Case NUR 211 2001 (NUR 211 2001) CARDIOVASCULAR DISORDERS-CEREBRAL VASCULAR ACCIDENT

Cerebral Vascular Accident (CVA) John Gates, 59 years old Primary Concept Perfusion Interrelated Concepts (In order of emphasis) 1. Stress 2. Coping 3. Clinical Judgment 4. Patient Education 5. Communication 6. Collaboration © 2016 Keith Rischer/www.KeithRN.com UNFOLDING Clinical Reasoning Case Study: STUDENT Cerebral Vascular Accident (CVA) History of Present Problem: John Gates is a 59-year-old male with a history of diabetes type II and hypertension who was at work when he had sudden onset of right-sided weakness, right facial droop, and difficulty speaking. He was transported to the emergency department (ED) where these symptoms continue to persist. It has been one hour from the onset of his neurologic symptoms when he presents to the ED. You are the nurse responsible for his care. Personal/Social History: John lives with his wife in their own home in a small rural community. He owns a hardware store where he remains active and involved in the day-to-day operations. His wife insists on being by his side and talking to John despite John’s frustration in not being able to answer her questions. His wife reports that the past week he has been complaining of episodes where his heart felt as if it was beating irregularly and fast but then resolved. His wife also states that he has been complaining of pain in his right foot the past week. John has been trying to quit smoking the past month and has been using a nicotine patch. His wife reports that he does not regularly check his blood glucose and eats what he wants. He is 6 feet tall and weighs 250 pounds (113.6 kg/BMI of 33.9). What data from the histories are RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: Hx of diabetes type II and hypertension Sudden onset of right-sided weakness, facial droop, and difficulty speaking 1 hour from the onset of neuro symptoms Hypertension is the leading cause for stroke and diabetes leads to vascular changes in the body, both of these conditions increases the patient’s risk for stroke These symptoms are some of the common symptoms for stroke, these deficits can correlate with the areas of the brain that the stroke occurred in If this is an ischemic stroke, tPA can be administered within 3 hours of the symptoms of stroke to increase the chances of recovery RELEVANT Data from Social History: Clinical Significance: Frustration in not being able to answer wife’s questions Episodes of irregular rapid heartbeat Pain in his right foot Trying to quit smoking --- using a nicotine patch Does not regularly check blood glucose and eats what he wants BMI of 33.9 Frustration is normal for those in situation when they are having difficulty speaking, it is important to try and communicate with the patient in other way and talk to the doctor for a referral for a speech therapist to collaborate in the patients care The patient is experiencing periods arrythmias, which can increase the patient’s risk for stroke due to the change in blood flow which can form clots Most likely caused diabetic neuropathy due to damage to the small nerve endings in the foot, due to his uncontrolled diabetes Cigarette smoking doubles the patient’s risk for ischemic stroke and