Florida Gulf Coast University
School of Nursing
NUR 3286L Gerontological Nursing Clinical
Clinical Worksheet
Patient Information:
Age: 77 years old
Gender: Male
Allergies: NKA
Race: Caucasian
Date of admission: 9/14/2024
Reason for admission: The patient has residual right-sided weakness following a cerebral vascular accident (CVA) last
month. He was referred to the rehab floor for therapy to improve his mobility, strength, and overall functional
independence.
Disease Process: A cerebral vascular accident (CVA) is more commonly known as a stroke and is a medical emergency.
It is classified as a sudden loss of blood flow to the brain that causes damage to the brain tissue. There are two main types
of CVA, ischemic and hemorrhagic. Ischemic strokes are the most common and occur when a blood vessel that supplies
the brain is blocked. This blockage can result from an embolic stroke, where a clot, fat, or air bubble (embolus) forms
away from the brain travels through the bloodstream, and gets stuck in the narrow brain arteries. It can also be blocked
because of a thrombotic stroke where a blood clot (thrombus) forms within the artery and occludes blood flow to that area
of the brain. The lack of blood flow to that brain area leads to a decrease in oxygen and nutrients to the neurons, which
leads to cell death. A hemorrhagic stroke happens when a blood vessel in the brain is ruptured causing bleeding and
swelling of the brain tissue and spasms of the surrounding blood vessels. Both types of strokes lead to cellular injury and
death, leading to neurological deficits depending on the brain region that was affected. The risk of stroke is increased by
many factors such as older age, smoking, coronary artery disease (CAD), family history, high blood pressure, and high
cholesterol. In this patient’s case, he had nearly all these risk factors. He is a current smoker, has a family history of stroke
with his brother and father, has CAD, and hypertension, and is of an older age. Smoking and hypertension both cause
damage to blood vessels and increase the risk of clot formation. CAD indicates atherosclerosis in the coronary arteries
which also increases the risk for formation. Given these risk factors and his symptoms of right-sided weakness, the patient
likely suffered from an ischemic stroke affecting the left side of his brain which controls the movement of the right side of
the body.
Diagnostic tests (reason for test and result):
CBC w/o diff: 9/13/2024
WBC: 4.4 x10E3/uL
RBC: 4.31 x10E6/uL
Hgb: 13.9 gm/dL
Hct: 40.2%
MCV: 84.5 fL
MCH: 27.6 pg
MCHC: 32.7 gm/dL
RDW: 14.2%
Platelets: 196 x10E3/uL
MPV: 9.9
The patient was admitted to the hospital for his cerebral vascular accident and had these labs drawn as part of a daily
routine of care. Daily hospital labs are drawn in the hospital to monitor the patient’s status to ensure they have nothing
acute occurring. CBCs are important for assessing the patient’s oxygen-carrying capacity and detecting any bleeding or
anemia that could complicate their recovery. White blood cell counts can indicate potential infections such as pneumonia
or urinary tract infections, which are common in post-stroke patients. This patient’s labs were all within normal limits
which supported the decision to discharge him to rehab.
Florida Gulf Coast University
School of Nursing
NUR 3286L Gerontological Nursing Clinical
Clinical Worksheet
CMP: 9/13/2024
A/G ratio: 1.4
ALT: 39 IU/L
AST: 31 IU/L
Albumin: 3.6 g/dL
Alkaline Phosphatase: 75 IU/L
BUN: 19 mg/dL
Creatinine: 1.1 mg/dL
BUN/Creat. Ratio: 16
Bilirubin: 0.4 mg/dL
Anion: 7mmol/L
Calcium: 8.8 mg/dL
Carbon Dioxide: 28 mmol/L
Chloride: 105 mmol/L
Globulin: 2 g/dL
Glucose: 103 mg/dL
Potassium: 4.5 mmol/L
Protein: 6.2 g/dL (low)
Sodium: 137 mmol/L
eGFR: 90 mL/min/1
The CMP was drawn as a part of daily lab work while the patient was admitted to the hospital. The CMP can provide
insight into the patient’s metabolic health. Monitoring the patient's kidney and liver function is important as many
medication dosages and metabolism can be affected if they are impaired. In terms of this patient, all of his labs were
within a normal range except for his protein. When asked he stated he doesn’t really eat much protein and didn’t have a
desire to start. He has been taking a protein supplement since his admission to the facility but has not had repeat labs
done since his admission.
CT Head w/o contrast: 9/4/2024
- No evidence of intracranial hemorrhage, shift, or mass effect.
