Category: A nurse is caring for a client who had a cerebrovascular accident

17.04.2021

A nurse is caring for a client who had a cerebrovascular accident

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a nurse is caring for a client who had a cerebrovascular accident

Featured Quizzes. Are You Really Best Friends? Related Topics. Questions and Answers. Remove Excerpt. Removing question excerpt is a premium feature. Nurse Karen is caring for a client who had a cerebrovascular accident CVA.

Which nursing intervention promotes urinary continence? Nurse Sandy assesses for tenderness at the costovertebral angle by placing the left hand over this area and striking it with the right fist. A male client with chronic renal failure has a serum potassium level of 6.

What should nurse Olivia assess first? Nurse Harry is aware that the following is an appropriate nursing diagnosis for a client with renal calculi? A male client develops acute renal failure ARF after receiving I.

Nurse Billy suspects that the client is at risk for:. After undergoing transurethral resection of the prostate to treat benign prostatic hyperplasia. On the first day after surgery. What should Nurse Anthony do first? When performing a scrotal examination. Nurse Payne finds a nodule. What should the nurse do next? A male client who has been treated for chronic renal failure CRF is ready for discharge.

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Nurse Billy should reinforce which dietary instruction? Nurse Gil is aware that the following statements describing urinary incontinence in the elderly is true? The client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation.

Nurse Yonny is aware that the following nursing interventions is appropriate? Tell the client to try to urinate around the catheter to remove blood clots.

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If loading fails, click here to try again Choose the letter of the correct answer. Good luck! Question 1 Mr. Mendoza who has suffered a cerebrovascular accident CVA is too weak to move on his own. To help the client avoid pressure ulcers, Nurse Celia should: A Turn him frequently.

B Perform passive range-of-motion ROM exercises. C Reduce the client's fluid intake. D Encourage the client to use a footboard. If pressure isn't relieved, capillaries become occluded, reducing circulation and oxygenation of the tissues and resulting in cell death and ulcer formation. During passive ROM exercises, the nurse moves each joint through its range of movement, which improves joint mobility and circulation to the affected area but doesn't prevent pressure ulcers.

Adequate hydration is necessary to maintain healthy skin and ensure tissue repair. A footboard prevents plantar flexion and footdrop by maintaining the foot in a dorsiflexed position. Question 2 Which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke?

C The presence of bronchogenic carcinoma. D A right-sided carotid bruit. A bruit in the carotid artery would predispose a client to an embolic or ischemic stroke. High blood glucose levels could predispose a patient to ischemic stroke, but not hemorrhagic. Cancer is not a precursor to stroke. Question 3 Ms. She has been taught to walk with a cane. The nurse is evaluating her use of the cane prior to discharge.

Which of the following reflects correct use of the cane? A Holding the cane in her left hand, Ms. When Ms. As she moves the weak leg, the cane and the strong leg provide support. Finally, the cane, which is even with the weak leg, provides stability while she moves the strong leg.

She should not hold the cane with her weak arm. The use of the cane requires arm strength to ensure that the cane provides adequate stability when standing on the weak leg. The cane should be held in the left hand, the hand opposite the affected leg. If Ms. This would be unstable at best; at worse, impossible Question 4 A male client who has suffered a cerebrovascular accident CVA is too weak to move on his own.

To help the client avoid pressure ulcers, the nurse should: A perform passive range-of-motion ROM exercises. B encourage the client to use a footboard.

C turn him frequently.A patient with a temporary loss of motor function is diagnosed with a transient ischemic attack TIA. What should the nurse include when assisting in the teaching about this health problem? The nurse is assisting with teaching a patient who has had a transient ischemic attack TIA. On which understanding should the nurse base teaching?

The nurse is planning care for a client with right-sided weakness and aphasia from a transient ischemic attack TIA. Which area of the brain should the nurse realize was affected in this client? A patient with a cerebrovascular accident stroke has left-sided flaccidity and is unable to speak but seems to understand everything the nurse says.

Which term should the nurse use to document the patients communication impairment? The nurse is documenting care provided to a patient with left-sided flaccidity caused by a stroke. Which term should the nurse use to document this patients motor status?

