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
© 2016 Keith
Rischer/www.KeithRN.com
, Interrelated Concepts (In order of emphasis)
1. Stress
2. Coping
3. Clinical Judgment
4. Patient Education
5. Communication
© 2016 Keith
Rischer/www.KeithRN.com
, 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, All of these symptoms are reflecting acute neurologic changes that
right facial droop, and difficulty speaking are due to disruption in cerebral blood flow either because of
(dysarthric speech) embolism or hemorrhagic event. The location of the affected area will
determine the type and severity of symptoms.
During transport, he had increased All of these symptoms are reflecting acute neurologic changes that are
agitation and confusion to place and time 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
It has been 30 minutes from the onset of
ED and if not contraindicated, he is a candidate for thrombolytic
neurologic symptoms when he presents to
therapy such as tPA that can re-establish cerebral blood flow and limit
the ED
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 The wife’s attitude MAY be a problem. Will need further
talking to John despite John’s frustration assessment. Regarding his speech; is he expressive or receptive
in not being able to answer her questions aphasia or both? This is reflecting EXPRESSIVE aphasia
Nicotine patch use 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!
Pain on the right food for the past week 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
© 2016 Keith
Rischer/www.KeithRN.com
Answered
Cerebral
Vascular Accident (CVA)
John Gates, 59 years old
Primary Concept
Perfusion
© 2016 Keith
Rischer/www.KeithRN.com
, Interrelated Concepts (In order of emphasis)
1. Stress
2. Coping
3. Clinical Judgment
4. Patient Education
5. Communication
© 2016 Keith
Rischer/www.KeithRN.com
, 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, All of these symptoms are reflecting acute neurologic changes that
right facial droop, and difficulty speaking are due to disruption in cerebral blood flow either because of
(dysarthric speech) embolism or hemorrhagic event. The location of the affected area will
determine the type and severity of symptoms.
During transport, he had increased All of these symptoms are reflecting acute neurologic changes that are
agitation and confusion to place and time 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
It has been 30 minutes from the onset of
ED and if not contraindicated, he is a candidate for thrombolytic
neurologic symptoms when he presents to
therapy such as tPA that can re-establish cerebral blood flow and limit
the ED
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 The wife’s attitude MAY be a problem. Will need further
talking to John despite John’s frustration assessment. Regarding his speech; is he expressive or receptive
in not being able to answer her questions aphasia or both? This is reflecting EXPRESSIVE aphasia
Nicotine patch use 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!
Pain on the right food for the past week 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
© 2016 Keith
Rischer/www.KeithRN.com
