NGN Case Study: Acute Stroke Walkthrough
Full unfolding case study on ischemic stroke from ED arrival through tPA decision.
Stroke case studies emphasize FAST recognition, tPA window, and post-stroke nursing.
Presentation
72 y/o brought to ED 45 min after sudden right-sided weakness and slurred speech noticed at breakfast. AFib history. BP 178/96. NIHSS 12.
Recognize cues
Right hemiparesis, dysarthria, sudden onset, AFib (embolic source), elevated BP. All cardiac risk factors.
Analyze
Ischemic stroke most likely. Confirm with CT head.
Prioritize
Time-critical workup: CT head (rule out bleed), labs (glucose, coags). Symptom onset within window for tPA.
Take action
tPA within 4.5h if no contraindications. NPO. Frequent neuro checks. BP <185/110 before tPA. Aspirin held until 24h after tPA.
Evaluate
Improving NIHSS, stable BP, no headache (could indicate hemorrhagic conversion).
Frequently asked
BP target during tPA?
<180/105 for 24h after tPA. Aggressive control with labetalol/nicardipine.
Bleeding after tPA?
Stop infusion. CT head. Reverse with cryo, FFP if needed.
Quick check
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