Abel – Case Study 6 of 6
Evaluate Outcomes
The nurse evaluates the client across three time points. Indicate whether each parameter is improving, no change, or declining.
| Parameter | 1000 | 1100 | 1200 |
| Blood pressure | 150/90 | 148/88 | 182/106 |
| Neuro deficits | Facial droop, arm drift, leg weakness, dysarthria | Mild improvement in dysarthria | Worsened arm weakness, decreased LOC |
| LOC | Alert but confused | Alert, mild improvement | Responds to pain only |
| Headache | Present at onset | Not documented | Sudden severe 10/10 |
| SpO₂ | 95% RA | Not documented | Not documented |
| Seizure activity | History only | None reported | 30-sec episode at 1145 |
Rationale
Blood pressure → ↓ Declining — minimal improvement then surge to 182/106 = rising ICP from hemorrhagic transformation
Neuro deficits → ↓ Declining — initial partial improvement reversed by hemorrhagic transformation
LOC → ↓ Declining — alert to responds-to-pain-only = expanding hemorrhage or herniation
Headache → ↓ Declining — escalation to 10/10 post-tPA = hemorrhagic transformation
SpO₂ → → No change — 95% at arrival; no subsequent values documented; trend cannot be confirmed
Seizure activity → ↓ Declining — none at arrival; new episode at 1145 = complication of worsening intracranial event
Overall: All declining trends consistent with hemorrhagic transformation. Stop tPA, emergent CT, prepare for neurosurgical intervention.
Blood pressure → ↓ Declining — minimal improvement then surge to 182/106 = rising ICP from hemorrhagic transformation
Neuro deficits → ↓ Declining — initial partial improvement reversed by hemorrhagic transformation
LOC → ↓ Declining — alert to responds-to-pain-only = expanding hemorrhage or herniation
Headache → ↓ Declining — escalation to 10/10 post-tPA = hemorrhagic transformation
SpO₂ → → No change — 95% at arrival; no subsequent values documented; trend cannot be confirmed
Seizure activity → ↓ Declining — none at arrival; new episode at 1145 = complication of worsening intracranial event
Overall: All declining trends consistent with hemorrhagic transformation. Stop tPA, emergent CT, prepare for neurosurgical intervention.
