Scenario
P.S., a 76-year-old woman, was brought to the emergency department (ED) by ambulance after her
husband found her sitting on the side of the bed, awake but nonverbal. She has a history of chronic
atrial fibrillation, osteoarthritis, and hypertension. Her current medications include diltiazem, carvedilol,
and dabigatran. Upon arrival to the ED, she was sent for a STAT CT scan, then evaluated by the Stroke
Team nurse. Her initial vital signs include BP 110/60, P 158, R 20, T 100.8° F (38.2° C). She weighs 198
pounds (90 kg).
1. What are the risk factors for a stroke? Underline at least 2 risk factors P.S. has that led to the
evaluation for a stroke.
-Hx of stroke
-TIA
-Heart disease
-Diabetes
-Obesity
-Alcohol use
-Smoking
-HTN
-Hyperlipidemia
2. What other things will you ask about when completing the history?
- Medication adherence/ other medications she takes OTC or herbal
-Does she smoke or drink alcohol – if so how often/ how many?
- Do you monitor your blood pressure at home – if so what have they been/ are you writing them down?
- When did your symptoms start?
- Ask the husband what he saw when he found her.
CASE STUDY PROGRESS
The CT scan results were normal, and the NIHSS Stroke score was rated as zero. The ED physician orders
lab work, which has been drawn. P.S. asks to use the bedpan, and her urine was noted to be dark
orange, cloudy, with a strong odor. You perform a point of care urinalysis and, suspecting a urinary tract
, infection (UTI), sends a specimen for culture and sensitivity. A second set of vital signs are recorded: BP
98/58, P 164, R 18, T 101.6° F (38.7° C).
3. Underline the laboratory results concern you and explain why.
-Lactic acid of 3.2mg/dL – Normal ranges are 4.5-19.8mg/dL, can be indicative of sepsis, heart disease,
HIV, Short bowel syndrome, alcohol use disorder, or regular use of acetaminophen.
- WBC count of 18,600/mm3 – Normal ranges are 4,000-11,000/mm3. This is an increased level of WBCs
and indicates an infection.
4. The ED physician suspects that P.S. has sepsis. Explain sepsis.
Sepsis is a serious infection that can be life threatening and occurs when the immune system does not
react properly to an infection. This causes a systemic infection through the body which can result in
tissue damage, organ failure, and possibly death. Those who are more at risk for developing sepsis are
people older than 65 years old, Infants, newborns, pregnant women, those with diabetes, obesity,
immunocompromised, and those with severe injuries such as widespread burns or wounds. This can also
affect those who have catheters, any kind of IV, or breathing tubes.
Mayo Clinic. (2023). Sepsis - symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/sepsis/symptoms-causes/syc-20351214
5. After reviewing P.S.’s assessment, which findings reflect positive SIRS criteria? Select all that apply.
a. Elevated pulse
b. Elevated temperature
P.S., a 76-year-old woman, was brought to the emergency department (ED) by ambulance after her
husband found her sitting on the side of the bed, awake but nonverbal. She has a history of chronic
atrial fibrillation, osteoarthritis, and hypertension. Her current medications include diltiazem, carvedilol,
and dabigatran. Upon arrival to the ED, she was sent for a STAT CT scan, then evaluated by the Stroke
Team nurse. Her initial vital signs include BP 110/60, P 158, R 20, T 100.8° F (38.2° C). She weighs 198
pounds (90 kg).
1. What are the risk factors for a stroke? Underline at least 2 risk factors P.S. has that led to the
evaluation for a stroke.
-Hx of stroke
-TIA
-Heart disease
-Diabetes
-Obesity
-Alcohol use
-Smoking
-HTN
-Hyperlipidemia
2. What other things will you ask about when completing the history?
- Medication adherence/ other medications she takes OTC or herbal
-Does she smoke or drink alcohol – if so how often/ how many?
- Do you monitor your blood pressure at home – if so what have they been/ are you writing them down?
- When did your symptoms start?
- Ask the husband what he saw when he found her.
CASE STUDY PROGRESS
The CT scan results were normal, and the NIHSS Stroke score was rated as zero. The ED physician orders
lab work, which has been drawn. P.S. asks to use the bedpan, and her urine was noted to be dark
orange, cloudy, with a strong odor. You perform a point of care urinalysis and, suspecting a urinary tract
, infection (UTI), sends a specimen for culture and sensitivity. A second set of vital signs are recorded: BP
98/58, P 164, R 18, T 101.6° F (38.7° C).
3. Underline the laboratory results concern you and explain why.
-Lactic acid of 3.2mg/dL – Normal ranges are 4.5-19.8mg/dL, can be indicative of sepsis, heart disease,
HIV, Short bowel syndrome, alcohol use disorder, or regular use of acetaminophen.
- WBC count of 18,600/mm3 – Normal ranges are 4,000-11,000/mm3. This is an increased level of WBCs
and indicates an infection.
4. The ED physician suspects that P.S. has sepsis. Explain sepsis.
Sepsis is a serious infection that can be life threatening and occurs when the immune system does not
react properly to an infection. This causes a systemic infection through the body which can result in
tissue damage, organ failure, and possibly death. Those who are more at risk for developing sepsis are
people older than 65 years old, Infants, newborns, pregnant women, those with diabetes, obesity,
immunocompromised, and those with severe injuries such as widespread burns or wounds. This can also
affect those who have catheters, any kind of IV, or breathing tubes.
Mayo Clinic. (2023). Sepsis - symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/sepsis/symptoms-causes/syc-20351214
5. After reviewing P.S.’s assessment, which findings reflect positive SIRS criteria? Select all that apply.
a. Elevated pulse
b. Elevated temperature
