Clinical presentation and nursing care of a patient with acute ischemic stroke

Vithya1, Anbarasi2

1Staff Nurse, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

Introduction

A 77-year-old male was admitted with complaints suggestive of an acute ischemic stroke. He was initially treated at a local hospital and later transferred here for further neurological management.

Definition

A stroke is a sudden onset of neurological deficit due to interruption in blood supply to the brain, either from ischemia or hemorrhage. In this case, the patient suffered an ischemic stroke in the left middle cerebral artery (MCA) territory.

Case Presentation

The patient presented with acute onset of right-sided weakness and deviation of the mouth to the left. He had a history of hypertension, diabetes mellitus, obstructive sleep apnea (OSA), and coronary artery bypass graft (CABG) done in 2001.

On examination

GCS: E2V1M5, Pulse: 97/min, BP: 140/100 mmHg, Sp O₂: 100% with 2 L O₂

Left UL/LL: Power 3/5, Right UL/LL: Power 1/5

Plantar: Right – mute, Left – down

MRI brain: Revealed a left MCA territory infarct with an old right MCA infarct.

Pathophysiology

The left MCA infarct resulted from an occlusion in the middle cerebral artery, leading to ischemia of the left front-to-parietal region, causing contralateral (right-sided) hemiparesis and facial weakness. The patient’s preexisting vascular comorbidities (diabetes, hypertension, CAD) increased his risk for recurrent stroke.

Signs and Symptoms

  • Sudden onset of weakness on the right side of the body
  • Deviation of angle of mouth
  • Slurred speech / decreased verbal response
  • Altered sensorium (Low GCS)
  • Difficulty in swallowing (RT feeds initiated)

Medical Management

  • Acute thrombolysis with Inj. Tenecteplase was administered in the previous hospital.
  • Ongoing Neuromonitoring in Neuro ICU
  • Oxygen therapy: Nasal prongs 2 L/min.
  • Antibiotics: Started for aspiration pneumonia.
  • RT feeding for nutrition.
  • BIPAP support overnight for OSA.
  • Blood investigations: Monitored and managed accordingly.
  • CT brain follow-up: Showed evolving infarct in left MCA territory with chronic infarct on right side.
  • Multidisciplinary care: Neurology, Pulmonology, and Nursing team

CT Evidence

Nursing Management

  • Continuous neurological assessment (GCS monitoring).
  • Maintenance of airway and oxygen therapy.
  • Proper positioning and use of nimbus bed to prevent pressure sores.
  • RT feed administration and tolerance monitoring.
  • Catheter care and intake-output charting.
  • Mouth care and back care to maintain hygiene.
  • Strict infection control practices.
  • Emotional support to family and coordination for discharge planning

Nursing Interventions

  • Airway management: Maintain O₂ therapy, monitor saturation.
  • Nutrition: Administer RT feeds as per schedule.
  • Skin care: Two-hourly repositioning and pressure area care.
  • Elimination: Catheter care and documentation.
  • Neurological observation: Monitor level of consciousness and limb movement.
  • Medication administration: As prescribed (antibiotics, Anti-hypertensive, etc.).
  • Patient and family education: Regarding long-term care and prognosis.

Outcome

  • Patients remained hemodynamically stable but neurologically GCS needs to improve.
  • Transferred to a long-term healthcare facility for continuous medical and nursing care.
  • Long-term neurological prognosis explained to relatives.

Patient Satisfaction and Feedback

Family expressed satisfaction with the multidisciplinary team’s efforts and care during hospital stay. They were counseled about prognosis and post-discharge plans.

Evaluation

The care plan was effectively implemented with timely nursing interventions, infection prevention, and supportive therapy. Despite of neurological recovery slight improvement, systemic stability was maintained.

Conclusion

This case highlights the management of a recurrent ischemic stroke (Left MCA infarct) in an elderly male with multiple comorbidities. Prompt thrombolysis, comprehensive ICU care, and coordinated nursing interventions contributed to the stabilization of the patient. Continued institutional care was planned for long-term management and rehabilitation.

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