CT Perfusion 9/4/2024
- No abnormal perfusion to suggest ischemia/oligemia.
CTA Head and Neck 9/4/2024
- No large vessel occlusion. No aneurysm.
MRI Head w/o 9/4/2024
- No acute infarct.
MRI Head w/o 9/11/2024
- No acute infarct.
The patient presented to the emergency room with right-sided weakness, right facial droop, and slurred speech. These
studies were performed as a part of a stroke alert work-up, but all resulted as normal. Not a TPA candidate as his last
known normal was 03:00 am and he was not seen in the emergency room until 12:22 pm, and he is taking apixaban
daily. The second MRI was performed to see if any areas of ischemia were present after a few days as strokes are
sometimes not visible for a while after the onset. However, it was normal as well. It was interesting they diagnosed him
with a CVA since I was unable to find any evidence of testing that proved the occurrence of one. It is entirely possible I
just missed it within the binder.
Florida Gulf Coast University
School of Nursing
NUR 3286L Gerontological Nursing Clinical
Clinical Worksheet
PATIENT INFORMATION PHYSICAL FINDINGS
General: Well appearing, well-nourished and in no distress.
Skin: Good turgor, no rash, unusual bruising or prominent lesions
Hair: Normal texture and distribution.
Nails: Normal color, no deformities
Head: Normocephalic, atraumatic, no visible or palpable masses, depressions, or scaring.
Eyes: Conjunctiva clear, sclera non-icteric, EOM intact, PERRLA.
Nose: No external lesions, mucosa non-inflamed.
Mouth: Multiple teeth missing, evident tooth decay and cavities.
Heart: Regular rate and rhythm. +2 radial pulses. Unable to assess pedal pulses. Good capillary refill to upper extremities.
Lungs: No adventitious lung sounds noted. No shortness of breath, use of accessory muscles, or cough.
Abdomen: Bowel sounds normal, no tenderness. Last bowel movement 10/2/2024.
Musculoskeletal: 5/5 motor grade strength for the LUE and LLE. The patient has 4/5 motor grade strength for the RLE
and RUE. All extremities have full sensation and active range of motion. His gait is unsteady, and he uses a walker to
ambulate.
Vital Signs:
BP: 126/70
O2: 94%
HR: 61
RR: 16
Temperature: 98.1 tympanic
MANAGEMENT OF CARE; WHAT NEEDS TO BE DONE FOR THIS PATIENT
TODAY?
1. Monitor vitals daily to assess for any potential complications such as aspiration
pneumonia, high blood pressure, or elevated temperature.
2. Medication administration of anticoagulants, antiplatelets, and antihypertensives to
lower the risk of future strokes.
3. Assist to and in the bathroom due to weakness to prevent falls.
4. Monitor during and after meals to prevent aspiration due to muscle weakness in the face and possibly throat.
5. Physical therapy session to work on strength, balance, and mobility.
LIST COMPLICATIONS THAT MAY OCCUR; RELATED TO DX, PROCEDURE, COMORBIDITIES
1. Skin integrity could be compromised due to the patient’s mobility issues. It is causing him to remain
immobile for longer periods than normal which can lead to skin breakdown.
2. The patient is at an increased risk for bleeding due to the medications he is taking for antiplatelet and
anticoagulation.
3. He is at an increased risk for a pneumonia infection due to his swallowing difficulties and reduced mobility.
PHARMACOLOGY WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: apixaban
CLASSIFICATION: Factor Xa inhibitor
PROTOTYPE: rivaroxaban
Source: Lippincott advisor
SAFE DOSE OR DOSE RANGE, SAFE ROUTE (Please show your calculations for safe dosing)
- 5 mg twice a day
- Max dose 20 mg daily
PURPOSE FOR TAKING THIS MEDICATION
- Apixaban is an anticoagulant medication that was prescribed to prevent blood clots. Since this patient was
diagnosed with a CVA, most likely caused by a blood clot, this is being used as long term risk reduction.
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
- Do not stop taking unless directed by a doctor as you have a higher risk of forming blood clots. Nausea, easy
bruising and minor bleeding are common side effects. This medication can cause serious bleeding. Notify
your provider if you have any signs such as an unstoppable nosebleed, prolonged bleeding from gums or
cuts, coffee ground emesis, or black tarry stools.
- Nursing considerations
- Monitor patient for bleeding and signs and symptoms of blood loss. Discontinue at least 24 hours before
surgery or invasive procedures.