A patient comes into the emergency department with symptoms of a stroke. Which medication should the nurse expect may be given to the patient if diagnostic testing confirms an ischemic stroke? A patient is prescribed an antiplatelet agent to prevent strokes. Which agent was this patient most likely prescribed? A patient with symptoms of impending stroke is scheduled to have a cerebral angiogram. Which statement should the nurse include when assisting with patient teaching?

The nurse is caring for a hospitalized patient who has had a stroke and is waiting to be transferred to a rehabilitation facility. What nursing action can best maximize the patients rehabilitation potential while awaiting the transfer? The nurse is assisting in preparing a patient for transfer to a rehabilitation facility after a stroke.

What should the nurse explain as the goal for rehabilitation? A patient is admitted to the hospital with a severe headache and photophobia. A lumbar puncture confirms a bleeding aneurysm.Cerebrovascular accident CVA is the medical term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood vessel. There are important signs of a stroke that you should be aware of and watch out for.

Seek medical attention immediately if you think that you or someone around you might be having a stroke. The more quickly you receive treatment, the better the prognosis, as a stroke left untreated for too long can result in permanent brain damage. There are two main types of cerebrovascular accident, or stroke: an ischemic stroke is caused by a blockage; a hemorrhagic stroke is caused by the rupture of a blood vessel.

Both types of stroke deprive part of the brain of blood and oxygen, causing brain cells to die.

Cerebrovascular Accident (Stroke)

An ischemic stroke is the most common and occurs when a blood clot blocks a blood vessel and prevents blood and oxygen from getting to a part of the brain. There are two ways that this can happen. One way is an embolic strokewhich occurs when a clot forms somewhere else in your body and gets lodged in a blood vessel in the brain. The other way is a thrombotic stroke, which occurs when the clot forms in a blood vessel within the brain. A hemorrhagic stroke occurs when a blood vessel ruptures, or hemorrhages, and then prevents blood from getting to part of the brain.

The hemorrhage may occur in any blood vessel in the brain, or it may occur in the membrane surrounding the brain. The quicker you can get a diagnosis and treatment for a stroke, the better your prognosis will be. The symptoms of a stroke can vary depending on the individual and where in the brain it has happened.

This sound, which is called a bruit, indicates abnormal blood flow. Your doctor may also perform diagnostic tests to discover the cause of the stroke and pinpoint its location.

These tests may include one or more of the following:. The goal of treatment for ischemic stroke, for instance, is to restore the blood flow. Treatments for hemorrhagic stroke are aimed at controlling the bleeding.

To treat an ischemic stroke, you may be given a clot-dissolving drug or a blood thinner. You may also be given aspirin to prevent a second stroke. Emergency treatment for this type of stroke may include injecting medicine into the brain or removing a blockage with a procedure.

For a hemorrhagic strokeyou may be given a drug that lowers the pressure in your brain caused by the bleeding.

Cerebrovascular Accident

If the bleeding is severe, you may need surgery to remove excess blood. The length of recovery varies depending on how severe the stroke was. This can include speech therapy or occupational therapy, or work with a psychiatrist, neurologist, or other healthcare professional.Smith, a businessman, has a history of hypertension.

He does not take any maintenance medications and smokes three packs of cigarettes every day. During one of his meetings, he felt like he cannot speak properly. After a day, he started feeling numbness on his face, and he cannot see objects beyond his periphery. The day that he was brought to the emergency room, he cannot move his right arm and leg. He was diagnosed with ischemic stroke by the attending physician.

Stroke is a worldwide phenomenon suffered through all walks of life. Stroke can cause a wide variety of neurologic deficits, depending on the location of the lesion, the size of the area of inadequate perfusion, and the amount of the collateral blood flow. Any patient with neurologic deficits need a careful history and complete physical and neurologic examination. Patients who have experienced TIA or stroke should have medical management for secondary prevention.

After the stroke is complete, management focuses on the prompt initiation of rehabilitation for any deficits. Based on the assessment data, the major nursing diagnoses for a patient with stroke may include the following:. In summary, here are some nursing interventions for patients with stroke:.

Cerebrovascular Accident Nursing Care Plan & Management

All questions are given on a single page and correct answers, rationales or explanations if any are immediately shown after you have selected an answer. No time limit for this exam. The degree of neurologic damage that occurs with an ischemic stroke depends on the:. Location of the lesion. Size of the area of inadequate perfusion. Amount of collateral blood flow. Combination of the above factors.

