Stroke pt with increased weakness and slurring

  1. 0 If you have a patient admitted two days ago for stroke with left sided weakness and all of a sudden she is showing increased weakness to the left side, more pronounce facial droop, and slurring of her words, what would you do? I called the doctor (Neurologist and Generalist), put on some O2, took vital signs, did the NIH scale and talked with her until the transport came up for the STAT CT scan. What else can we do without an order? I really wanted to do more for this lady and consulted my charge nurse, but she said that we have done everything within our scope. I just want to have more tools in my tool box for if and when such a thing happends again. Thank you.
  2. Visit  TonyaM73 profile page

    About TonyaM73

    TonyaM73 has '3' year(s) of experience and specializes in 'MED/SURG STROKE UNIT, LTC SUPERVISOR'. From 'FL'; Joined May '09; Posts: 251; Likes: 503.

    11 Comments so far...

  3. Visit  K+MgSO4 profile page
    3
    you did everything right no intervention going to be carried out until CT done.

    O Did you do a blood sugar? Urine dipstick? just some ideas she may of been hypo/hyper. Or have a stinking UTI?

    But you did the right things. Called the Docs and done the obs consulted your charge nurse and let her know what was going on. No more could be done at that point.
    wooh, ObtundedRN, and canoehead like this.
  4. Visit  Jonesskky RN profile page
    1
    In my ER department, the latest updates in treating stroke patients includes: doing the blood work, especially a pt/ptt level BEFORE the patient goes to ct scan because the delay of tPa treatment was related to the these important labs not getting done. It is "slowly" becoming a requirement so I don't believe you need a doctor's order but always check you policies and protocols...stroke requirements are changing frequently.
    kaliRN likes this.
  5. Visit  nyrn5125 profile page
    1
    stat blood sugar as the above post stated stat head ct. coag profiles and sometimes ammonia level
    have seen worsening after the initial symptoms and some neurologists don't get too concerned. one pt we had was neg on ct for bleed and was started on aspirin. 2 days later he lost peripheral vision in left eye and stat ct showed 7cm bleed..
    kaliRN likes this.
  6. Visit  LouisVRN profile page
    0
    Had a pt like this myself, converted from an ischemic to hemorrhage stroke after she was supposed to be discharged. You called a "rapid response". That way they were able to get things rolling while waiting for the doctors. Only thing I would have done in addition to a blood sugar, vitals would be ensure that the head of bed is flat (this is per our stroke neurologist's recommendations).
  7. Visit  nminodob profile page
    0
    All the posts were right on the money, but I would think if this woman was not already NPO then she probably should be at this point.
  8. Visit  Esme12 profile page
    2
    Quote from TonyaM73
    If you have a patient admitted two days ago for stroke with left sided weakness and all of a sudden she is showing increased weakness to the left side, more pronounce facial droop, and slurring of her words, what would you do? I called the doctor (Neurologist and Generalist), put on some O2, took vital signs, did the NIH scale and talked with her until the transport came up for the STAT CT scan. What else can we do without an order? I really wanted to do more for this lady and consulted my charge nurse, but she said that we have done everything within our scope. I just want to have more tools in my tool box for if and when such a thing happends again. Thank you.

    Good job!. The only other thing to maybe consider would be a fingerstick glucose while you are waiting for the MD to call back. Call a rapid response if you ahve one. Consider other labs based upon meds ie: if the patient was being anticoagulated a coag profile would be in order. You did GOOD! It is frustrating when things are happening right before your eyes and there is nothing you can do..................but you did do something you recognized the symptoms you call the MD and called for help and reflected and evaluated to see if it could be improved upon! WELL DONE!
    kaliRN and wooh like this.
  9. Visit  TonyaM73 profile page
    0
    Thank you so much for your responses. We had just done a fingerstick before lunch, so this was happening just an hour afterwards. There were no orders for labs after the deterioration due to recent labs being drawn that morning. She is not a candadit for TPA, due to the fact that she was admitted two days prior with stroke symptoms.

    I just felt so helpless and couldn't think of what else I could have done other than call a rapid response, that is why I went to the charge nurse. She said that if she deteriorates further, we would call for the rapid response but the pt did not do so before they came for the CT. The CT showed no changes from the day before.

    Can an ischemic stoke produce worsening symptoms days after it happends and then get better or will she continue to deteriorate until she reaches a stopping point and then that will be her norm from then on? I have been trying to research this since I got home last night, but all I have found is just what to do in the immediate after the initial signs of stroke.
  10. Visit  TonyaM73 profile page
    1
    Thank you so much for your encouragement ESME 12. I have been beating myself up about this, but from everything I have read and what you guys are telling me, I acted appropriately. Thank you so much. I just felt so helpless and wanted the magic pill or something to reverse what was happening.'
    Esme12 likes this.
  11. Visit  Esme12 profile page
    0
    Quote from TonyaM73
    Thank you so much for your encouragement ESME 12. I have been beating myself up about this, but from everything I have read and what you guys are telling me, I acted appropriately. Thank you so much. I just felt so helpless and wanted the magic pill or something to reverse what was happening.'

    Be kinder to yourself!
  12. Visit  talaxandra profile page
    1
    Quote from TonyaM73
    Can an ischemic stoke produce worsening symptoms days after it happends and then get better or will she continue to deteriorate until she reaches a stopping point and then that will be her norm from then on?
    Usually an increase in symptom severity and/or emergence of new symptoms indicates an extension of the original infarct or a haemmorhage into the affected area. It's possible that the brain will recover, but generally speaking an extension or haemmorhagic transformation is a signidicant event that increases the likelihood of permanent disability or death.
    kaliRN likes this.
  13. Visit  TonyaM73 profile page
    0
    talaxandra : That was what I was afraid of. The CT r/o any bleed and it was unchanged from the day before, but the neurologist says that sometimes an increase of the ischemic stroke will not show up on the CT right away. I think that he was just r/o a bleed at that point. Thank you so much for the info.


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