SIMULATION ADMISSION TICKET
Acute Ischemic Stroke
Name: Nadine Cruz Vega Date: August 26, 2025 Instructor: Amy Beachy
** Reminder: To attend simulation sessions, this admission ticket must be
completed and a PRINTED copy brought with you to the simulation center. **
Simulation Learning Objectives:
1. Complete focused neurological assessment and reassessments as needed based on
patient condition and interventions.
2. Prioritize & perform interventions based on patient’s problems and healthcare provider
orders.
3. Evaluate effectiveness of interventions and revise the plan of care to treat actual patient
problems.
Patient Overview:
Client Name: Jasper Coleman Gender: Male Race: African American Age: 66
Weight: 195 lbs Height: 5’11” Location: ED Physician: Dr. Sabato
Client Information: Mr. Coleman walked into the kitchen this morning and his wife noticed his
slurred speech. His wife called EMS and Mr. Coleman was transported to the nearest
Emergency Department.
Past Medical History: Hypertension, atherosclerosis, gout, TIAs
Surgeries/Procedures: None
Social History: Mr. Coleman is married. He and his wife live in a private residence. He is a
retired basketball coach.
Potential Skills for Scenario:
Perform a focused neurological assessment using the NIH stroke scale (NIHSS) and Glasgow
Coma Scale (GCS). Refer to video examples posted on D2L for NIHSS and GCS. Administration
of IV meds; blood glucose monitoring, completion of tPA eligibility checklist, and interpretation of
lab values. *Students are expected to review these skills prior to simulation in order to
perform them independently during scenario.
Scenario Medication List: labetalol IV, normal saline IV, tissue plasminogen activator (tPA)
Home Medications: metoprolol PO, hydrochlorothiazide PO, pravastatin PO, apixaban PO,
colchicine PO, diltiazem PO.
Initial Lab Work:
CBC: WBC-9.8, RBC-5.2, Hgb-13.8, Hct-42, MCV-86, MCH-28.5, MCHC-32.6, RDW-13.5,
Platelets-278
CMP: Na+-135, K+-3.8, Cl--99, CO2-25.8, BG-152, BUN-16, Creatinine-0.9, Ca+-8.9, AST-33,
ALT-38, ALK Phos-52, Total Bili-0.9, Total Prot-5.8, Albumin-3.2
PT/INR: 10/0.68 PTT: 20 seconds
Troponin: 0.04
Revised January 2025
, **Admission tickets will be submitted electronically to a designated location determined by
your classroom faculty, i.e. learning management system, Google docs, etc. Submissions will
be time sensitive in order to provide faculty time to verify completion.
On the day of simulation, the student will provide a screenshot of submission confirmation but
will not need to provide a printed paper copy of the ticket to the center. If the student wishes
to print the ticket for their own use during the simulation experience that is optional OR the
student may bring hand-written notes for reference.
Please answer the following questions as part of preparation for simulation. Utilize evidence-
based resources, i.e. textbooks, websites such as UpToDate, research articles, governing
bodies, etc…
Pathophysiology:
1. Explain the pathophysiology of acute ischemic stroke in your own words. What is the
difference between an ischemic and hemorrhagic stroke?
A cerebrovascular accident is characterized by the sudden onset of a focal
neurological deficit in a specific area of the brain. An ischemic stroke occurs
when a blood clot blocks an artery in the brain, while a hemorrhagic stroke is
caused by bleeding or rupture of a blood vessel in the brain.
2. What are the most common causes and risk factors for acute ischemic stroke?
The most common risk factors are atherosclerosis, vasculitis, arterial dissection,
blood clots, high blood pressure, smoking, unhealthy diet, and obesity.
3. What clinical signs and symptoms should the nurse anticipate assessing in this patient?
Sudden weakness or numbness on one side of the body, difficulty speaking or
understanding speech, vision problems, dizziness and loss of coordination, severe
headache, and seizures.
4. What is the recommended treatment for acute ischemic stroke per the American Stroke
Association?
Treatment includes administering alteplase (IV tPA) within 3 to 4.5 hours of the onset
of stroke symptoms. Other treatments include a carotid endarterectomy and
sometimes use angioplasty and stents.
Other types of medications are aspirin and clopidogrel, which are
antiplatelet/anticoagulants.
5. Explain the rationale for TIMELY assessment and treatment of a patient experiencing
acute ischemic stroke. What are the recommended time frames for treatment of acute
ischemic stroke? (Refer to your textbook and the American Stroke Association website.)
The ASA emphasizes the importance of rapid treatment after identifying a patient
as having a stroke, as this helps improve patient outcomes. The recommended
time frame of the IV alteplase is within 4.5 hours of symptom onset. The
mechanical thrombectomy should be done within 6 hours, the door-to-needle
time less than 60 minutes and the door-to-device less than 90 minutes to the first
thrombectomy device pass.
6. What potential problems is Jasper Coleman at risk for in the emergency department due
to his diagnosis of an acute ischemic stroke? What assessment data (subjective and
objective (vital sign changes, lab values, etc.) would support the potential problem being
an actual problem? How would you manage the problem (nursing interventions)? Use
the answer to these questions to complete the Clinical Reasoning Activity on the
next page.
