MRS GIAMMO TRANSIENT ISCHEMIC ATTACK CASE STUDY
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
GENDER Female
AGE 59
SETTING Hospital
ETHNICITY Black American
CULTURAL CONSIDERATIONS
PREEXISTING CONDITION Hypertension (HTN)
COEXISTING CONDITION Hypercholesterolemia
COMMUNICATION
DISABILITY
SOCIOECONOMIC
History of tobacco use for twenty-five years—quit ten years ago; husband smokes one pack per day; positive family history of heart disease; occasionally takes walks in the neighborhood with friends but does not have a regular exercise regimen
Mrs. Giammo
SPIRITUAL/RELIGIOUS
PHARMACOLOGIC
Atenolol (Tenormin); heparin (Heparin Sodium); atorvastatin (Lipitor)
LEGAL
ETHICAL
ALTERNATIVE THERAPY
Lifestyle modification
PRIORITIZATION
DELEGATION
Overview: This case requires the nurse to recognize the signs and symptoms of a transient ischemic attack (TIA) and define the difference between a cerebrovascular accident (CVA, stroke) and a TIA. The nurse must recognize the risk factors for a possible stroke and suggest lifestyle modifications to decrease risk. Explanations of test results and physical assessment findings are offered. Appropriate nursing diagnoses for this client are prioritized.
Client Profile Mrs. 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 on one side.” Mrs. Giammo told her husband that she felt some numbness on the right side of her face and in 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 are temperature 98.28F (36.78C), blood pressure 148/97, pulse 81, and respiratory rate 14. An electrocardiogram (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 the right side with a slight facial droop when she smiles. Her speech is clear. She is able to move all of her extremities and follow commands. Her pupils are round, equal, and reactive to light (4 mm to 2 mm) and accommodation. 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 visual complaints. She is not experiencing any significant weakness, has a steady gait, and is able to swallow without difficulty. Labora-tory blood test results are as follows: white blood cell count (WBC) 8,000 cells/mm3, hemoglobin (Hgb) 14 g/dL, hematocrit (Hct) 44%, platelets = 294,000 mm3, erythrocyte sedimentation rate (ESR) 15 mm/hr, prothrombin time (PT) 12.9 sec-onds, international normalized ratio (INR) 1.10, sodium (Na2+) 149 mEq/L, potas-sium (K+) 4.5 mEq/L, glucose 105 mg/dL, calcium (Ca2+) 9.5 mg/dL, blood urea nitrogen (BUN) 15 mg/dL, and creatinine (creat) 0.8 mg/dL. A head com-puted tomography (CT) scan is done which shows no acute intracranial change and a magnetic resonance imagery (MRI) is within normal limits. Mrs. Giammo is started on an intravenous heparin drip of 25,000 units in 500 cc of D5W at 18 mL per hour (900 units per hour). Mrs. Giammo is admitted for a neu-rology evaluation, magnetic resonance 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 her complaint of numbness has subsided.
Questions
- The neurologist’s consult report states, “At no time during the episode of numbness did the client ever develop any scotoma, amaurosis, ataxia, or diplopia.” Explain what these terms mean.
- The neurology consult report includes the following statement: “Client’s diet is notable for moderate amounts of aspartame and no significant glutamate.” What are aspartame and glutamate? Why did the neurologist assess Mrs. Giammo’s intake of aspartame and glutamate?
- Discuss the pathophysiology of a transient ische-mic attack (TIA). Include in your discussion what causes a TIA and the natural course of a TIA.
- Giammo asks, “How is what I had different from a stroke?” Provide a simple explanation of how a transient ischemic attack (TIA) differs from a cere-brovascular accident (CVA, stroke).
- Discuss the defining characteristics of a transient ischemic attack (TIA).
- How does Mrs. Giammo’s case fit the profile of the “typical” client with a TIA?
- Giammo has her fasting cholesterol levels checked. How long must Mrs. Giammo fast before the test?
- 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 and which of her results are of concern and why?
- When told that her cholesterol levels are elevated, Mrs. Giammo asks, “I always see commercials on television saying you should lower your cholesterol. What is cholesterol anyway?” How could the nurse explain what cholesterol is and why it increases the risk of heart disease and stroke?
- Identify Mrs. Giammo’s predisposing risk factors for a TIA and possible stroke. Which factors can she change and which factors are beyond her control?
- Giammo takes atenolol at home. What is the most likely reason why she has been prescribed this medication?
- The nurse hears a carotid bruit on physical assessment. What is a bruit and why is this of concern to the nurse? What would be likely diagnostic proce-dures ordered by the health care provider because of this assessment finding?
- If a carotid ultrasound, carotid duplex, and/ or MRA reveals carotid artery stenosis, what surgical procedure can resolve the stenosis?
- Provide a simple rationale for including intrave-nous heparin in Mrs. Giammo’s treatment plan.
- Identify the potential life-threatening adverse effects/complications of heparin therapy and the treatment of heparin toxicity or overdose.
- To assess for bleeding and possible hemorrhage, explain what the nurse monitors while Mrs. Giammo is on heparin therapy.
- What is the major complication associated with a TIA?
- Identify six nursing diagnoses in order of prior-ity appropriate for Mrs. Giammo.
- Atorvastatin 10 mg PO per day is prescribed for Mrs. Giammo. Explain the therapeutic effects of atorvastatin.
- What type of lifestyle modifications should the nurse discuss with Mrs. Giammo (and her husband) prior to discharge?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. The can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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