Below is a summary of Maya’s electronic health record during her four hours in the emergency room. As her ED physician, you are responsible for examining Maya and ordering tests. These tests will help diagnose her condition. Answer the following questions and be prepared to discuss the responses with the rest of Maya’s healthcare team.

1. Review Maya’s VPE: You assess Maya’s condition and review her vitals listed in her EHR. Maya’s blood pressure and pulse rate are high, and you are concerned that Maya is having a stroke. You immediately begin performing the National Institute of Health’s Stroke Scale (NIHSS). Maya’s results show her score as a 24, which indicates that she has suffered a severe stroke.

After reviewing her NIHSS score in VPE, which areas are of high concern?


A. LOC question: Month and age.

B. LOC question: Open and close eyes

C. Gaze

D. Visual field

D. Facial palsy



2. Internet Research: There are three types of strokes. Your first task is to determine what type of stroke Maya is having.
   Match the name of the stroke with the correct description.

   ____ Ischemic	A. A weakened blood vessel ruptures.
   ____ Hemorrhagic	B. A temporary clot.
   ____ Transient Ischemic Attack	C. An obstruction within a blood vessel.



Of the three types of strokes, which is the most common type of stroke?

A. Transient Ischemic Attack (TIA)

B. Hemorrhagic stroke

C. Ischemic stroke

D. Both B and C



3. Internet Research: You write orders for an immediate CT Angiography of Maya’s brain.
What information can be obtained from a CT Angiography that may be helpful in determining Maya’s diagnosis?

A. Determine if there is insufficient blood flow to the heart.

B. Determine if there is blockage of the brain’s blood vessels.

C. Determine if there is blockage of the carotid arteries.



4. Review Maya’s ED EHR: What do the results of Maya’s CT Angiography indicate?

   A. Slurred, unrecognizable speech.

   B. Loss of mobility in both right arm and leg.

   C. Diffused region of hypodensity, left ventricle.

   D. All the above

   
   
5. Internet Research: You determine Maya is having an ischemic stroke. Which is the BEST treatment for her?

   A. Cardiovascular procedure

   B. Surgical treatment

   C. tPA injection

   D. Both A and B



View Maya’s EHR – ED Chart   Virtual Physical Exam
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National Institute of Health’s Stroke Scale (NIHSS): A standardized tool used by physicians and other health care professionals to measure the level of impairment caused by a stroke.

(MD, PhD Jose Vega. “How Is the NIH Stroke Scale Used for The Evaluation of Stroke?” Verywell. N.p., n.d. Web. 12 May 2017.)
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Ischemic stroke: (is-skem-ik) The most common kind of stroke, which is caused by an interruption in the blood flow to the brain. (“Stroke.” Mayo Clinic. N.p., n.d. Web 15 Sept. 2014.)