Case Study: Stroke
Case Study Overview
Stroke occurs when there is ischemia (inadequate blood flow) to a part of the brain or
hemorrhage (bleeding) into the brain that results in death of brain cells. Functions such as
movement, sensation, or emotions that are controlled by the affected area of the brain are
lost or impaired. The severity of the loss of function varies according to the location and
extent of the brain involved. The loss of function may be temporary or permanent. The term
brain attack is also used to describe stroke. This term communicates the urgency of
recognizing the clinical manifestations of a stroke and treating a medical emergency, similar to
what would be
done with a heart attack. Following the onset of a stroke, immediate medical attention is crucial
to decrease disability and death. Treatment includes drug and/or surgical therapy, dependent
on the type of stroke, location, timing, and severity of the symptoms. After the patient with a
stroke has stabilized for 12 to 24 hours, interprofessional care shifts from preserving life to
lessening disability and attaining optimal function.
Case Study Objectives
• Differentiate between a transient ischemic attack (TIA) and ischemic stroke.
• Identify risk factors for stroke.
• Evaluate results of diagnostic testing in a patient with a neurologic deficit.
• Identify relevant assessment data for a patient with a neurologic deficit.
• Develop a prioritized nursing care plan for a patient with a stroke.
• Appropriately delegate nursing care of a patient with a neurologic deficit.
• Describe the interprofessional care of a patient with a stroke.
• Discuss health promotion strategies to decrease the risk of stroke.
, Case Study
(©iStockphoto/Thinkstock)
T.C. is a 65-year-old African American truck driver who woke up with weakness of the left side of
his body, loss of vision in one eye, and an inability to speak this morning. He sat on the edge of
the bed, and the symptoms resolved in about 20 minutes. His wife insisted that she bring him to
the emergency department, where he insists that he is fine, doesn't need to see a doctor, and
that he has never been sick a day in his life. Despite his protests, you take his vital signs while
performing a brief health history and physical assessment. Assessment findings include the
following vital signs: BP 194/108 mm Hg, heart rate (HR) 84 beats/minute, respiratory rate (RR)
22 breaths/minute, temperature 97.8° F (36.6° C). He moves all of his extremities well, he has
equal grip strength in his hands, and his pupils react equally and briskly to light. His last visit to a
health care provider was 7 years ago when he finally had a repair of an inguinal hernia that he
had had for more than 20 years. He tells you that he doesn't smoke or drink alcohol, but he has
been a "steak and potato" man all of his life.
Fill in the Blanks:
Based on the history of T.C.'s symptoms, you suspect that he has experienced a: TIA
The main assessment finding of T.C. that indicates that he is at risk for a stroke is his elevated:
High BP
With knowledge of cerebrovascular disease, you recognize that T.C.'s symptoms may be
caused by microemboli breaking off from atherosclerotic plaque located within
the coronary artery.
Case Study Overview
Stroke occurs when there is ischemia (inadequate blood flow) to a part of the brain or
hemorrhage (bleeding) into the brain that results in death of brain cells. Functions such as
movement, sensation, or emotions that are controlled by the affected area of the brain are
lost or impaired. The severity of the loss of function varies according to the location and
extent of the brain involved. The loss of function may be temporary or permanent. The term
brain attack is also used to describe stroke. This term communicates the urgency of
recognizing the clinical manifestations of a stroke and treating a medical emergency, similar to
what would be
done with a heart attack. Following the onset of a stroke, immediate medical attention is crucial
to decrease disability and death. Treatment includes drug and/or surgical therapy, dependent
on the type of stroke, location, timing, and severity of the symptoms. After the patient with a
stroke has stabilized for 12 to 24 hours, interprofessional care shifts from preserving life to
lessening disability and attaining optimal function.
Case Study Objectives
• Differentiate between a transient ischemic attack (TIA) and ischemic stroke.
• Identify risk factors for stroke.
• Evaluate results of diagnostic testing in a patient with a neurologic deficit.
• Identify relevant assessment data for a patient with a neurologic deficit.
• Develop a prioritized nursing care plan for a patient with a stroke.
• Appropriately delegate nursing care of a patient with a neurologic deficit.
• Describe the interprofessional care of a patient with a stroke.
• Discuss health promotion strategies to decrease the risk of stroke.
, Case Study
(©iStockphoto/Thinkstock)
T.C. is a 65-year-old African American truck driver who woke up with weakness of the left side of
his body, loss of vision in one eye, and an inability to speak this morning. He sat on the edge of
the bed, and the symptoms resolved in about 20 minutes. His wife insisted that she bring him to
the emergency department, where he insists that he is fine, doesn't need to see a doctor, and
that he has never been sick a day in his life. Despite his protests, you take his vital signs while
performing a brief health history and physical assessment. Assessment findings include the
following vital signs: BP 194/108 mm Hg, heart rate (HR) 84 beats/minute, respiratory rate (RR)
22 breaths/minute, temperature 97.8° F (36.6° C). He moves all of his extremities well, he has
equal grip strength in his hands, and his pupils react equally and briskly to light. His last visit to a
health care provider was 7 years ago when he finally had a repair of an inguinal hernia that he
had had for more than 20 years. He tells you that he doesn't smoke or drink alcohol, but he has
been a "steak and potato" man all of his life.
Fill in the Blanks:
Based on the history of T.C.'s symptoms, you suspect that he has experienced a: TIA
The main assessment finding of T.C. that indicates that he is at risk for a stroke is his elevated:
High BP
With knowledge of cerebrovascular disease, you recognize that T.C.'s symptoms may be
caused by microemboli breaking off from atherosclerotic plaque located within
the coronary artery.
