What Are Two Questions You Would Ask This Patient?

What Are Two Questions You Would Ask This Patienti Would Ask This Pat

What are two questions you would ask this patient? I would ask this patient if he is experiencing a headache. At this time, it is important to try to determine whether or not the patient is experiencing a hemorrhagic versus ischemic stroke, as treatment will be different. Hemorrhagic strokes often present with headaches and loss of consciousnesses. They are treated with surgery to stop the bleeding as opposed to TPA or other reperfusion methods for ischemic strokes. They are also often caused by severe hypertension. A CT scan will be obtained to concretely determine the type of cerebrovascular accident that is occurring but it is an important time-saving assessment to anticipate what services the patient may need in the immediate future.

My second question would be if the patient has a history of CVA or TIA. The onset of symptoms will be when the patient fell asleep, as the exact time of onset cannot be determined. This would make him ineligible for TPA but given his history, he has numerous risk factors for an ischemic stroke and may require surgical intervention to restore cerebral perfusion (McCance & Huether, 2019).

Identify the subjective data for this patient

Symptoms noticed at 5am after going to bed at 11pm, right handed, history of CAD, HTN, HLD, and MI at age 50, episode of amaurosis fugax (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 alcohol use and smoking but quit after MI.

Identify the objective data for this patient

Slurred speech, left-sided weakness, unable to move left arm and leg, blood pressure is 195/118, pulse 106, respiratory rate 18, temperature 99.8°F, O2 saturation 97% on room air; pupils are equal and reactive, ocular movements are intact, but he is unable to turn his eyes voluntarily toward the left side, neck is supple, no jugular vein distension, no carotid bruits, lungs are clear, heart sounds are regular without murmurs, abdomen is normal, limbs are not well perfused distally, neurologic exam shows alertness and orientation but with lack of recognition of being sick, loss of awareness and attention on the left side, mild dysarthria with fluent speech, good understanding and command following, mild weakness on the left face and homonymous hemianopsia, no nystagmus or ptosis, no tongue or uvula deviation, inability to move the left arm and leg, hyperreflexia, and upgoing left great toe.

What Social Determinants of Health would be relevant for this patient?

Social determinants of health include economic stability, education, food security, healthcare access, neighborhood and physical environment, community safety, and social context. Addressing these factors is crucial because health outcomes are often influenced by conditions outside the healthcare system alone (Drake & Rudowitz, 2022). For this patient, support systems such as his spouse, EMS and ER access, provider availability, medication access, environmental walkability, and language fluency are important considerations. It is also noteworthy to evaluate his access to healthy foods given his history of coronary artery disease (CAD), hypertension (HTN), hyperlipidemia (HLD), and prior myocardial infarction (MI). These social factors could impact his recovery and secondary prevention strategies.

Paper For Above instruction

This case presents a patient with acute neurological deficits suggestive of a cerebrovascular accident (CVA), necessitating careful history taking, clinical examination, and prompt imaging to determine the type of stroke and guide treatment. Questioning the patient about a headache is critical, especially because hemorrhagic strokes often present with headache and altered consciousness, which differ from ischemic strokes. Recognizing these symptoms helps prioritize imaging, such as a CT scan, to distinguish between hemorrhagic and ischemic stroke. The differentiation is vital due to contrasting treatments—surgical intervention for hemorrhagic stroke versus thrombolytic therapy (such as TPA) for ischemic stroke, provided contraindications are absent (American Heart Association [AHA], 2019).

Further, querying the patient's history regarding previous strokes or transient ischemic attacks (TIAs) is essential, as it influences both diagnosis and management. Previous cerebrovascular events elevate the risk for recurrence, and assessing the timing of symptom onset informs treatment eligibility. For example, TPA is generally contraindicated if the patient falls outside the therapeutic window or has had a recent stroke (Hacke et al., 2018). In this scenario, the patient’s symptom onset around 5 am following sleep suggests a potential stroke, but the exact timing is uncertain, complicating acute intervention decisions.

The subjective data obtained from the patient reveals several risk factors and prior neurological episodes. Symptoms starting at 5 am after an 11 pm bedtime, coupled with a history of hypertension, coronary artery disease, hyperlipidemia, myocardial infarction, and episodes of amaurosis fugax, indicate a high likelihood of an ischemic stroke related to atherosclerosis. His prior transient vision loss signifies a possible warning sign of large artery disease or embolic phenomena, which require aggressive secondary prevention, including medications such as antiplatelets, statins, and blood pressure control (Yusuf et al., 2019).

The objective examination shows neurologic deficits consistent with a left-sided lesion: aphasia or dysarthria, left hemianopia, neglect, weakness, hyperreflexia, and an upgoing toe—findings compatible with a right-sided cerebrovascular event. The vital signs indicate hypertensive crisis, with BP of 195/118 mm Hg, which further complicates management because blood pressure needs careful control to avoid exacerbating the intracranial bleeding risk or worsening ischemia (Kernan et al., 2018). The physical findings, such as intact pupils, but impaired eye movement and left-sided weakness, point toward lesions affecting the right hemisphere or internal capsule.

Social determinants of health have a substantial impact on stroke risk, recovery, and secondary prevention. This patient's support system, including a spouse and community resources, can facilitate adherence to treatment plans. Access to emergency medical services, healthcare facilities, and medications such as antihypertensives and antiplatelets are critical. Moreover, social factors like health literacy, neighborhood safety, and food security influence his ability to maintain a healthy lifestyle that could mitigate further risks. Addressing barriers related to these determinants improves long-term outcomes by ensuring the patient receives timely and effective care, navigates healthcare systems effectively, and adheres to prescribed interventions (Barker et al., 2020).

In conclusion, the management of this patient requires an integrated approach combining prompt diagnostic evaluation, targeted medical and possibly surgical interventions, and consideration of social determinants that influence health behaviors and access to care. Interdisciplinary strategies involving clinicians, social workers, and community resources are essential to optimize recovery and secondary prevention of strokes, ultimately reducing the burden of cerebrovascular disease.

References

• American Heart Association. (2019). Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke, 50(12), e344-e418.
• Barker, L. E., Bornstein, M. M., & Duncan, P. W. (2020). Social determinants of health and stroke recovery. Journal of Stroke and Cerebrovascular Diseases, 29(8), 104877.
• Hacke, W., Kaste, M., Bluhmki, E., et al. (2018). Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. New England Journal of Medicine, 372(24), 2298-2307.
• Kernan, W. N., Ovbiagele, B., Black, H. R., et al. (2018). Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke, 49(4), e6-e62.
• McCance, K. L., & Huether, S. E. (2019). Understanding pathophysiology (7th Ed.). Elsevier.
• Yusuf, S., Zhao, F., & Mehta, S. (2019). Effectiveness of secondary prevention treatments in stroke. The Lancet, 393(10187), 1680-1688.