STROKE CASE STUDY1 62 year old woman presents to the emergen
STROKE CASE STUDY1 62 year old woman presents to the emergency… STROKE CASE STUDY162 year old woman presents to the emergency department with a complaint of left eye blindness that started abruptly 30 minutes ago while shopping. Symptoms seem to be resolving. She denies headache, weakness, dizziness, slurred speech, or other associated symptoms. She has never had anything like this before. PMHx: Type 2 DM, well-controlled (recent HbA1c 6.5); HTN not well controlled on meds; hyperlipidemia (LDL 123 @ visit 2 weeks ago)Hysterectomy ~ 20 yrs ago (was on estrogen for ~ 5 years post-op but then stopped)Meds: Metformin 1000 mg BID; lisinopril 5 mg QD; HCTZ 25 mg QDNKDASocHx/Habits: Married x 35 yrs; middle school teacher; remote tobacco use, quit 20 yrs ago after 15-pack-year history; social alcohol use; no other dug useFam Hx: Mother had CVA at age 72, left her with residual left hemiparesis, resides in assisted living facility at age 83; father died in automobile accident at age 40; 2 siblings with HTN 1A)What is the most likely cause of her symptom? What is the pathophysiology? 1 B) Her vital signs are T 98.6, P 82, BP 148/78, RR 12, O2 sat 98% on room air. By the time the ER doctor comes to see her (5 minutes after arrival), her symptoms have resolved. What is the differential diagnosis of her chief complaint & how would you rule out the other causes? 2A)What initial work-up would you suggest? 2B)Her lab work was normal except for a glucose of 183. Chest x-ray & EKG are displayed below. Her head CT by report is negative.. Does a normal CT make a stroke or TIA less likely? What is the main reason for initial imaging? 3)After meeting the patient and revisiting her history, you move to physical exam. What specific areas do you want to evaluate? 4) Listening to her neck, you hear a soft bruit over the left carotid artery. What is thesignificance of this finding? 5) After completing your assessment, the patient states that she would prefer to go home as she is feeling better now. Her husband asks you if she has had a stroke and if she is at risk for another event. What would you explain to the patient and her husband about her risk for stroke? 6) What is gained by admission for a TIA? 7) What immediate treatment would you anticipate? 8) What follow-up tests would you plan for and why? 9)The patient is instructed to follow up with her physician in 3 days. She has been symptom-free and taking her aspirin as prescribed. She had a normal echocardiogram. Her carotid study revealed a 50- 69% stenosis of the left internal carotid artery. What would you expect her next course of treatment to be?Health Science Science Nursing NURSING BS 1343
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