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Posted: July 18th, 2022
Which two questions would you ask this patient?
I would inquire if this patient is suffering from a headache. It is critical at this point to determine whether the patient is having a hemorrhagic or ischemic stroke, as treatment will differ. Headaches and loss of consciousness are common symptoms of hemorrhagic strokes. In contrast to TPA or other reperfusion methods for ischemic strokes, they are treated with surgery to stop the bleeding. They are also frequently the result of severe hypertension. A CT scan will be obtained to confirm the type of cerebrovascular accident, but it is an important time-saving assessment to anticipate what services the patient may require in the near future. My next question is whether the patient has a history of CVA or TIA. Because the exact time of onset cannot be determined, symptoms will begin when the patient fell asleep. This would preclude him from receiving TPA, but given his history, he is at high risk of having an ischemic stroke and may require surgical intervention to restore cerebral perfusion (McCance & Huether, 2019).
Determine the patient’s subjective data.
Right handed, history of CAD, HTN, HLD, and MI at age 50, episode of amaurosis fugux (blindness) in his right eye one month ago that lasted for 5 minutes, bilateral leg pain 3 months ago during 15 minute walk, currently takes baby aspirin a day, ace inhibitor, and statin, history of ETOH and smoking but quit after MI
Determine the patient’s objective data.
Slurred speech, left sided weakness, inability to move left arm and leg, blood pressure is 195/118, pulse 106, respiratory rate 18, temperature 99.8, O2 sat is 97% on room air, despite the fact that his pupils are equal and reactive, and his ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side, the neck is supple, there is no jugular vein distension, and there are no bruits,
What Social Determinants of Health are important to this patient?
Economic stability, education, food, health care system, neighborhood and physical environment, community, safety, and social context are all examples of social determinants of health. A wide range of determinants outside of the healthcare system frequently influence health outcomes. Taking care of the social determinants of health improves patient outcomes and decreases health disparities (Drake & Rudowitz, 2022). This patient has a spouse to provide support, as well as EMS and ER access, provider availability, medication access, environmental walkability, and language fluency. Given his history of CAD, HTN, HLD, and MI, it would be worthwhile to assess his access to healthy foods.
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