Question

The nurse is caring for a client who reports sudden right-sided numbness and weakness of the arm and leg. The nurse also observes a distinct right-sided facial droop. After reporting the findings to the healthcare provider, the nurse receives several prescriptions for the client, including a STAT computerized tomography scan of the head. Which intervention should the nurse perform in the immediate management of the client?

Answer 1

The nurse should prioritize life-supporting interventions, closely monitor the patient, ensure rapid CT scan preparation, and possibly initiate treatments like aspirin to limit blood clots after consulting with a physician.

Step-by-step explanation:

The nurse is dealing with a client showing symptoms indicative of a stroke, such as sudden right-sided numbness and weakness, and right-sided facial droop. The immediate management after reporting to the healthcare provider and receiving orders for a STAT computerized tomography (CT) scan of the head includes ensuring the client's airway is clear, monitoring vital signs, providing reassurance, and preparing the client for the scan. Recognizing the urgency of the situation following the FAST mnemonic (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services), the nurse should prioritize interventions that support life, prevent further harm, and facilitate rapid diagnosis and treatment. Detailed neurological examinations such as checking reflexes, sensory responses, and motor control help localize the neurological deficit, which is crucial for targeted therapy. In the provided scenario, aspirin therapy might be initiated to limit the possibility of further blood clots. However, this would depend on the precise diagnosis confirmed by the CT scan and physician's orders in consideration of potential contraindications.