- What are two questions you would ask this patient?
- I would ask this patient if he is experiencing a headache. At this time, it is important to try to determine whether or not the patient is experiencing a hemorrhagic versus ischemic stroke, as treatment will be different. Hemorrhagic strokes often present with headaches and loss of consciousnesses. They are treated with surgery to stop the bleeding as opposed to TPA or other reperfusion methods for ischemic strokes. They are also often caused by severe hypertension. A CT scan will be obtained to concretely determine the type of cerebrovascular accident that is occurring but it is an important time saving assessment to anticipate what services the patient may need in the immediate future. My second question would be if the patient has a history of CVA or TIA. The onset of symptoms will be when the patient fell asleep, as the exact time of onset cannot be determined. This would make him ineligible for TPA but given his history, he has numerous risk factors for an ischemic stroke and may require surgical intervention to restore cerebral perfusion (McCance & Huether, 2019).
- Identify the subjective data for this patient.
- Symptoms noticed at 5am after going to bed at 11pm, right handed, history of CAD, HTN, HLD, and MI at age 50, episode of amaurosis fugux (blindness) in his right eye one month ago that lasted for 5 minutes, bilateral leg pain 3 months ago during 15 minute walk, currently takes baby aspirin a day, ace inhibitor, and statin, history of ETOH and smoking but quit after MI.
- Identify the objective data for this patient.
- Slurred speech, left sided weakness, unable to move left arm and leg, blood pressure is 195/118, pulse 106, respiratory rate 18, temperature 99.8, O2 sat is 97% on room air, although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side, the neck is supple, there is no jugular vein distension, and there are no bruits, the lungs are clear heart sounds regular without murmurs, and abdomen is normal, the limbs are not well perfused distally, the neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick, he shows loss of awareness and attention with respect to objects or stimuli on his left side, he has mild dysarthria but, his speech is fluent, and he understands and follows commands very well, there is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation, he is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.
- What Social Determinants of Health would be relevant for this patient?
- Social determinants of health include economic stability, education, food, health care system, neighborhood and physical environment, and community, safety, and social context. Health outcomes are often driven by a vast amount of determinants outside of the healthcare system. Addressing social determinants of health improves patient outcomes and reduces health disparities (Drake & Rudowitz, 2022). This patient has a spouse for a support system, EMS access, ER access, provider availability, access to medications, environmental walkability, and language fluency. It would be noteworthy to evaluate access to healthy foods given his past medical history of CAD, HTN, HLD, and MI.
