NRNP 6537 Week 8 Acute Stroke Write-Up Example

Course	NRNP 6537 Adult Acute Care: Comprehensive Patient Management I
Week	Week 8
Paper type	Acute stroke pathway write-up
Length	About 1,030 words, 6 pages
Format	APA 7 student paper
School	Walden University
Program	MSN Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)
Updated	October 2026

Free sample paper for NRNP 6537 Week 8

Acute Stroke Pathway Write-Up: Right Hemiparesis and Aphasia Discovered on Waking in a 66-Year-Old Man

Student Name

College of Nursing, Walden University

NRNP 6537: Advanced Nurse Practice in Adult/Gerontology Acute Care I

Instructor Name

Month Day, Year

What this page is doingThe title records that the deficits were discovered on waking, which is the detail that makes last known well the first problem to solve. A stroke write-up follows the pathway in order, and the title points to where that order begins.

Acute Stroke Pathway Write-Up: Right Hemiparesis and Aphasia Discovered on Waking in a 66-Year-Old Man

Timeline

Last known well: 22:30 the previous evening, when his wife saw him walk to bed and heard him speak normally. Discovered: 06:10, when she found him unable to speak clearly and unable to lift his right arm. Emergency medical services arrival: 06:25. Emergency department arrival and stroke alert: 06:48. Glucose checked: 06:50. Neurological examination and NIH Stroke Scale: 06:55. Noncontrast computed tomography: 07:08. Computed tomographic angiography and perfusion: 07:12. Neurology decision: 07:30.

Last Known Well, Fixed From the Family's Account

The patient is a composite: a 66-year-old retired postal carrier with hypertension, atrial fibrillation for which he stopped his anticoagulant six months ago because of cost, and a prior transient ischemic attack. Last known well is 22:30, not 06:10. The time of discovery tells us only when the deficit was noticed; the stroke could have occurred at any point in the night. Because he cannot give his own history, his wife's account fixes the time, and it is documented in her words, including that he got up once around 01:00 to use the bathroom without difficulty that she noticed, which she was not certain of. Because the uncertain 01:00 observation cannot be confirmed, the documented last known well remains 22:30. This distinction governs every reperfusion decision that follows (Powers et al., 2019).

NIH Stroke Scale by Domain

The NIH Stroke Scale was performed at 06:55 and is recorded by domain to describe the pattern of the deficit, not only its total (Brott et al., 1989). Level of consciousness: alert, answers one of two questions correctly, follows one of two commands. Gaze: partial gaze deviation to the left. Visual fields: right lower quadrant field loss suspected but difficult to test. Facial palsy: right lower face weakness. Motor arm: right arm drifts to the bed within ten seconds; left normal. Motor leg: right leg drifts but does not hit the bed; left normal. Limb ataxia: not testable on the right due to weakness. Sensory: mild loss on the right. Language: severe expressive aphasia with some comprehension preserved. Dysarthria: moderate. Extinction: none. The pattern, right face and arm more than leg weakness with aphasia and leftward gaze preference, localizes to the territory of the left middle cerebral artery, the total score reflects a moderate to severe deficit, and the combination of aphasia and gaze deviation raises concern for a large vessel occlusion.

What this page is doingRecording the scale by domain lets the pattern localize the lesion, left middle cerebral artery territory with a possible large vessel occlusion, which a total score alone cannot do. That localization shapes the imaging and reperfusion questions that follow.

Mimics

Hypoglycemia first: it can produce focal deficits indistinguishable from stroke, it is quick to exclude, and it is easy to miss when attention jumps to imaging; his capillary glucose was 142 mg/dL at 06:50. Seizure with a postictal deficit: no witnessed seizure, no tongue biting or incontinence, and no seizure history, although an unwitnessed nocturnal seizure cannot be fully excluded. Complicated migraine: no headache history and an age and vascular risk profile that make it unlikely. Other mimics, such as sepsis unmasking an old deficit or a subdural hematoma, are addressed by history and imaging.

