Crebrovascular Accident Case Study

Jose R Tapanes
International Institute for Health Care Professionals

Case 1:
Mrs. Skelt is a 75-year-old female who was admitted to an extended care facility for rehabilitative care following a cerebrovascular accident (CVA). She has right-sided hemiplegia.

1. Go to www.jointcommission.org and locate the National Patient Safety Goals (NPSGs). Which ones are appropriate for Mrs. Skelt?

- Fall reduction program
- Pressure ulcer prevention program

2. At 7:00 PM, the off-going nurse is giving report to the oncoming nurse who will care for Mrs. Skelt until 7:00 AM.
What are the components of the SBAR process that the off-going nurse should communicate to the oncoming nurse?

- Situation.
Name of the patient Mrs. Skelt
Diagnosis: CVA (cerebrovascular accident) and right hemiplegia
-Background
75-year-old female admitted to extended care for rehabilitation, CVA with right hemiplegia.
-Assessment
Rehabilitation
Prevent fall
-Recommendation
Prevent fall
Prevent pressure ulcer
Mobilization of the patient

3. Compare and contrast the SBAR and PACE communication processes. (PACE components include Patient Problem, Assessment/Actions, Continuing/Changes, and Evaluation.)

SBAR: (Situation–Background–Assessment–Recommendation) is a formal method of hand-off communication between two or more health care team members including is a tool that allows the medical team to communicate with each other in a standard way, an easy and objective way to remember and building any communication, especially in critical situations.

This method uses a correct transfer of medical vital information of the patients during shift change that needs immediate attention, SBAR is achievable for nurses and identification of any error in information transfer process can be possible easily. This technique enhances the communication between health professionals and increase patient

safety.

PACE: (P-Patient, Procedure, Problem A-Assessment, Actions C-Continuing Treatments, Changes, Counts E-Evaluation). Is a formal method of hand-off communication used in surgical services is used in PACU (Post Anesthesia Care Units) where the nurses are intensely involved with one or two patients at a time, providing in-depth care before transferring them to their next destination, usually within one to two hours.

Case 2:

Mrs. DeLuca is a 68-year-old woman who has been brought to the ED by ambulance with a change in mental status. She is noted to have a temperature of 103° F and is crying uncontrollably while aggressively thrashing her arms. Her daughter reports that at her baseline, Mrs. DeLuca is oriented to person, place, and time, and that she is well enough to perform all ADLs without assistance. Her medical history includes mild hypertension controlled by 20 mg of hydrochlorothiazide (HydroDIURIL) taken once daily.

1. Based upon an immediate nursing assessment of Mrs. DeLuca, which plan of care for her condition would the nurse anticipate?

- Assessment. Change of mental status, fever, irritability and hypertension
- Diagnosis. Change in mental status, fever and irritability due to infection and dehydration
- Planning. Reduce fever, to improve the mental status and irritability
- Intervention. Assess every four hours the patient’s temperature and report any temperatures greater than 100.4 to the doctor. The nurse will administer ordered antipyretics to the patient for a temperature greater than 100.4. Administer fluids to treat dehydration and antibiotic for infection as ordered

2. Mrs. DeLuca is diagnosed with a severe urinary tract infection. The nurse administers fluids, initial antibiotics, and antipyretics as ordered.
What outcomes of these interventions should the nurse expect?

The desired outcome is to improve patient comfort reducing the fever, improving the mental status, controlling the infection with antibiotics and to reduce the risk of medical complications due to very high body temperature and systemic infection