Maria Carr is a 67-year-old retired teacher. She has been admitted to the accident and emergency (A&E) department with left sided arm and facial weakness, which started an hour ago. While in A&E an emergency CT scan was performed and confirms the diagnosis of an ischaemic stroke.
As Maria had been in A&E less than 4.5 hours, the medical team administered Alteplase 900 micrograms/kg as prescribed. GCS and BP to be monitored at 30-minute intervals to check for deterioration. If BP increases above 180 mmHg systolic or 105 mmHg diastolic, Maria is to be reviewed by the medical team. She has been transferred to the acute stroke unit. You have been assigned to her care.
On admission Maria is very drowsy but responding to verbal stimuli, she is snoring loudly, and her left sided weakness remains.
Medications as per drug chart
Dipyridamole 200 mg BD (twice a day)
Aspirin 75 mg OD (once a day)
Ward baseline Observations
Pulse: 90 beats per minute
Respiration rate: 9 breaths per minute
Blood Pressure: 170/95mmHg
Temperature: 36.50C
Oxygen saturation: 94% on Room Air
Verbal on ACVPU scale
Her pupils are size 3mm equal and reacting to light (PEARL)
Glasgow Coma Scale: 11
Considering relevant pathophysiology, discuss Maria’s acute management and nursing care in the first 24 hours after admission.
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