Reference no: EM133869256

Assignment:

N.T., a 79-year-old woman, arrives at the emergency department with expressive aphasia, left facial droop, left-sided hemiparesis, and mild dysphagia. Her husband states that when she awoke that morning at 0700, she stayed in bed, saying she had a mild headache over the right temple and was feeling weak. He went and got coffee, then thinking it was unusual for her to stay in bed, went back to check on her. He found she was having trouble saying words and had a left-sided facial droop. When he helped her up from the bedside, he noticed weakness in her left hand and leg and brought her to the emergency department. Her medical history includes atrial fibrillation, hypertension, and hyperlipidemia. A recent cardiac stress test was normal, and her blood pressure is under good control. N.T. is currently taking amiodarone, amlodipine, aspirin, simvastatin, and lisinopril. The provider suspects N.T. is having a CVA.

1. During the first 24 hours after initiation of tPA, explain why N.T.'s blood pressure should be controlled.
2. Why was N.T. placed on clopidogrel post-CVA? When should anticoagulant or antiplatelet drugs be initiated following thrombolytic therapy?
3. Is there a benefit to continuing simvastatin? Explain.
4. The provider orders a modified barium swallow study and referral for a speech-language pathologist. Give the rationale for these orders.

Case Study Outcome

After spending 1 week on the neurology unit, N.T. is discharged to a rehabilitation center for continued therapy. Though she is still experiencing some mild deficits, she is able to go home after 6 weeks.