Quiz Me. Test my Knowledge.

Okay...

Let's begin from a few simple things:

(the following are not about real patients):

- you got your AM assignment, and the departing shift RN tell you that the patient had stroke and now is "locked in". Where was the stroke? What will be ONE SPECIFIC question you would like to ask the departing n to provide effective care for this patient?

- your patient is undergoing cardiac ultrasound for Afib and murmur. Which TWO findings will make you PARTICULARLY alert about increased risk of stroke?

- the patient is 40 y/o female with KNOWN murmur over carotid artery. She is scheduled for elective carotid endarterectomy tomorrow, but right now her monitor is beeping. You run in her room and see her in mild distress, sweaty and complaining on palpitations. She says she's having panic attack because she just thought of Donald Trump becoming a President of the USA. Monitor shows SVT with HR of 224. What is ONE thing you would NOT do? (Cue: it is from ACLS protocol and frequently described as "first thing to do" for SVTs).

Happy studying!

Okay...

Let's begin from a few simple things:

(the following are not about real patients):

- you got your AM assignment, and the departing shift RN tell you that the patient had stroke and now is "locked down". Where was the stroke? What will be ONE SPECIFIC question you would like to ask the departing n to provide effective care for this patient?

- your patient is undergoing cardiac ultrasound for Afib and murmur. Which TWO findings will make you PARTICULARLY alert about increased risk of stroke?

- the patient is 40 y/o female with KNOWN murmur over carotid artery. She is scheduled for elective carotid endarterectomy tomorrow, but right now her monitor is beeping. You run in her room and see her in mild distress, sweaty and complaining on palpitations. She says she's having panic attack because she just thought of Donald Trump becoming a President of the USA. Monitor shows SVT with HR of 224. What is ONE thing you would NOT do? (Cue: it is from ACLS protocol and frequently described as "first thing to do" for SVTs).

Happy studying!

Good questions!

I think the most important question is, what do YOU think about stroke? For example, what do you feel might be the short- and long-term implications for the patient, e.g. physical disability, psychosocial issues and changes in lifestyle or living arrangements? You learn to critically think when you go beyond the surface appearances of a situation. Good luck on your exams!

With all due respect....

It is most wonderful to sit and think about implications of something. But I once saw a poor soul who, after having a bulbar stroke with minimal disruption of speech and swallowing, was put on "thick puree diet, no pieces". Plus there were already restrictions due to CRF, not dialysis yet. The diagnosis the poor thing was brought in with was "scurvy". For MONTHS the patient was, under watchful eye of a home care RN, eating mostly toast soaked in sweet tea. It was in 100% accordance with prescribed diet. It was in 100% accordance with plan of care, aide workload, etc., and even "client satisfaction scores". It also made no sense whatsoever.

I do not know what this so-called "nurse" was ever thinking of, but for me it was one example how excellent ability to discuss implications (for I had fun of calling and listening of her doing just that for good half an hour) combined with total absence of common sense, self-critique and critical thinking led to painful and prolonged loss of a human life.

The OP will learn about all the implications in her good time. Now, what exactly must she NOT do with that panicking lady? Once she knows, it should be like a lightning bolt in her head every time she sees older patient with SVTs, or.... well, you know better than me what might happen.

Why do Neuro doctors refuse to prescribe narcotics?

It helps to know that after TPA, assessment is done frequently (ie: Q15 min x4 -> Q30 x 4 -> Q 1 hr x4...)

Also, why do we assess so much after TPA?