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CCU   (355 Views | 2 Replies)
by pnwRN88 pnwRN88 (New) New

406 Profile Views; 3 Posts

Beginning of shift, you're getting report on pt. Hx: TIA ,DM, and COPD. Hospitalized due to afib with rvr, on a dilt drip, NPO. You go to assess pt, pt is hard to awaken, slurred speech, BP 87/60, HR 115 afib, RR 14 93%room air. What's running through you're head and what do you do? 

 

My thoughts: first off pt is hard to awaken, and slurred speech, hx of TIA, first I'm worried about stroke. Also worried about low BP, which dilt drip could be at fault. Slurred speach and arousability could also come from low blood sugar, would check that as well. If pt is not waking up for me, I would call a rapid, possibly code stroke if after more assessment pt shows signs of stroke. Meanwhile I will be checking that blood sugar. 

What else am I missing here?

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Mavnurse17 has 3 years experience as a BSN, RN.

100 Posts; 1,371 Profile Views

I think your thought process is spot on.  The first thing that came to my mind reading your post was a possible stroke.  Is the patient on any anticoagulation?  

Hard to assess if the BP is the culprit here without knowing the patient's baseline, but you're right to assume that it could be especially with the dilt gtt.  Has the drip been running or is this recently started?

Hopefully BG's are being monitored with the pt's hx of DM and NPO status. 

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kaylee. has 7 years experience and specializes in Stepdown . Telemetry.

298 Posts; 3,449 Profile Views

Agree with OP and PP: suspect stroke, meaning call RR...in the meantime, get a blood sugar. 
 

Although not directly r/t stroke, would stop the dilt drip, the appropriate action in the face of low BP ~ until alternative rate control measures can be implemented. 

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