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Severe vomiting. A second stroke in 6 to 12 hours. Cardiogenic emboli. Large artery thrombotic. Small artery thrombotic. Since we started inNurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals.It can help you find your way home, settle pub debates and, heck, even make the odd phone call or two.

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Unless, of course, you set your music to turn off on a timer. In the Clock app, slide along to the Timer options. Here under the 'When Time Ends' tag, you can switch out the alarm option for a 'Stop Playing' tag.

This will turn off the tunes, be it through Apple Music or Spotify, when the timer hits zero. TAKE A PHOTO WITHOUT TOUCHING YOUR PHONEAn oldie but a goodie iPhone hack is using your volume control buttons to capture a snap - thus saving your meaty paw blocking the screen as you attempt to hit the touchscreen controls.For instance, we anticipated that impulse buying would remain lower than in other countries and that value for money would continue to be an important consideration when choosing products and services.

Interestingly, Chinese consumers across all age groups have, in some ways, become even more pragmatic. The individual consumer We also predicted that as Chinese consumers aspire to a better life and trade up their purchases, they would become more discerning and gradually more individualistic.

Chapter 49. Nursing Care of Patients With Cerebrovascular Disorders My Nursing Test Banks

This would lead, for example, to a shift toward more healthy choices, more user-friendly products, and products and brands that better fit their personality. This could be a big opportunity for niche brandsand a threat to the mass-market brands that had won big in previous years by using scale and ubiquitous availability, supported by the trust gained by heavy advertising.

Our latest research certainly shows a decrease in consumption in categories deemed less healthy and a willingness to spend significantly more on health and more environmentally conscious categories. It also shows consumers are more likely to spend more to indulge themselves and more likely to try new technology.

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While their consumption choices have become more individualistic, though, it is important to note that family values continue to be at the top of their priorities (Exhibit 3). One area our predictions missed, however, was by anticipating that consumers, as they became more individualistic in their choices, might focus less on basic product reliability and safety.

Perhaps in part because of a number of more recent food scandals, however, consumers seemed more concerned with these issues in 2015 than they were before. When our team first started researching Chinese consumers, nearly ten years ago, many of us were surprised by their fickle attitude toward brands.

Fewer than half of consumers tended to stick with their favorite brands, compared, for example, with almost three quarters of US consumers.

As we debated this tendency while making our predictions, we wondered if, in the clash between pragmatism and individualism, brand loyalty would stay low, increase, or even decline.

a nurse is caring for a client who had a cerebrovascular accident

Ultimately, we decided it would increase as the emotional benefits of brands became more important to consumers and as increased choice and availability of branded products (online and off) would allow consumers to optimize for price and convenience without changing choices too often.

Our recent research confirmed the changes we anticipated. Consumers are now significantly less likely to buy a brand that is not already among their favorites, continuing the upward trend we observed in 2011 (Exhibit 4). The modern shopper Our 2011 predictions were bullish on e-commerce, predicting that Chinese consumers would adapt their channel choices even faster than has occurred in developed markets.

We estimated that by 2020, online consumer-electronics purchases would jump to 40 percent, from about 10 percent.

More mainstream categories would rise to 15 percent, and some categories, such as groceries (now below 1 percent), could reach about 10 percent.

a nurse is caring for a client who had a cerebrovascular accident

These changes are occurring even as the enduring pragmatism and diligence of the Chinese consumer continue to be in place. Our latest research shows that consumers of all age groups are much more likely to collect information online, even on fast-moving consumer goods, than they were just three years ago. In 2015, online food and beverages sales (excluding fresh) reached 7. The online share of consumer-electronic purchases, meanwhile, has reached a whopping 39 percent in 2015, and it now looks possible that by 2020 it will be about 50 percent of overall sales.

Making predictions may be difficult, especially about the futureas US Baseball Hall of Famer Yogi Berra famously observed. But they can still provide valuable foresight for executives. Create a profile to get full access to our articles and reports, including those by McKinsey Quarterly and the McKinsey Global Institute, and to subscribe to our newsletters and email alerts.

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