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:
Hx of diabetes type II and hypertension 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
Sudden onset of right-sided weakness, facial
These symptoms are some of the common symptoms for stroke, these
droop, and difficulty speaking
deficits can correlate with the areas of the brain that the stroke occurred in
1 hour from the onset of neuro symptoms
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
B1 B1 B1 B1 B1 B1 B1 Frustration is normal for those in situation when they are having
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
questions
B1 B1 difficulty speaking, it is important to try and communicate with the
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
B1 patient in other way and talk to the doctor for a referral for a speech
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
therapist to collaborate in the patients care
B1 B1 B1 B1 B1 B1 B1
Episodes of irregular rapid heartbeat
B1 B1 B1 B1
The patient is experiencing periods arrythmias, which can increase
B1 B1 B1 B1 B1 B1 B1 B1
B1 the patient’s risk for stroke due to the change in blood flow which
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
can form clots
B1 B1 B1
Pain in his right foot
B1 B1 B1 B1
Most likely caused diabetic neuropathy due to damage to the small
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
B1 nerve endings in the foot, due to his uncontrolled diabetes
B1 B1 B1 B1 B1 B1 B1 B1 B1
Trying to quit smoking --- using a nicotine
B1 B1 B1 B1 B1 B1 B1
Cigarette smoking doubles the patient’s risk for ischemic stroke and
B1 B1 B1 B1 B1 B1 B1 B1 B1
patch
B1
B1 increases the patient’s risk for cerebral hemorrhage
B1 B1 B1 B1 B1 B1
Does not regularly check blood glucose and
B1 B1 B1 B1 B1 B1
Self-testing blood glucose is an important tool for managing diabetes
B1 B1 B1 B1 B1 B1 B1 B1 B1
B1 eats what he wants
B1 B1 B1
B1 and preventing complications. Since the patient is not regularly
B1 B1 B1 B1 B1 B1 B1 B1
B1 monitoring his blood glucose and eats what he wants, his diabetes my
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
be uncontrolled and can further increase his risk for stroke
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
BMI of 33.9
B1 B1
Being overweight increases the patient’s risk for stroke
B1 B1 B1 B1 B1 B1 B1
Patient Care Begins: B1 B1
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:
Hx of diabetes type II and hypertension 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
Sudden onset of right-sided weakness, facial
These symptoms are some of the common symptoms for stroke, these
droop, and difficulty speaking
deficits can correlate with the areas of the brain that the stroke occurred in
1 hour from the onset of neuro symptoms
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
B1 B1 B1 B1 B1 B1 B1 Frustration is normal for those in situation when they are having
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
questions
B1 B1 difficulty speaking, it is important to try and communicate with the
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
B1 patient in other way and talk to the doctor for a referral for a speech
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
therapist to collaborate in the patients care
B1 B1 B1 B1 B1 B1 B1
Episodes of irregular rapid heartbeat
B1 B1 B1 B1
The patient is experiencing periods arrythmias, which can increase
B1 B1 B1 B1 B1 B1 B1 B1
B1 the patient’s risk for stroke due to the change in blood flow which
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
can form clots
B1 B1 B1
Pain in his right foot
B1 B1 B1 B1
Most likely caused diabetic neuropathy due to damage to the small
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
B1 nerve endings in the foot, due to his uncontrolled diabetes
B1 B1 B1 B1 B1 B1 B1 B1 B1
Trying to quit smoking --- using a nicotine
B1 B1 B1 B1 B1 B1 B1
Cigarette smoking doubles the patient’s risk for ischemic stroke and
B1 B1 B1 B1 B1 B1 B1 B1 B1
patch
B1
B1 increases the patient’s risk for cerebral hemorrhage
B1 B1 B1 B1 B1 B1
Does not regularly check blood glucose and
B1 B1 B1 B1 B1 B1
Self-testing blood glucose is an important tool for managing diabetes
B1 B1 B1 B1 B1 B1 B1 B1 B1
B1 eats what he wants
B1 B1 B1
B1 and preventing complications. Since the patient is not regularly
B1 B1 B1 B1 B1 B1 B1 B1
B1 monitoring his blood glucose and eats what he wants, his diabetes my
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
be uncontrolled and can further increase his risk for stroke
B1 B1 B1 B1 B1 B1 B1 B1 B1 B1
BMI of 33.9
B1 B1
Being overweight increases the patient’s risk for stroke
B1 B1 B1 B1 B1 B1 B1
Patient Care Begins: B1 B1
