The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient’s temperature is 37.4°C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg. A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?

Question

The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient&rsquo;s temperature is 37.4&deg;C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg.  A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?

Accepted Answer

Mannitol. The patient is exhibiting signs of a hemorrhagic stroke because of the presence of hyperechogenicity on the CT scan 3 hours after onset of symptoms; ischemic stroke does not present on CT as quickly as hemorrhagic stroke. The patient&rsquo;s severe hypertension must be lowered to help manage the intracranial hemorrhage; mannitol will decrease blood pressure and intracranial pressure. Heparin and alteplase will worsen the patient&rsquo;s condition by interfering with the patient&rsquo;s ability to clot the bleed. Hydralazine is less helpful than mannitol to lower the patient&rsquo;s intracranial pressure.

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