Question

A patient presents with headache, slurred speech, and numbness. The doctor orders brain magnetic resonance imaging (MRI) to test for signs of ischemic or hemorrhagic stroke. To obtain the patient's informed consent, the nurse can best explain the procedure this way:

1) "The doctor believes you may be having a stroke. The doctor would like us to do an MRI to determine the type of stroke and whether or not it will respond to anticoagulants. We could skip the test and just give you the anticoagulants, but if the stroke is hemorrhagic, the anticoagulants could make it worse or even fatal. I do need to know whether you have any ferrous metals in your body. Please sign this consent form so we can do the test immediately."

2) "I understand you've got a headache and that you're having some trouble talking. The doctor who just saw you thinks she knows what's causing it, but she needs to do a test to be sure. It's called an MRI, and it requires us to put you inside a big machine where there will be quite a bit of noise. However, we can give you some earphones to listen to music while the MRI is being done. If you are claustrophobic at all, your doctor can prescribe a sedative to help you stay relaxed. The only real problem would be if you have any metal in your body. Please sign this consent form as long as you don't have any metal inside you."

3) "The doctor says we need to do an MRI to find out what's wrong with you. Here's a pamphlet that will tell you all about MRIs, and you can read it while I go get the MRI machine ready for you. We need to do the test right away so we can start treating you quickly, because if you're having a stroke, we only have an hour before the damage becomes permanent. I'll leave you with this consent form as well. Please sign it before I get back so we can do the MRI right away and treat you as quickly as possible."

4) "Your doctor says we need to do an MRI to determine whether you're having a stroke and, if so, how best to treat you. Here's a pamphlet that describes the MRI. In general, an MRI takes a detailed picture of your brain that will show us there is a blood clot or bleeding in your brain. We could give you anticlotting medicine now, but if there is bleeding, the anticlotting medicine could make it worse and even life-threatening. The MRI machine makes loud noises, but I can get you some earphones so you can listen to music during the test. You'll be inside the machine—if you are claustrophobic, your doctor can prescribe a sedative. I do need to know whether you have any metal implants, aneurysm clips, residual buckshot from gunshot wounds, or a pacemaker. If you're okay with us doing the MRI, please sign this consent form."

Answer 1

An MRI scan is crucial in differentiating between ischemic and hemorrhagic strokes, guiding appropriate treatment, despite drawbacks like cost and patient discomfort. Patients must be informed about the procedure and assessed for contraindications such as the presence of metal implants before obtaining consent.

Step-by-step explanation:

When a patient is suspected of having a stroke, it is critical to determine the type of stroke as quickly as possible. A magnetic resonance imaging (MRI) scan is a sophisticated procedure that utilizes a powerful magnetic field to generate detailed images of the brain, helping to differentiate between ischemic and hemorrhagic strokes.

Since the treatment for these two types of strokes differs significantly, with anticoagulants potentially being harmful in the case of a hemorrhagic stroke, obtaining an accurate diagnosis through MRI is essential.

However, MRI scans have certain drawbacks such as their cost, the discomfort of being enclosed in a noisy, metal tube-like device, and the exclusion of patients with iron-containing metallic implants since the magnetic field can dislodge these implants.

Despite these challenges, MRIs remain one of the most informative diagnostic tools for stroke assessment, and newer developments, such as open MRI machines, help to alleviate some of the claustrophobic discomfort associated with traditional closed MRI scans.

It's also important to consider any contraindications for an MRI, such as the presence of pacemakers or other ferrous metal objects within the body, because the powerful magnetic field can impact these devices, potentially causing harm to the patient.

After explaining the procedure and its importance, acquiring the patient's informed consent is necessary before proceeding with the MRI.