Cerebral Vascular Accident (CVA) John Gates is a 59-year-old male -Answered

Cerebral Vascular Accident (CVA) John Gates is a 59-year-old male -Answered 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 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: Sudden onset of right-sided weakness, right facial droop, and difficulty speaking (dysarthric speech) During transport, he had increased agitation and confusion to place and time It has been 30 minutes from the onset of neurologic symptoms when he presents to the ED All of these symptoms are reflecting acute neurologic changes that are due to disruption in cerebral blood flow either because of embolism or hemorrhagic event. The location of the affected area will determine the type and severity of symptoms. All of these symptoms are reflecting acute neurologic changes that are due to disruption in cerebral blood flow either because of embolism or hemorrhagic event and is a clinical RED FLAG because it is a change that is reflecting a worsening in status Has been only 30 minutes since onset of neuro symptoms. Is now in ED and if not contraindicated, he is a candidate for thrombolytic therapy such as tPA that can re-establish cerebral blood flow and limit severity of CVA deficits dramatically. TIME IS NEURONS as it is estimated that millions of neurons are lost every minute that tPA therapy is delayed! RELEVANT Data from Social History: Clinical Significance: His wife insists on being by his side and talking to John despite John’s frustration in not being able to answer her questions Nicotine patch use Pain on the right food for the past week The wife’s attitude MAY be a problem. Will need further assessment. Regarding his speech; is he expressive or receptive aphasia or both? This is reflecting EXPRESSIVE aphasia Is the patch still on him?…. May elevate BP and should be removed during the acute episode for now. The nurse needs to find it! Be sure to take his shoes off and perform a skin and joint assessment. Think gout or potential for skin breakdown. He is a diabetic and clustering these 2 pieces of clinical data requires the nurse to assess this