Case Study, Chapter 67, Management of Patients With Cerebrovascular Disorders

1. Penny Williams, a 74-year-old patient, is admitted to the telemetry unit with the diagnosis of acute

ischemic stroke. The patient is experiencing paroxysmal atrial fibrillation with a controlled ventricular

rate on the monitor.
A CT of the head without contrast reveals no evidence of hemorrhage. The transesophageal

echocardiogram reveals moderate mitral valve insufficiency and embolism as a primary cause of the

stroke. The patient is on a
weight-based heparin protocol. The patient received digitalis to keep the ventricular rate of the atrial

fibrillation controlled. The patient has right-sided paralysis and global aphasia. The patient has unilateral

neglect of her right side and has right field homonymous hemianopsia. Papilla edema is present bilaterally.

The patient is drooling from the right side of her mouth and coughs periodically. The patient was found by

her daughter when she got home from work. The daughter stated her mother was normal before she left

for work, and 10 hours later the mother exhibited the symptoms described above. The time of onset for the

stroke could not be safely determined so no interventions could be used to treat the stroke. (Learning

Objective 4)
What principles of nursing management should the nurse provide the patient during the acute stage of the
ischemic stroke based on the assessment findings from the case study? Place the assessment findings

that are supported by the nursing principle(s) in parenthesis.

Sample Solution

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(1) STATE the single most obvious ethical problem or uncertainty in the study.
(2) EXPLAIN specifically what about each study raises the ethical concern.
(3) State WHAT SHOULD BE DONE DIFFERENTLY in each study to reduce or eliminate your concern.
A researcher plans to conduct a study about friendship among college women. The researcher plans to

recruit pairs of girls to be interviewed together to discuss the nature of their friendship. Then the

researcher will interview the students separately and ask questions about their concerns about their

friendship. Finally, the researcher will bring the girls back together to discuss the findings of their

separate discussions. In that final interview, the researcher will state that one of the girls made negative

statements about the other to observe how the subjects resolve the conflict arising from the negative

statements. This conflict will be videotaped.

Sample Solution

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