PHARMACOLOGY WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: aspirin
CLASSIFICATION: Anti-inflammation/Salicylate
PROTOTYPE: aspirin
Source: Lippincott advisor
SAFE DOSE OR DOSE RANGE, SAFE ROUTE (Please show your calculations for safe dosing)
- 81 mg daily
- Max dose 4 grams daily
PURPOSE FOR TAKING THIS MEDICATION
- Aspirin has anti-inflammatory, analgesic, and antipyretic properties. It also contains antiplatelet properties
which is why it was prescribed to this patient to aid in stroke risk reduction. It is often prescribed to patient
with high blood pressure or history of heart disease.
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
- It is important to take this medication exactly as prescribed. Be aware of potential side effects such as
gastrointestinal upset and an increased risk in bleeding. If you notice any unusual bruising, blood in your
urine or stool, or prolonged bleeding from cuts notify your healthcare provider immediately. One tablet of
aspirin contains 553 mg of sodium so be careful if on a low sodium diet.
- Nursing considerations
- Monitor patient frequently for signs of bleeding. Avoid using in patients with severe liver or kidney
impairment, or history of peptic ulcer disease.
PHARMACOLOGY WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: amlodipine
CLASSIFICATION: calcium channel blocker
PROTOTYPE: verapamil
Source: Lippincott Advisor
SAFE DOSE OR DOSE RANGE, SAFE ROUTE (Please show your calculations for safe dosing)
- 5 mg daily
- Max dose 10 mg daily
PURPOSE FOR TAKING THIS MEDICATION
- Amlodipine works by blocking calcium from entering the cells of blood vessels. This leads to relaxation and
widening the arteries, lowering blood pressure. This patient has a history of hypertension and was prescribed
this medication for it. It can also aid in stroke prevention as high blood pressure is a risk for stroke.
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
- This medication has many potential side effects including swelling in the legs or ankles, dizziness, and
flushing. It is important to monitor your blood pressure regularly. Take this medication at the same time daily
with or without food. Do not stop taking this medication without doctor supervision.
- Nursing considerations
- Monitor blood pressure frequently. Abrupt withdrawal may increase frequency and duration of chest pain.
Notify provider if signs of heart failure occur such as swelling of the hands and feet or shortness of breath.
PHARMACOLOGY WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: clopidogrel
CLASSIFICATION: platelet aggregation inhibitor
PROTOTYPE: aspirin
Source: Lippincott advisor
SAFE DOSE OR DOSE RANGE, SAFE ROUTE (Please show your calculations for safe dosing)
- 75 mg daily
- Max dose is 300 mg daily
PURPOSE FOR TAKING THIS MEDICATION
- Clopidogrel works by inhibiting platelet aggregation to lower the risk of developing blood clots. Since the
patient was diagnosed with a CVA, this medication is given to further reduce his risk of an additional
thrombotic event occurring.
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
- It is important to take this medication exactly as prescribed. Do not crush or chew the tablet as this can
affect the medication action. Common side effects are bleeding or bruising more easily. Avoid injury and use
a soft toothbrush and electric razor. It is important to inform your doctor of any other supplements or
medications as they can interact with this drug.
- Nursing considerations
- Discontinue drug at least five days prior to elective surgeries. Use cautiously in patients with an increased
risk for bleeding or those with liver and kidney impairments.
PHARMACOLOGY WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION: lisinopril
CLASSIFICATION: ACE inhibitor
PROTOTYPE: captopril
Source: Lipincott advisor
SAFE DOSE OR DOSE RANGE, SAFE ROUTE (Please show your calculations for safe dosing)
- 10 mg daily
- Max dose is 40 mg
PURPOSE FOR TAKING THIS MEDICATION
This patient has been diagnosed with hypertension and was prescribed this medication to help lower his blood
pressure. It is important to aid in both stroke recovery and to prevent further strokes or cardiovascular events.
PATIENT EDUCATION WHILE TAKING THIS MEDICATION
- Do not give use this drug if you are pregnant or planning to get pregnant. To avoid feeling dizzy or passing
out rise slowly if you have been sitting or lying down. Check blood pressure as often as your doctor
recommended. If you are taking this drug and have high blood pressure, talk with your doctor before using
OTC products that may raise blood pressure. Drink plenty of fluids if you sweat, are throwing up, or have
loose stools. This medication may cause a persistent dry, tickling, non-productive cough.
- Nursing considerations
- Use cautiously in patient with impaired kidney function, and those at risk for hyperkalemia or hypotension.
Patients who are black with idiopathic or hereditary angioedema are at an increased risk for angioedema
from this medication. Monitor BP and serum potassium levels frequently.