Imaging: The Question of Hemorrhage First

The first imaging question is whether there is hemorrhage, because hemorrhage excludes thrombolysis and changes everything else. Noncontrast computed tomography showed no hemorrhage, with early subtle loss of gray-white differentiation in the left insular region. Computed tomographic angiography showed an occlusion of the proximal left middle cerebral artery. Perfusion imaging showed a small core of irreversibly injured tissue and a much larger surrounding region of tissue at risk but still salvageable.

Reperfusion Eligibility as a Series of Questions

Is there hemorrhage? No. Is the time since last known well within the window for intravenous thrombolysis on the basis of time alone? No; the interval is too long, and the time of onset is unknown. Could advanced imaging identify a patient who might still benefit? For wake-up strokes, some patients are selected by imaging findings that suggest a recent onset, but his imaging does not show that pattern clearly, so thrombolysis is not given. Is there a large vessel occlusion in the anterior circulation? Yes. Does perfusion imaging show a small core with a large region of salvageable tissue, the profile that selected patients for thrombectomy in the extended window trials, one of which showed benefit from thrombectomy between six and sixteen hours in patients chosen by perfusion imaging (Albers et al., 2018)? Yes. Does he have a disabling deficit and good function before the stroke? Yes; he lived independently. The answer is that he is a candidate for mechanical thrombectomy, and the neurointerventional team is activated (Powers et al., 2019). His recent discontinuation of anticoagulation is documented, since it explains the likely cardioembolic source and matters for later decisions.

Safety Criteria Before and After the Procedure

Swallowing: he is kept nothing by mouth until a formal swallow screen is passed, because aphasia, facial weakness, and reduced alertness raise aspiration risk. Airway: his alertness and ability to protect his airway are reassessed before transport; the anesthesia team decides whether sedation or intubation is needed for the procedure. Neurological checks: the NIH Stroke Scale and level of consciousness are repeated at defined intervals, and any worsening prompts urgent repeat imaging for hemorrhage or reocclusion. Blood pressure is managed according to the guideline for patients undergoing thrombectomy, with the neurology team setting his targets. His wife is updated on the plan and the reasons for it.

After the Procedure

If reperfusion is achieved, the next priorities shift from speed to prevention of complications and of recurrence. The neurological examination is repeated on a set schedule in the neuroscience intensive care unit, with any new decline prompting urgent imaging. Once hemorrhage has been excluded on follow-up imaging, the stroke team will decide when to restart anticoagulation for his atrial fibrillation, balancing the risk of hemorrhagic transformation in a new infarct against the risk of another embolic stroke. The reason he stopped anticoagulation, cost, is part of the discharge plan rather than a footnote: a case manager will address coverage before he leaves, because a secondary prevention plan he cannot afford will fail the same way the first one did. Early rehabilitation assessment by speech, physical, and occupational therapy begins within the first days, and his wife is included in the planning.

References

Albers, G. W., Marks, M. P., Kemp, S., Christensen, S., Tsai, J. P., Ortega-Gutierrez, S., McTaggart, R. A., Torbey, M. T., Kim-Tenser, M., Leslie-Mazwi, T., Sarraj, A., Kasner, S. E., Ansari, S. A., Yeatts, S. D., Hamilton, S., Mlynash, M., Heit, J. J., Zaharchuk, G., Kim, S., . . . Lansberg, M. G. (2018). Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. New England Journal of Medicine, 378(8), 708-718. https://doi.org/10.1056/NEJMoa1713973

Brott, T., Adams, H. P., Jr., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J., Holleran, R., Eberle, R., & Hertzberg, V. (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke, 20(7), 864-870. https://doi.org/10.1161/01.STR.20.7.864

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke, 50(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211

What the NRNP 6537 Week 8 instructions ask for

The eighth week of NRNP 6537 often asks for a write-up of an acute neurological pathway such as stroke. You build a timeline, establish last known well, score the deficit with a validated scale, consider mimics, interpret imaging and work through treatment eligibility and post-treatment monitoring. Faculty grade timing first. Four to six pages is common in NRNP 6537 for this write-up, with the AHA/ASA guideline and trials cited. Some sections omit thrombolytic doses and exact time windows. Family communication and consent are often required elements. A clear statement of which treatments the patient qualifies for, and why, closes most strong papers. NRNP 6537 sections often ask which imaging was done first and why, and how hemorrhage was excluded. Name the trials behind extended window treatment. State the blood pressure targets before and after treatment and who checks them.

