advancing the vision of the neurological institute patient experience 2014
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Advancing the Vision of the Neurological Institute Patient Experience 2014 Julie Fussner BSN, RN, CPHQ, SCRN. Patient Experience. April 26, 2012 49 yo F Hx: HTN, Bipolar 10:20 L weakness, slurred speech, and collapsed at Vet’s office Taken to OSH – arrived at 10:40 - PowerPoint PPT PresentationTRANSCRIPT
Advancing the Vision of the Neurological Institute Patient Experience 2014
Julie Fussner BSN, RN, CPHQ, SCRN
Advancing the Vision of the Neurological Institute Patient Experience 2014
Julie Fussner BSN, RN, CPHQ, SCRN
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Patient Experience• April 26, 2012• 49 yo F Hx: HTN, Bipolar• 10:20 L weakness, slurred speech, and collapsed at
Vet’s office• Taken to OSH – arrived at 10:40• VS: B/P 159/63 HR 120, R 20 BS 138• NIHSS=10• CT small right parietal hypodensity – did not explain
symptoms• UH transfer center called and IV tPA recommended• 11:20 IV tPA started (Door to drug = 40 mins)
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Patient Experience• 12:14 arrival to UH CMC by helicopter• VS: B/P 145/86 HR 112 Pulse ox 96% on 2L NC• Exam: Alert and oriented x3, responding to
questions, following commands, looking to the right, visual field cut (Homonymous Hemianopia), no movement on left side, dense sensory loss on left, mild dysarthria, L neglect
• NIHSS = 20• IV tPA infusion finishing• Foley • Menses
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Patient Experience- NIHSS• 1a. LOC - 0• 1b. LOC Questions - 0• 1c. LOC Commands - 0• 2. Best Gaze - 2• 3. Visual Fields -2• 4. Facial Palsy - 1• 5. Motor Arm - 4• 6. Motor Leg - 4 • 7. Limb Ataxia - 0 • 8. Sensory - 2• 9. Best Language - 0 • 10. Dysarthria - 1• 11. Neglect - 2
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Patient Experience Endovascular Intervention
• IV TPA 33% benefit• 12:45 Taken for Neuro angio suite• 13:05 Groin access (Door to groin = 51 mins)• R MCA Occlusion (R Middle cerebral artery)• MCA Branches
Anterior – occluded Middle - occluded Posterior - patent
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Patient Experience - MRI
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Patient Experience Endovascular devices
Solitaire Penumbra
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Patient ExperienceEndovascular Intervention
• Solitaire #1• Solitaire #2• Penumbra #1• Penumbra #2• TPA – 2 mg IA tPA• Penumbra # 3 – successful in the anterior branch• TPA – 2.5mg IA tPA• Solitaire #3 – Intermittent revascularization of middle
branch• Post procedure NIHSS =18
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Patient Experience
• Stroke Work up:– Lipid panel: LDL = 99– HbA1c = 5%– Echocardiogram: EF >65%, No PFO, + atrial septal
aneurysm– Troponin leak 0.13 but no EKG changes
• Hospital course:– Anemia
• Hb = 5.2 due to uterine bleeding- Tx with 2U PRBC’s
– Diabetes Insipidus
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Patient Experience Diabetes Insipidus
• Kidneys are unable to conserve water as they perform their function of filtering blood.
• Amount of water conserved is controlled by antidiuretic hormone (ADH), also called vasopressin.
• ADH is a hormone – Produced in the hypothalamus– Stored and released from the pituitary gland, a small gland
at the base of the brain.• DI caused by a lack of ADH is called central diabetes
insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus
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Patient ExperienceDiabetes Insipidus (DI)
• Hypernatremia - Na = 160’s• Urine output 200 - 300cc/ hr• TX: DDAVP, hypo osmotic fluids• Renal consult: Nephrogenic DI induced by
lithium therapy• NSU for 6 days
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Patient Experience
• Therapy (PT, OT, ST ) recommending acute rehab– Maximal assist to move in bed and sit up– Able pivot– Poor trunk control
• Modified Barium Swallow– Passed for pureed with nectar thick liquids– unable to take in enough calories
• PEG placed on May 3
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Patient Experience• Discharged to Acute rehab on May 4, 2012• Alert Ox 2• R gaze but able to cross over to left side• L visual field cut• LUE – 0/5• LLE – 1/5• L neglect• L sensory• Dysarthria but no aphasia • NIHSS = 16
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Patient ExperienceDischarge Medications
• ASA • Atorvastatin• HCTZ• Metoprolol• Ferrous Sulfate• Synthroid• Ranitidine• Heparin SQ• Ciprofloxacin for UTI