Question

1. What are causes of strokes in younger women?
2. Describe your neurological assessment of a patient who just experienced a stroke.
3. What education needs to be provided regarding signs and symptoms of stroke, and when to call 911?

Athena Washington

Your patient is a 48-year-old female brought to the emergency department for stroke-like symptoms.

1. What are your primary concerns for this patient and what assessments and interventions would be associated with your concerns, and why?

2. What do you anticipate the patient’s home medications prior to admission might be, and why?

3. What medications do you anticipate the health care provider would prescribe while the patient is in the hospital, and why?

4. What medications do you anticipate the health care provider prescribing for the patient’s discharge, and why?

Answer 1

Causes of stroke in younger women

• Obesity
• Hypertension
• Any history or cardiovascular disease
• Type 2 diabetes mellitus
• Smoking and oral contraceptive
• African women are more prone to get stroke than white women
• Sickle cell anemia
• Pregnancy

Neurological assessment of a patient who just experienced a stroke

Check for

• Confusing symptoms like (Total facial paralysis , brainstem symptoms)
• Lab test and EKG values
• CT scan and head MRI
• Mental status
• Motor function and balanceEvaluation nerves
• Coordination examination

Education needs to be provided regarding signs and symptoms of stroke, and when to call 911

• Call 911 immediatly if you are feeling sudden signs of stroke like numbness and weakness of an extremity
• Signs include sudden confusion , trouble in speaking and understanding
• Severe headache that occur without any cause
• Loss of balance and coordination
• Feeling of dizziness
• Trouble seeing in one or both eyes
• It can be detected by the code F A S T
• F- face
• A -arm
• S-speech
• T-Time

• Perform FAST stroke test to cofirm it is stroke

  F-Ask them to smile.Does one side of face look like drooping

  A-Instruct to raise both arm.Does one arm drift downward

  S-Ask them to say something. Does it feel strange

  T-If you observe any of these symptoms call 911 immedietly

Primary concerns for this patient

• Any patient with neurologic deficit need a creful history eliciting the last time patient was seen well and a rapid focused physical and neurologic examination
• Initial assesment focuses on airway patency which may be compromised by loss of gag or cough reflex and altered respiratory pattern , cardiovascular status including( blood pressure, cardiac rhythm and rate , carotid bruit) and gross neurologic deficit.
• The initial diagnostic test for stroke is usually CT scan .
• This is performed within 25 minutes or less from time patient present to emergency department
• Then diagnostic test include ECH and carotid ultra sound
• MRI and magnetic resonance angiography of brain and neck vessels , transcranial Doppler flow studies etc are also done

Home medications prior to admission

• The patient may not be taking any pre medication before admission to hospital because an IV injection of recombinant tissue plasminogen activator is the medication that is used to treat stroke that may not be available in home settings

Medication in hospital

• Patient who have experience stroke should have medical mangement for secondary prevention
• Those with atrial fibrillation are treated with dose adjusted warfarin with a target international normalized ratio of 2 to 3
• Anticoagulants like Dabigatran. apixaban edoxaban are also given
• If alticoagulants are contraindicated aspirin alone is best option
• After acute stroke period antihypertensive medication are also used if indicated
• Preferd drud include angiotensin converting enzyme inhibitors and diuretics or combination of both

Medicine at home after discharge

• All of your prescriptions must be filled before you go home.
• It is very important that you take your medicines the way prescribed
• Medicines may include

- antiplatelet medicines

-Beta blockers

-diuretics

-ACE inhibitors

-Statins