Revised January 2025
Acute Ischemic Stroke
Name: Nadine Cruz Vega Date: August 26, 2025 Instructor: Amy Beachy
** Reminder: To attend simulation sessions, this admission ticket must be
completed and a PRINTED copy brought with you to the simulation center. **
Simulation Learning Objectives:
1. Complete focused neurological assessment and reassessments as needed based on
patient condition and interventions.
2. Prioritize & perform interventions based on patient’s problems and healthcare provider
orders.
3. Evaluate effectiveness of interventions and revise the plan of care to treat actual patient
problems.
Patient Overview:
Client Name: Jasper Coleman Gender: Male Race: African American Age: 66
Weight: 195 lbs Height: 5’11” Location: ED Physician: Dr. Sabato
Client Information: Mr. Coleman walked into the kitchen this morning and his wife noticed his
slurred speech. His wife called EMS and Mr. Coleman was transported to the nearest
Emergency Department.
Past Medical History: Hypertension, atherosclerosis, gout, TIAs
Surgeries/Procedures: None
Social History: Mr. Coleman is married. He and his wife live in a private residence. He is a
retired basketball coach.
Potential Skills for Scenario:
Perform a focused neurological assessment using the NIH stroke scale (NIHSS) and Glasgow
Coma Scale (GCS). Refer to video examples posted on D2L for NIHSS and GCS. Administration
of IV meds; blood glucose monitoring, completion of tPA eligibility checklist, and interpretation of
lab values. *Students are expected to review these skills prior to simulation in order to
perform them independently during scenario.
Scenario Medication List: labetalol IV, normal saline IV, tissue plasminogen activator (tPA)
Home Medications: metoprolol PO, hydrochlorothiazide PO, pravastatin PO, apixaban PO,
colchicine PO, diltiazem PO.
Initial Lab Work:
CBC: WBC-9.8, RBC-5.2, Hgb-13.8, Hct-42, MCV-86, MCH-28.5, MCHC-32.6, RDW-13.5,
Platelets-278
CMP: Na+-135, K+-3.8, Cl--99, CO2-25.8, BG-152, BUN-16, Creatinine-0.9, Ca+-8.9, AST-33,
ALT-38, ALK Phos-52, Total Bili-0.9, Total Prot-5.8, Albumin-3.2
PT/INR: 10/0.68 PTT: 20 seconds
Troponin: 0.04
Revised January 2025
, **Admission tickets will be submitted electronically to a designated location determined by
your classroom faculty, i.e. learning management system, Google docs, etc. Submissions will
be time sensitive in order to provide faculty time to verify completion.
On the day of simulation, the student will provide a screenshot of submission confirmation but
will not need to provide a printed paper copy of the ticket to the center. If the student wishes
to print the ticket for their own use during the simulation experience that is optional OR the
student may bring hand-written notes for reference.
Please answer the following questions as part of preparation for simulation. Utilize evidence-
based resources, i.e. textbooks, websites such as UpToDate, research articles, governing
bodies, etc…
Pathophysiology:
1. Explain the pathophysiology of acute ischemic stroke in your own words. What is the
difference between an ischemic and hemorrhagic stroke?
A cerebrovascular accident is characterized by the sudden onset of a focal
neurological deficit in a specific area of the brain. An ischemic stroke occurs
when a blood clot blocks an artery in the brain, while a hemorrhagic stroke is
caused by bleeding or rupture of a blood vessel in the brain.
2. What are the most common causes and risk factors for acute ischemic stroke?
The most common risk factors are atherosclerosis, vasculitis, arterial dissection,
blood clots, high blood pressure, smoking, unhealthy diet, and obesity.
3. What clinical signs and symptoms should the nurse anticipate assessing in this patient?
Sudden weakness or numbness on one side of the body, difficulty speaking or
understanding speech, vision problems, dizziness and loss of coordination, severe
headache, and seizures.
4. What is the recommended treatment for acute ischemic stroke per the American Stroke
Association?
Treatment includes administering alteplase (IV tPA) within 3 to 4.5 hours of the onset
of stroke symptoms. Other treatments include a carotid endarterectomy and
sometimes use angioplasty and stents.
Other types of medications are aspirin and clopidogrel, which are
antiplatelet/anticoagulants.
5. Explain the rationale for TIMELY assessment and treatment of a patient experiencing
acute ischemic stroke. What are the recommended time frames for treatment of acute
ischemic stroke? (Refer to your textbook and the American Stroke Association website.)
The ASA emphasizes the importance of rapid treatment after identifying a patient
as having a stroke, as this helps improve patient outcomes. The recommended
time frame of the IV alteplase is within 4.5 hours of symptom onset. The
mechanical thrombectomy should be done within 6 hours, the door-to-needle
time less than 60 minutes and the door-to-device less than 90 minutes to the first
thrombectomy device pass.
6. What potential problems is Jasper Coleman at risk for in the emergency department due
to his diagnosis of an acute ischemic stroke? What assessment data (subjective and
objective (vital sign changes, lab values, etc.) would support the potential problem being
an actual problem? How would you manage the problem (nursing interventions)? Use
the answer to these questions to complete the Clinical Reasoning Activity on the
next page.
Revised January 2025
