CASE: TRANSIENT ISCHEMIC ATTACK Mrs. Giammo is a 59-year-old woman…

CASE: TRANSIENT ISCHEMIC ATTACK Mrs. Giammo is a 59-year-old woman… CASE: TRANSIENT ISCHEMIC ATTACKMrs. Giammo is a 59-year-old woman who was brought to the emergency department by her husband.Mr. Giammo noticed that all of a sudden his wife “was slurring her speech and her face was drooping onone side.” Mrs. Giammo told her husband that she felt some numbness on the right side of her face andin her right arm. Mr. Giammo was afraid his wife was having a stroke so he brought her to the hospital.Case Study In the emergency department, Mrs. Giammo is alert and oriented. Her vital signs aretemperature 98.28F (36.78C), blood pressure 148/97, pulse 81, and respiratory rate 14. Anelectrocardiogram (ECG, EKG) monitor shows a normal sinus rhythm. Mrs. Giammo is still complaining of”numbness” of the right side of her face and down her right arm. Her mouth is noted to divert to theright side with a slight facial droop when she smiles. Her speech is clear. She is able to move all of herextremities and follow commands. Her pupils are round, equal, and reactive to light (4 mm to 2 mm) andaccommodation. There is no nystagmus noted. Her right hand grasp is weaker than her left. Mrs.Giammo does not have a headache and denies any nausea, vomiting, chest pain, diaphoresis, or visualcomplaints. She is not experiencing any significant weakness, has a steady gait, and is able to swallowwithout difficulty. Laboratory blood test results are as follows: white blood cell count (WBC) 8,000cells/mm3, hemoglobin (Hgb) 14 g/dL, hematocrit (Hct) 44%, platelets = 294,000 mm3, erythrocytesedimentation rate (ESR) 15 mm/hr, prothrombin time (PT) 12.9 seconds, international normalized ratio(INR) 1.10, sodium (Na2+) 149 mEq/L, potassium (K+) 4.5 mEq/L, glucose 105 mg/dL, calcium 9.5 mg/dL,blood urea nitrogen (BUN) 15 mg/dL, and creatinine 0.8 mg/dL. A head computed tomography (CT) scanis done which shows no acute intracranial change and a magnetic resonance imagery (MRI) is withinnormal limits. Mrs. Giammo is started on an intravenous heparin drip of 25,000 units in 500 cc of D5W at18 mL per hour (900 units per hour). Mrs. Giammo is admitted for a neurology evaluation, magneticresonance angiography (MRA) of the brain, a fasting serum cholesterol, and blood pressure monitoring.Upon admission to the nursing unit, her symptoms have resolved. There is no facial asymmetry and hercomplain of numbness has subsided.Questions 1. The neurologist’s consult report states, “At no time during the episode of numbness did the client everdevelop any scotoma, amaurosis, ataxia, or diplopia.” Explain what these terms mean.2. The neurology consult report includes the following statement: “Client’s diet is notable for moderateamounts of aspartame and no significant glutamate.” What are aspartame and glutamate? Why did theneurologist assess Mrs. Giammo’s intake of aspartame and glutamate?3. Discuss the pathophysiology of a transient ischemic attack (TIA). Include in your discussion whatcauses a TIA and the natural course of a TIA.4. Mrs. Giammo asks, “How is what I had different from a stroke?” Provide a simple explanation of how atransient ischemic attack (TIA) differs from a cerebrovascular accident (CVA, stroke).5. Discuss the defining characteristics of a transient ischemic attack (TIA).6. How does Mrs. Giammo’s case fit the profile of the “typical” client with a TIA? 7. Mrs. Giammo has her fasting cholesterol levels checked. How long must Mrs. Giammo fast before thetest?8. Mrs. Giammo’s cholesterol lab work reveals total cholesterol 5 242 mg/dL, low-density lipoprotein(LDL) 5 165 mg/dL, high-density lipoprotein (HDL) 5 30 mg/dL. Discuss the normal values of each andwhich of her results are of concern and why.9. When told that her cholesterol levels are elevated, Mrs. Giammo asks, “I always see commercials ontelevision saying you should lower your cholesterol. What is cholesterol anyway?” How could the nurseexplain what cholesterol is and why it increases the risk of heart disease and stroke.10. Identify Mrs. Giammo’s predisposing risk factors for a TIA and possible stroke. Which factors can shechange and which factors are beyond her control?11. Mrs. Giammo takes atenolol at home. What is the most likely reason why she has been prescribedthis medication?12. The nurse hears a carotid bruit on physical assessment. What is a bruit and why is this of concern tothe nurse? What would be likely diagnostic procedures ordered by the health care provider because ofthis assessment finding?13. If a carotid ultrasound, carotid duplex, and/ or MRA reveals carotid artery stenosis, what surgicalprocedure can resolve the stenosis? Health Science Science NursingShare QuestionEmailCopy linkComments (0)

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