Nursing Care Plan

Topics: Blood, Myocardial infarction, Blood pressure, Nursing / Pages: 14 (2431 words) / Published: Oct 2nd, 2014
3N Clinical Nursing Care Plan
NURS 2230
Lakehead University
October 2, 2014

I declare that this paper is my original work. Excepting where I have cited my own previous work, this paper in its entirety, or any portion thereof, has not been submitted to meet the requirements of any other credit course.

Student Signature: ____________________________________ Date: ____________________

Patient History
In the context of this paper, the patient will be referred to as “Mrs. V.” Mrs. V is a seventy-two year old female. On August 12, 2014 Mrs. V’s life changed considerably. She was fairly independent with her ADLs prior to that day. She was ambulating with a walker for the last four years. She was able to thrive with minimal assistance in an assisted living home. On August 9, 2014, Mrs. V was admitted to the Thunder Bay Regional Health Sciences Centre after a fall. The records state that she felt presyncopal upon standing and fell down. She did not hit her head. She denied any chest pain, shortness of breath, palpitations, nausea, vomiting or abdominal pain. Upon admission, her blood pressure was 241/115, heart rate was 77, oxygen was 94% on room air, and her respirations were 20 breaths per minute. She was afebrile. She had a decreased range of motion at her left knee with tenderness. Two days later, on August 11, she complained of left arm weakness that had increased in severity. On August 12 at 5:30 am, she was noted to have left facial droop and left leg weakness. A small suspicious basal ganglia lacunar stoke was visible on the CT scan. The records state that it was a possible pure motor stroke secondary to the right basal ganglia lacunar recent infarction. In view of her blood pressure upon admission, she was prescribed hydrochlorothiazide and Lipitor. She was loaded with 160 mg of aspirin and added Plavix to her current treatment. She was transferred to St. Joseph’s Hospital on August 25, 2014 for stroke



References: Gulanick, M., & Myers, J. L. (2011). Nursing care plans: diagnoses, interventions, and outcomes (7th ed.). St. Louis, Mo.: Elsevier ggggggggMosby.

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