Med Surg Case Study #29: Stacy Marie Jones

Stacy Marie Jones | 67 years old

Chief Complaint: Stacy Complains of a severe headache and sudden loss of consciousness.

Medical History:

• Hypertension

• Type 2 Diabetes Mellitus

• Hyperlipidemia

• Previous transient ischemic attack (TIA) 2 years ago

Open each expandable tab to get more information.

0800

Nurse's Note: Patient found unresponsive by family at home.

• Family reports sudden severe headache and collapse.

• EMS arrived and noted altered level of consciousness.

• Transported to the emergency department (ED).

Vital Signs:

• Blood pressure: 190/110 mmHg

• Heart rate: 110 bpm

• Respiratory rate: 22 breaths/min

• Temperature: 98.6°F (37°C)

• SpO2: 95% on room air

Provider Orders:

• Stat CT scan of the head

• Initiate IV access, 0.9% Normal Saline at 75 mL/hr

• Administer labetalol 10 mg IV push for BP management

• Obtain blood samples for CBC, BMP, PT/INR, PTT

1000

Nurse's Note: Patient intermittently responsive, exhibiting left-sided hemiparesis. She complains of severe headache when conscious. Vomited once, suction at bedside to prevent aspiration.

Vital Signs

• Blood pressure: 170/100 mmHg

• Heart rate: 105 bpm

• Respiratory rate: 24 breaths/min

• Temperature: 98.7°F (37.1°C)

• SpO2: 94% on 2L nasal cannula
  

Provider Orders:

• Transfer to ICU for close monitoring

• Continuous cardiac and respiratory monitoring

• Administer mannitol 1 g/kg IV over 30 minutes

• Start nimodipine 60 mg orally every 4 hours

• Strict intake and output monitoring

• Neurologic checks every hour

1400

Nurses Note: Report given to ICU RN Caroline and patient transferred to ICU. At time of transfer patient responsive to painful stimuli but not fully conscious. Continues to display left-sided hemiparesis. Increased drowsiness noted, but can follow simple commands intermittently.

No further vomiting observed.

Vital Signs:

• Blood pressure: 160/95 mmHg

• Heart rate: 100 bpm

• Respiratory rate: 20 breaths/min

• Temperature: 98.8°F (37.1°C)

• SpO2: 96% on 2L nasal cannula
  

Question 1: What is the primary goal of administering mannitol to Stacy Jones?

Question 2: Why was nimodipine prescribed for Stacy Jones, and how does it help in her condition?

Question 3: What is the significance of hourly neurological checks for Stacy Jones?

Answers to Questions Below

ULTIMATE Med Surg Notebook

Buy Now

Answers

Question 1: What is the primary goal of administering mannitol to Stacy Jones?

The primary goal of administering mannitol is to reduce intracranial pressure (ICP) by promoting osmotic diuresis. Mannitol helps to pull water out of the brain tissue, reducing cerebral edema and the risk of herniation.

Question 2: Why was nimodipine prescribed for Stacy Jones, and how does it help in her condition?

Nimodipine was prescribed to prevent cerebral vasospasm, which is a common and serious complication after a subarachnoid hemorrhage.

Question 3: What is the significance of hourly neurological checks for Stacy Jones?

Hourly neurological checks are crucial to monitor for any changes in Stacy's neurological status, which could indicate worsening of her condition, such as increased intracranial pressure, rebleeding, or the onset of vasospasm.

Med Surg Case Study