid Ultrasound:
sound waves create detailed images of the
inside of the carotid arteries in the neck
and shows the buildup of fatty deposits.
CT scan result:
showed progression of
RT MCA stroke with
Transtentorial herniation
and cerebral edema.
Laboratory Studies:
Result Normal Range
Troponin-I 281.7 ng\ml <2.0 ng\ml

PT 18 sec 10-14 sec

Hgb 11.2 g\dL 12-16 g\dL

Mg 0.71 mEq\L 1.6-2.5 mEq\L

Ca 2.12 mg\dL 8.5-10.5 mg\dL

Treatment &
Management:
 Medication treatment:
an IV injection of tissue
plasminogen activator (tPA) also
known as Alteplase, it improves the
blood flow to the brain by
dissolving the blood clot causing the
stroke.
Treatment & Management
Cont.
 Mechanical treatment:
Thrombectomy is used to remove a clot in
patients with large vessel occlusion using a
wire-cage device called a stent retriever. They
thread a catheter through an artery in the groin
up to the blocked artery in the brain. The stent
opens and grabs the clot after breaking it down
to small pieces or it’s removed by suctioning
the clot.
 Medications:
Medication Dose Route Action
Name
Diuretic, to decrease ICP and cerebral
Mannitol 50 gm IV
edema

Opioid analgesic, decrease neuronal cell

Fentanyl 100 MCG IV
death (neuroprotectant)

Antiepileptic, preventing post-stroke

Keppra 500 mg IV
seizures

Calcium 1000 mg IV Manage hypocalcemia

gluconate
Magnesium 3000 mg IV Anticonvulsant, vasodilator
sulfate
Nursing Diagnosis:

1. Ineffective cerebral tissue perfusion

2. Alteration in respiratory status
3. disturbed sensory perception
4. Self care deficit
5. Risk for infection
 Nursing Diagnosis Goals Interventions Evaluation
Ineffective Patient level of - Put the patient on elevated Goal wasn’t
consciousness will position. achieved, there is no
cerebral tissue be improved and improvement in
perfusion maintaining - Apply compression devices as patient’s LOC.
adequate blood ordered.
Related to: supply to body
tissue. - Encourage range of motion
interruption of (ROM) exercises.
blood flow and
cerebral edema. - Check capillary refill time and
peripheral pulses.
Evidenced by: - Note any changes LOC using
altered level of GCS.
consciousness
GCS: 3\15 - Monitor vital signs.
 Nursing Diagnosis Goals Interventions Evaluation
Alteration in Patient will be able - Change patient position Goal achieved,
to maintain adequate frequently. patient maintained
respiratory status oxygenation and adequate
absence of - Monitor changes in RR, lung oxygenation o2 sat
Related to: complication from sound, skin color. is 100%.
neurological the mechanical
ventilator. - Elevate head of the bed 30
deterioration. degrees.

Evidenced by: - Monitor o2 sat using pulse

decreased oxygen oximetry.
saturation < 94%. - Assess for correct ET tube
placement.

- Assess the ventilator settings

and alarm system every hour.
 Nursing Diagnosis Goals Interventions Evaluation
Disturbed sensory Patient will regain - Encourage family members to Goal wasn’t
usual level of touch and talk to the patient. achieved, patient
perception consciousness and still have the same
perceptual - Minimize the stimulation to the LOC and doesn’t
Related to: functioning. patient by limiting background response to any
neurologic noises and having only one stimuli.
impairment. person to speak at a time.

- Assess sensory awareness: dull

Evidenced by: from sharp, hot from cold,
altered level of position of body parts.
consciousness 3\15, - Protect from temperature
and no response to extremes and assess
external stimuli. environment for hazards.
 Nursing Diagnosis Goals Interventions Evaluation
Self care deficit Patient self care - Perform bed bath daily and as Goal achieved,
needs are met as required. patient looking neat
evidenced by neat and have groomed
Related to: and groomed - Provide oral hygiene every 4 appearance.
unconscious state. appearance and hours.
nourished look.
- Suction ET tube as necessary.
Evidenced by:
poorly nourished - Change position frequently.
look.
- Moisturizing and massaging the
body

- Stretching and changing the

linens
 Nursing Diagnosis Goals Interventions Evaluation
Risk for infection To decrease and - Follow hand hygiene and other Goal achieved,
minimize risk of infection control policies. patient remained
infection. free from infection.
Related to: - Maintain isolation precaution,
prolonged educate staff and visitors on
hospitalization. isolation protocol.

- Utilize personal protective

equipment.

- Assess for signs and symptoms

of infection ex. Redness,
swelling, fever.
 THANK
Resources:
YOU!
- Edward C Jauch, M. D. (2021, July 22). Ischemic stroke. Practice Essentials, Background,
Anatomy. https://emedicine.medscape.com/article/1916852-overview.

- Ischemic strokes (clots). www.stroke.org. (n.d.). https://www.stroke.org/en/about-stroke/types-

of-stroke/ischemic-stroke-clots.