Question

Neurological Disorders Case Study History of Present Problem: CV is a 68 year-old male was admitted to the skilled nursing care facility after a middle cerebral artery ischemic stroke. He was at City Center Hospital for 3 days and is coming for rehabilitation with physical therapy, occupational therapy and speech therapy. He presents with right sided weakness, difficulty speaking and swallowing. He has a history of hypertension, atherosclerosis, and smoked a pack of cigarettes a day for the last 40 years. The nurse comes into the room to complete her initial assessment. The patient is in bed and the nurse notices he is leaning to his right side and his right hand is tucked by his right hip. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Data from Present Problem: Clinical Significance: Whar other health history questions should the nurse ask and what is the clinical significance? Question Clinical significance

Answer 1

Stroke: The loss of brain function arising when the blood supply to the brain is suddenly interrupted.

Ischemic stroke happens when the blood flow to the brain is blocked due to a clot or breakage in blood vessels resulting in lack of blood flow and oxygen supply to the part of brain.

Relevant data from present problems and its Significance:

* Right sided weekness and difficulty in speaking and swallowing

Clinical significance: Dysphagia( difficulty in swallowing) and trouble speeking, weekness and numbness of face, extremities of one side ( right side) are the main clinical manifestations of Ischemic stroke.

* History of Hypertension, atherosclerosis, smoking

Clinical significance: Major risk factors of Stroke are Hypertension ( High blood pressure), Atherosclerosis ( Formation of fatty plaques, atheroma at inner side of blood vessels and resulting in narrowing of arteries) and smoking (for past 30years).

* Position of the patient with right sided lying

Clinical significance: Patient has to be positioned with head end elevation of the bed to maintain normal Intracranial pressure ( ICP) and compressive neuropathy.

Other health history questions ( nurse can ask)

* Ask questions to check orientation ( Time, place, person), memory status, mood and speech and language

Clinical significance: In Post acue phase of Ischemic cerebral stroke, the patient has to be checked for his orientation, conscious level, memory, attention and speech to assess the level of disability and the areas affected.

* observe emotional responses ( crying, agitation), presence of hallucination.

Clinical significance: Abnormal behaviour pattern may complicate the treatment.

* Ask about the vision

There may be the chances of visual deficits in patients with stroke.

* Ask to move the extremities, upper and lower to check the motor control

* Ask regarding bowel and bladder movement

* Ask to walk a 50ft on level without stopping to check the mobility.

* Ask the patient to touch and hold some objects

: To stimulate sense of touch.