Video Case Study - Caring for Patients With Cerebral Vascular Accidents

Nurse Darius works in a rehabilitation unit and is caring for Calvin, a 67-year-old with a history of hyperlipidemia who was admitted following a stroke.

In collaboration with the registered nurse, RN Alli, Nurse Darius goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Calvin’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Darius recognizes important cues including Calvin’s vital signs which are temperature 98.8 F, or 37.1 C, heart rate 98 beats per minute, respirations 16 breaths per minute, blood pressure 146/92 mmHg, and oxygen saturation 96 percent on room air.

Nurse Darius also notes that the left side of Calvin’s face is drooping and sees that he favors his right hand. Nurse Darius also overhears Calvin mixing up his words while trying to talk to the dietary staff about his lunch tray.

Next, Nurse Darius analyzes these cues. He reviews the electronic health record, or EHR, and sees Calvin has undergone an MRI of his head.

The results show that Calvin had an ischemic stroke, where an occlusion in an artery caused inadequate blood flow to his brain.

Nurse Darius knows Calvin’s hyperlipidemia was likely a contributing factor to his stroke, since it can lead to atherosclerosis and blockage of arteries.

He also knows the loss of oxygenated blood flow to the brain can cause damage to areas that control language and motor functions and lead to muscle weakness and aphasia.

Nurse Darius recognizes that he needs to effectively communicate with Calvin to properly care for him. Now, using the information he’s gathered, Nurse Darius discusses his findings with RN Alli, and they choose a priority hypothesis of impaired communication.

Then, they generate solutions to address Calvin’s impaired communication; and they establish the outcome that after intervening, Calvin will effectively communicate his needs by the end of the shift.

Nurse Darius and RN Alli then take action to implement these solutions. First, they collaborate with the speech therapist to use a communication board to compensate for Calvin’s new communication limitations.

Nurse Darius: How are you doing today, Calvin? Calvin: Faaahhh...Faaaahh...*huff* Nurse Darius: It must be frustrating and difficult to speak right now, but I brought a communication board for you to use.

I’ll try to keep my questions simple so you can use the board to answer. Is that okay with you?

Calvin: …...Yes. Nurse Darius: Feel free to use hand gestures if the board isn’t telling me what you want to say.

There’s no rush when you answer, I have plenty of time. Nurse Darius hands the communication board to Calvin and takes a seat in the chair at his bedside, as Calvin begins to use the board.

At the end of his shift, Nurse Darius evaluates the outcome of his interventions. He measures Calvin’s vital signs, which are temperature 98.0 F, or 36.7 C, heart rate 78 beats per minute, respirations 15 breaths per minute, blood pressure 130/90 mmHg, and oxygen saturation 98 percent on room air.

Nurse Darius also notes that Calvin has become more comfortable describing his needs using the communication board. Calvin has been able to tell Nurse Darius that he needs to use the bathroom and indicates what he wants to eat for dinner without frustration.

RN Alli plans to teach Calvin’s family how to use the communication board when they come to visit the next day. Alright, as a quick recap… Nurse Darius recognized and analyzed cues related to Calvin’s impaired communication from his stroke, and in collaboration with RN Alli prioritized hypotheses, and generated solutions to address this problem.

Nurse Darius and RN Alli then implemented measures to address Calvin’s impaired communication and evaluated outcomes by comparing them to the expected outcomes.

Since Calvin was able to effectively communicate his needs, they determined his plan of care was successful.