Chief Stroke Case Study

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

Visual fields are full to confrontation. Extraocular muscles intact. PERRLADC. Normal facial symmetry, sensation, and movement. Tongue and uvula are midline. Normal auditory acuity. Normal shoulder shrug.

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

Visual fields full to confrontation. Extraocular muscles intact. PERRLADC. Normal facial symmetry, sensation and movement. Tongue and uvula were midline. Normal auditory acuity. Shoulder shrug is normal.

Visual fields full to confrontation. Extraocular muscles intact. PERRLADC. Normal facial symmetry, sensation and movement. Tongue and uvula are midline. Normal auditory acuity. Normal shoulder shrug.

On 02/10/2015, he complained of chest pain and shortness of breath. He was evaluated with an electrocardiogram, which was abnormal. His

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

Patient has a history of a myocardial infarction (MI, or also known as a heart attack) in 2004, she had a hip pinning in 2005, and a traumatic amputation of fingers on her left hand in 1974 from a lawnmower accident.

John Doe, a 70 years old Caucasian male admitted to the acute rehab unit after Ischemic CVA of the right pareito-occipital region. He has left hemiparesis and newly diagnosed Type II Diabetes. He is a school teacher, and teaches Art and paintings. He is alert and oriented times four. His past medical history is Essential Hypertension, GERD, and Hyperlipidemia. He is non-compliant with his medications, he did not take his blood pressor medication properly. He is overweight and does not exercise. He lives with his wife, and have two sons and four grandchildren. His current medications include, Cozaar, Norvasc, Pepcid, Lipitor and he takes Aleve for pain. He has blood sugar checks before meals and at bedtime with a sliding scale coverage of Humalog insulin subcutaneously. His diet is Carbohydrate consistent, Fat Cholesterol modified, 2 gm Sodium.

Visual fields full to confrontation. Extraocular muscles intact. PERRLADC. Normal facial symmetry, sensation, and movement. Tongue and uvula were midline. Decreased auditory acuity bilaterally. Normal shoulder shrug.

“Patient is currently having blurred vision, facial pain, numbness in both upper and lower extremities,

Oct 1st This was the first day on the floor and I got a patient that is a 49 years old female. Her past medical history was HIV/AID (+), untreated hepatitis C, HTN, asthma, chronic back pain, respiratory failure and SOB. She current diagnosed is meningitis, COPD, and sleep apnea. Client was oriented and alert x3 and ambulates independently with a steady gait. She is allergy to ciprofloxacin HCI, efavirenz, nevirapine, and oxcarbazepine. When asked for pain, she stated at her belly and lower back. She has a Picc line on her left arm that was a little resistance. Patient was given hydromorphone 2mg/mL IV, and promethazine 25mg IV. I was not able to assess much of her since every

non-distended, no hepatosplenomegaly, no mass. EXTREMITIES: No clubbing, cyanosis, or edema. Warm well perfused with +2 pulses symmetrically. NEUROLOGIC EXAM: Sensorium intact. Cranial nerves II thru XII intact with the exception of Cranial nerve VIII on the right ear. Normal strength, normal tone, no ticks or tremor, normal gait, and stance. Deep tendon reflexes +2 symmetrically throughout.

Patient George Matthew was taken to the accident and emergency department and later admitted to the Acute Stroke Unit with issues caused by right sided weakness and slurred speech. When being admitted into hospital, his two daughters and his wife accompanied him. He is 75 years old and currently lives with his