Comprehensive Case Study: Acute Ischemic Stroke in a 72-
Year-Old Male with Atrial Fibrillation - ICU Management
and Nursing Care Plan
CASE BACKGROUND & PATIENT INFORMATION
Patient Profile:
text
NAME: David Chen
AGE: 72 years
GENDER: Male
MRN: 123456
ROOM: ICU-4
ADMISSION DATE: Today, 03:15
ADMITTING DIAGNOSIS: Acute altered mental status, rule out stroke
Medical History:
text
PRIMARY DIAGNOSES:
• Atrial Fibrillation (Diagnosed 2018, on anticoagulation)
• Hypertension (Diagnosed 2010)
• Hyperlipidemia (Diagnosed 2015)
• Type 2 Diabetes (Diagnosed 2017, diet-controlled)
• Osteoarthritis (Diagnosed 2015)
SURGICAL HISTORY:
• Left hip replacement (2018)
• Cataract surgery, both eyes (2021)
• Cholecystectomy (2005)
ALLERGIES:
,• Codeine (Nausea/vomiting)
• Contrast dye (Hives)
• No known food allergies
IMMUNIZATIONS:
• Influenza: Current season
• Pneumococcal: Received
• Shingles: Completed series
• Tdap: Current
Current Medications (Home):
text
1. Apixaban: 5 mg twice daily
2. Metoprolol: 50 mg twice daily
3. Atorvastatin: 40 mg daily
4. Lisinopril: 10 mg daily
5. Acetaminophen: 500 mg PRN for arthritis pain
Social History:
text
OCCUPATION: Retired high school teacher
TOBACCO: Never smoked
ALCOHOL: 1 glass of wine with dinner
SUBSTANCE USE: Denies
LIVING SITUATION: Lives with wife in two-story home
MOBILITY: Independent, uses cane occasionally for hip
DIET: Low sodium, diabetic diet per wife
ACTIVITY: Daily walks, gardening
SUPPORT SYSTEM: Wife (anxious but competent), 3 adult children nearby
COGNITIVE STATUS PREVIOUS: Wife reports "sharp as a tack until this morning"
📋 INITIAL ASSESSMENT DATA
, Vital Signs (ER at 03:30):
text
• Temperature: 36.8°C (98.2°F) oral
• Heart Rate: 128 bpm (irregularly irregular)
• Respiratory Rate: 22 rpm (regular but shallow)
• Blood Pressure: 210/110 mmHg (left arm, sitting)
• Oxygen Saturation: 92% on room air
• Blood Glucose: 145 mg/dL (fingerstick)
• Pain: Patient nonverbal, grimacing to touch
• Height: 178 cm (5'10")
• Weight: 82 kg (181 lbs)
• BMI: 25.9
Chief Complaint (Wife's Report):
"He woke up confused and couldn't talk right. His face looks droopy on one side, and he
can't move his right arm."
History of Present Illness (HPI from Wife):
text
TIMELINE:
• 22:00 last night: Went to bed normally, watched TV together
• 02:30 today: Wife awakened by "thump," found patient on floor
• 02:35: Patient awake but confused, trying to speak but words garbled
• 02:40: Right arm weakness noted, facial droop observed
• 02:45: 911 called
• 03:00: EMS arrived, reported GCS 10, right-sided weakness
• 03:15: Arrival at ED, NIH Stroke Scale 18
SYMPTOM PROGRESSION:
• Initial: Confusion, expressive aphasia
• Progressed to: Right hemiplegia, facial droop
• Current: Nonverbal, follows commands inconsistently
LAST KNOWN WELL: 22:00 last night (5.5 hours ago)
Year-Old Male with Atrial Fibrillation - ICU Management
and Nursing Care Plan
CASE BACKGROUND & PATIENT INFORMATION
Patient Profile:
text
NAME: David Chen
AGE: 72 years
GENDER: Male
MRN: 123456
ROOM: ICU-4
ADMISSION DATE: Today, 03:15
ADMITTING DIAGNOSIS: Acute altered mental status, rule out stroke
Medical History:
text
PRIMARY DIAGNOSES:
• Atrial Fibrillation (Diagnosed 2018, on anticoagulation)
• Hypertension (Diagnosed 2010)
• Hyperlipidemia (Diagnosed 2015)
• Type 2 Diabetes (Diagnosed 2017, diet-controlled)
• Osteoarthritis (Diagnosed 2015)
SURGICAL HISTORY:
• Left hip replacement (2018)
• Cataract surgery, both eyes (2021)
• Cholecystectomy (2005)
ALLERGIES:
,• Codeine (Nausea/vomiting)
• Contrast dye (Hives)
• No known food allergies
IMMUNIZATIONS:
• Influenza: Current season
• Pneumococcal: Received
• Shingles: Completed series
• Tdap: Current
Current Medications (Home):
text
1. Apixaban: 5 mg twice daily
2. Metoprolol: 50 mg twice daily
3. Atorvastatin: 40 mg daily
4. Lisinopril: 10 mg daily
5. Acetaminophen: 500 mg PRN for arthritis pain
Social History:
text
OCCUPATION: Retired high school teacher
TOBACCO: Never smoked
ALCOHOL: 1 glass of wine with dinner
SUBSTANCE USE: Denies
LIVING SITUATION: Lives with wife in two-story home
MOBILITY: Independent, uses cane occasionally for hip
DIET: Low sodium, diabetic diet per wife
ACTIVITY: Daily walks, gardening
SUPPORT SYSTEM: Wife (anxious but competent), 3 adult children nearby
COGNITIVE STATUS PREVIOUS: Wife reports "sharp as a tack until this morning"
📋 INITIAL ASSESSMENT DATA
, Vital Signs (ER at 03:30):
text
• Temperature: 36.8°C (98.2°F) oral
• Heart Rate: 128 bpm (irregularly irregular)
• Respiratory Rate: 22 rpm (regular but shallow)
• Blood Pressure: 210/110 mmHg (left arm, sitting)
• Oxygen Saturation: 92% on room air
• Blood Glucose: 145 mg/dL (fingerstick)
• Pain: Patient nonverbal, grimacing to touch
• Height: 178 cm (5'10")
• Weight: 82 kg (181 lbs)
• BMI: 25.9
Chief Complaint (Wife's Report):
"He woke up confused and couldn't talk right. His face looks droopy on one side, and he
can't move his right arm."
History of Present Illness (HPI from Wife):
text
TIMELINE:
• 22:00 last night: Went to bed normally, watched TV together
• 02:30 today: Wife awakened by "thump," found patient on floor
• 02:35: Patient awake but confused, trying to speak but words garbled
• 02:40: Right arm weakness noted, facial droop observed
• 02:45: 911 called
• 03:00: EMS arrived, reported GCS 10, right-sided weakness
• 03:15: Arrival at ED, NIH Stroke Scale 18
SYMPTOM PROGRESSION:
• Initial: Confusion, expressive aphasia
• Progressed to: Right hemiplegia, facial droop
• Current: Nonverbal, follows commands inconsistently
LAST KNOWN WELL: 22:00 last night (5.5 hours ago)
