Case Study Treating An Ischemic Brain Attack Nursing Essay

Case Study Treating An Ischemic Brain Attack Nursing Essay J Sparrow, a 70-year-old patient, presents to the emergency department 4 hours after experiencing an ischemic brain attack confirmed on the CT of the head without contrast. The patient is a candidate for intra-arterial thrombolytic therapy to dissolve the blood clot causing the significant stroke symptoms. The patient is scheduled for the emergent cerebral angiogram with possible intra-arterial thrombolytic therapy. The nurse provided patient and family education and received the informed written consent from the patient’s spouse. The patient has intravenous normal saline at 100 mL/hr infusing into the right forearm with an 18-gauge angiocath, which is patent. Interpretations and findings done by the group: Most books have cited the importance of the â€Å"3-hour window† for administration of thrombolytic therapies. This is to adhere to the fact that irreversible brain injuries usually take place after 3 hours from the onset of stroke, and any intervention to reverse t he condition would be deemed useless. But recent studies show that the 3 hour window was extended to 4.5 hours, and was proven to still be therapeutic if the drug was administered up to this time. In the patient’s case, even if it was 4 hours after the onset of stroke, he was still allowed to undergo possible Intra-arterial Thrombolytic therapy following a cerebral angiography since this was indicated for stroke patients with onset of symptoms for more than 3 hours. CT scan of the head without contrast was done as a differential diagnosis as to what type of stroke patient JS had experienced. This was an important test to determine further interventions needed, and to reduce risks for any complications if the client’s stroke was classified as hemorrhagic. Cerebral angiography was ordered to identify the exact area of occlusion, so that immediate administration of the thrombolytic drug can be done. Before patient JS became a candidate for thrombolytic therapy, several cr iteria for eligibility were assessed since not all stroke patients can have this kind of therapy. What labs should the nurse assess before the procedure and why? Patient JS is about to undergo cerebral angiography, wherein a contrast dye is to be injected to view the area of occlusion. Before the procedure, certain laboratory tests need to be assessed and reassessed as a standard protocol, and for further procedures which requires it. The cerebral angiography test is done to locate the area of occlusion or infarction to determine the area of administration of Thrombolytics. Since the client is about to undergo EMERGENT cerebral angiography, only the most significant laboratory tests are to be assessed. Blood tests Complete blood count with Platelet Count Hemoglobin count is important to determine the amount of oxygen in the blood. Low oxygen in blood aggravates the condition of the patient (in which a part of the brain is deprived already of oxygen), by depriving other parts of the brain or body of proper oxygen. Hematocrit can also determine if the client experiences alterations in fluid volume, especially within the blood vessels. Assessing these values can determine further interventions needed to be done before the procedure, such as administration of oxygen and increasing the rate of administration of fluids.