How the NRNP 6537 Week 8 example is put together

Five pages following the pathway as it runs in an emergency department, with a timeline box on page one. The opening fixes last known well from the family's account and explains why it differs from the time of discovery. A section records the NIH Stroke Scale by domain and uses it to describe the deficit's pattern, not just its total. Mimics are addressed next: hypoglycemia first, since it is quick to exclude and easy to miss, then seizure with a postictal deficit and a complicated migraine. Imaging is framed as the question of hemorrhage before anything else. Eligibility for reperfusion is argued as a series of questions answered from the case, with no time windows or blood pressure targets written in. Swallowing, airway and neurological checks close it as the safety criteria. The family and the patient are fictional.

Where the marks sit in the NRNP 6537 Week 8 rubric

Timing carries the first and heaviest judgment. A write-up that treats the moment of discovery as symptom onset has made the error the pathway exists to prevent, and faculty check the last known well paragraph before they read further. Scale use is next: a total reported without the domains gives a number with no localization, and the course usually rewards the pattern over the score. Third, mimics are often skipped, especially hypoglycemia, which is the one a grader looks for first in a case with endocrine history. Eligibility argued with numbers copied from a guideline, rather than reasoned from the case, reads as recall and invites error. Documents without explicit safety criteria for swallowing, airway and neurological change lose the deterioration points this week is framed around.

NRNP 6537 Week 8 help: mistakes that cost marks

Stroke write-ups lose the most when discovery time is treated as onset, which is the error the pathway exists to prevent. Fix last known well and explain how. Another common gap is skipping glucose before imaging, though hypoglycemia can mimic stroke. Writers also score the NIH Stroke Scale as a total without domains, which hides the deficits. Show the items. Avoid assuming a wake-up stroke excludes treatment; advanced imaging may change eligibility. Keep times consistent throughout. Include blood pressure limits around treatment. Close with monitoring after the procedure. Students also forget swallow screening before oral intake. Add it. Another frequent gap is leaving out large vessel occlusion screening, which decides thrombectomy. Describe it. Record what the family was told.

Get a NRNP 6537 Week 8 example written to your instructions

Your Week 8 prompt, rubric and case, if one was supplied, are all the desk needs to return a stroke pathway example with last known well fixed and every mimic excluded. No charge applies to the first, which lands in 24-48h, and an endocrine case can stand in if that is what your faculty set.

More NRNP 6537 papers and AGACNP samples

NRNP 6537 Week 8 questions, answered

Why does the write-up check glucose before imaging?

Because hypoglycemia can produce a focal deficit that looks like stroke, and it is excluded in moments without leaving the room. The sample places it first among the mimics to show the pathway did not skip a reversible cause on the way to the scanner. Many sections pair brain and endocrine emergencies in this week, and the glucose check is where the two meet.

Are reperfusion time windows included?

No windows, pressure limits or doses appear. Eligibility is argued as a sequence of questions, when the patient was last known well, what imaging showed, which contraindications exist, each answered from the case. The criteria themselves belong to current stroke guidance and change as evidence moves, so the sample shows the reasoning and leaves the numbers to the source.

Does the NIH Stroke Scale need to be scored item by item?

The sample records it by domain and gives the total, which suits most prompts. Some sections want the full item table in an appendix, and that can be added without changing the body. The grade turns on whether the scores describe the deficit's pattern, since a total alone tells a reader very little about where the lesion sits.

Where can I find a free NRNP 6537 Week 8 sample paper?

The wake-up stroke pathway is reproduced here with the timeline, last known well, NIHSS by domain, mimics, imaging and eligibility questions.

How is last known well set in NRNP 6537 Week 8?

From the last time someone saw the patient at baseline, here 22:30 the night before, not when the deficit was found. The example confirms it with his wife.