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Relevant Cues/Findings (assessment): history of cerebral infractions…

- - - - Nurse will assess for signs of stroke. Nurse will assess the patient's balance, eyes, face symmetry, arms/pronator drift, and speech. If the nurse identifies any signs indicative of a stroke, they will initiate a code stroke.
        
        Nurse will review prescribed drugs to ensure there are no drug-drug interactions that could cause seizures or increase intracranial pressure. Nurse will also be aware of medications that could mask symptoms of a stroke, seizure, or decreases in neurological function. Drugs could include narcotics, anti-seizure medications and antihypertensive. Nurse will administer prescribed drugs to help lower intracranial pressure, prevent clot formation, break up clots, and to decreases inflammation.
        
        Nurse will elevate head of bed to 30 degrees/ semi-fowlers position to decrease intracranial pressure. The bed should not be completely flat or raised higher then 30 degrees, as this could increase pressure in the skull.
    - - Patient will show signs of adequate cerebral perfusion. Patient will display normal neurological functioning. Patient has equal and reactive pupils, strong grip strength, and GCS of 15, and normal cognition. Patient shows no signs of any speech of memory deficit.
        
        CT and MRI scans show no signs of anastomotic stenosis. CT shows no signs of clot formations or bleeding that could impeded blood flow to the brain. CT shows signs of interval reperfusion of intracranial left internal carotid artery. CT and MRI post-operation shows no damaging/ extremely abnormal signs of inflammation that could impede healing and perfusion.
      - Discharge: Medical and nursing outcomes/resources needed
        
        Stroke and seizure symptoms will resolve after extracranial to intracranial bypass. Patient will report to follow up visit in 2 weeks to check perfusion (CT scan)
        
        Patient verbalizes an understanding of taking medications as well as the schedule and any implications that go along with administration. Patient will diligently maintain medication regimen as prescribed. Patient will take 750mg Keppra Q12h and 81mg aspirin daily to manage seizure symptoms and avoid the risk of any clot formations that could impede cerebral perfusion.
        
        Patient will maintain a healthy diet that aims to reduce LDL cholesterol levels and limits triglycerides. Lowering cholesterol levels can lower risk of clot formation and stenosis of cerebral arteries. Patient could be recommended to dietitian to plan discharge meals to help accomplish these goals long term.
        
        Patient has be educated and verbalizes and understanding of seeking medical help if they notice symptoms that could indicate decreased cerebral perfusion. Patient understandings BE FAST acronym and knows what symptoms could indicate a stroke. Family members are aware of symptoms that could indicate neurological changes/deficits such as changes in speech and gait. family members are aware of when to call for medical help as well.