Andy- Simplified RR Wow! What just happened? I was driving into town when my vision got blurred and I couldn’t see much for a while. Then, when I got out of the gravel truck, I lost my balance and fell back against the seat. Good thing my co-worker got me to the Emergency department quickly. I’m feeling better now, but the doctor thinks I might have had a mini stroke. He says he’s going to need to send me for some tests. I have to be transferred to another hospital for a scan of my head and arteries in my neck I’m not sure why. What teaching do you think Andy is ready for at this time? a) Information about what minor stroke is (yes) b) Description of the CT scan and CT angiogram and information it provides (yes) c) Review of all risk factors for stroke (NO) This information would be better provided after diagnosis is confirmed and patient is seen in the SPC How can Andy’s transition be supported smoothly between Healthcare Centres? a) Completion of inter-facility transfer form b) Completion of CT requisition with appropriate history c) Verbal communication with EMS Dispatch d) Provide CT requisition to patient and tell him he’ll hear from you soon (NO) Communication must happen between caregivers and results need to be available today So after the scan, the doctor gives me Aspirin to take and says I can go home, but I need to be seen by a stroke specialist in Edmonton tomorrow. I wonder how that is arranged. My wife and I feel a bit overwhelmed and anxious. What if it happens again? What teaching is appropriate for Andy at this time? a) Review how Aspirin works to prevent stroke b) Provide list of community supports (NO) This information would be better provided after patient is seen in the SPC c) Have the emergency physician explain why he/she does not think admission is needed d) Review signs of stroke and advise to call 911 if they occur How can Andy’s transition be supported between the Healthcare Centre and Stroke Prevention Clinic? a) Complete SPC referral form and fax to appropriate location b) Review TIA Discharge information and advise Andy not to drive until further assessed c) Determine Andy’s resources to get to the SPC in the city d) Ask wife what her specific concerns are about managing over the next 24 hours Today I saw the stroke specialist. He reviewed the scans and said there was no evidence of stroke, but he said I had a TIA. The doctor thinks it may have been caused by my high blood pressure, but I need more tests. He said he was going to increase my medication for my blood pressure. I also found out that I have to have some vision testing before I can return to driving. My son drove us to this appointment as my wife doesn’t drive either. We are worried about my job and getting around if I can’t drive. What teaching is appropriate for Andy at this time? a) Review risk factors for stroke and lifestyle changes b) Provide information regarding tests and preparation c) Provide information regarding home BP monitoring d) Provide information about hypertension and CDM education programs How could Andy’s transition be supported at this point? a) Provide information regarding community transportation options and contact info b) Complete referral to dietician for information on reducing sodium in diet c) Assist Andy to obtain an appointment for vision testing d) Ensure prescriptions are provided to patient or faxed to pharmacy e) Complete a depression screen and refer as necessary (NO) This may be too early in his recovery but should be considered in follow up Today I saw my family doctor in the Primary Care Network. He said he had received a letter back from the stroke specialist I saw 2 weeks ago. He reviewed my blood tests and told me my bad cholesterol was high, so he was starting me on a statin medication. He had a copy of the vision test I had last week and said it was normal. As well, the heart monitor I wore for 48 hours did not show any abnormalities. He said that since I have not had any recurrence of symptoms and my blood pressure has been good, that I could return to work next week. What teaching/ assessment is appropriate for the PCN nurse to do at this point? a) Review home BP measurements and re-enforce education on hypertension management b) Review information on lipid lowering medication and diet to reduce cholesterol c) Review signs of stroke and advise to call 911 if symptoms reoccur d) Assess for readiness for change in lifestyle and support him in that area