Nursing Care Plan of a Patient with Embolic CVA Essay

Summary of Admission History and Progress Notes 67-year-old masculine has a history of non-ischemic cardiomyopathy with sound projection component part of 24%, degenerative left ventricle thrombus on anticoagulant, hypertension, metastasis of prostate cancer, chronic kidney disease full point 3. unhurried was admitted to UCSD arrest department on 08/20 later falling down stairs. Patient presented confused but conscious. Upon presentation in the ED he had left face, left arm, and left leg flunk. After magnetic resonance imaging and cerebral angiogram, findings were conclusive to a obligation- lookd embolic CVA. Echocardiogram revealed 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 aspirin 81 milligrams was added. Left-sided weakness resolved deep down one to two age. tenderness specialist at UCSD recommends Cardiac Thrombectomy to proscribe furthe r snaps. Neurologist recommends endovascular intervention to prevent future embolic strokes though not during an acute episode. Patient was held at UCSD ED for permissive hypertension during acute stroke. Patient complained of cough with grand phlegm over the past few days chest roentgen ray findings of no local infiltrate.PathophysiologyEmbolic cerebral vascular accident (CVA) stroke  Etiology/Risk factors Risk factors include a history of casual ischemic attack, hypertension, elevated serum cholesterol, diabetes mellitus, smoking, cardiac valve diseases, anticoagulant therapy, oral encumbrance use, methamphetamine use, aneurysm, or previous stroke (Swearinger, 2012).Pathophysiology A stroke is caused by disruption of oxygen supply to the flair by either thrombotic occlusion, embolic occlusion or cerebral hemorrhage. Most thrombotic strokes are the result of atherosclerosis. plaque formation builds to the point of blockage in the large blood vessels that chuck up the sp onge blood to the brain. Most embolic strokes are caused by a cardiac emboli resulting from cardiac valve disease or atrial fibrillation. The carotid artery feeds the briny 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 whitethorn improve within 2 to 3 days as cerebral edema decreases. Patient may appear apathetic, irritable, disoriented, inert or comatose incontinence may occur unilateral weakness or paralysis may occur headache, neck stiffness or rigidity may be present. The patient may have clog chewing or swallowing and may present with unequal or fixated pupils (Swearinger, 2012). nosology Time is exact in diagnosing the type of stroke a patient has experienced. A patient is no biger eligible for rTPA if the critical window of 3 hours from last seen normal has expired. CBC, electrolytes, blood glucose and clotting factors sho uld be drawn immediately in order to determine eligibility for rTPA. An magnetic resonance imaging go forth reveal the site of infarction and other brain structure abnormalities cerebrate to cause and effect of the CVA. An MRI may take as long as an hour to complete. While a CT scan is broadly a diagnostic tool of choice in many emergency situations due 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 lively thrombi. Outside 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 the result of the hearts softness t o effectively 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 label by a GFR 30-59 mL per minute (Bladh, et. al., 2013). CKD is a progressive and permanent disorder. Aggressive management of Hypertension and Diabetes Mellitus, both of which are common add risk factors, may slow progression. Eventually CKD can progress to end-stage renal failure (ESRD). Before development of ESRD, a person with CKD can as yet manage normal daily living through diet and medicament (Swearinger, 2012).Diagnostic Tests, Results and RationalesDiagnostic TestsResultsRationalesMRISeveral areas of restricted diffusion within right MCA region consistent with acute embolic infarcts MRI images part between acute and chronic lesions. Ischemic strokes can be set early. Site of infection, hematoma, and cerebral edema can be viewed through MRI(Swearinger, 2012) Cerebral angiogra mRight MCA stroke, right internal artery non-flow limiting dissection with associated pseudo-aneurysm right superior trunk M3 occlusion Identify presence of hematoma in stasis of blood vessels after a rupture (Swearinger, 2012) Chest x-ray disallow for infiltrateA presence of infiltrate could indicate pneumonia or heart failure (Swearinger, 2012) Echocardiogram Severely 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 patent with antegrade flow Evaluation of carotid arteries to detect occlusions 3-dimensional visualization providing information on circumference, length, and thickness of plaque volume (Swearinger, 2012)