Cerebral Vascular Accident (CVA) John Gates is a 59-year-old male -Answered

Cerebral Vascular Accident (CVA) John Gates is a 59-year-old male -Answered History of Present Problem: John Gates is a 59-year-old male with a history of diabetes type II and hypertension who was at work when he had sudden onset of right-sided weakness, right facial droop, and difficulty speaking. He was transported to the emergency department (ED) where these symptoms continue to persist. It has been one hour from the onset of his neurologic symptoms when he presents to the ED. You are the nurse responsible for his care. Personal/Social History: John lives with his wife in their own home in a small rural community. He owns a hardware store where he remains active and involved in the day-to-day operations. His wife insists on being by his side and talking to John despite John’s frustration in not being able to answer her questions. His wife reports that the past week he has been complaining of episodes where his heart felt as if it was beating irregularly and fast but then resolved. His wife also states that he has been complaining of pain in his right foot the past week. John has been trying to quit smoking the past month and has been using a nicotine patch. His wife reports that he does not regularly check his blood glucose and eats what he wants. He is 6 feet tall and weighs 250 pounds (113.6 kg/BMI of 33.9). What data from the histories are RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: Sudden onset of right-sided weakness, right facial droop, and difficulty speaking (dysarthric speech) One hour from the onset of neurologic symptoms when he presents to the ED All of these symptoms reflect acute neurologic changes due to disruption in cerebral blood flow because of embolism or hemorrhagic event. The location in the brain will determine the type and severity of symptoms. F.A.S.T. is an easy way to remember the sudden signs of stroke. F.A.S.T. is: Facial drooping; Arm Weakness, Speech Difficulty, Time to call 911. [] It has been only 1 hour since onset of neurologic symptoms that suggest a CVA. John is now in ED and if not contraindicated, he is a candidate for thrombolytic therapy such as tissue plasminogen activator (tPA) that can re-establish cerebral blood flow and dramatically limit severity of CVA deficits. TIME IS BRAIN TISSUE. It is estimated that millions of neurons are lost every minute that the occlusion persists if this is an embolic event and tPA therapy is delayed! Thrombolytic therapy is considered only in ischemic strokes and ischemic strokes make up about 85% of CVAs. RELEVANT Data from Social History: Clinical Significance: His wife insists on being by his side and talking to John despite John’s frustration in not being able to answer her questions His wife reports that the past week he has been complaining of episodes where his heart felt as if it was beating irregularly and fast but then resolved. Wife is very nervous and needs to be educated on what is going on…ER is a fast-paced environment. You needs to remember that as you are able, the next of kin must be educated about the plan of care. Regarding his speech; is he experiencing expressive or receptive aphasia, or both?.  Expressive aphasia is when you know what you want to say, but you have trouble saying or writing what you mean.  Receptive aphasia - you hear the voice or see the print, but you can't make sense of the words. This situation reflects EXPRESSIVE aphasia. Why would he have irregular and rapid heart rate that does not persist? The most common cardiac dysrhythmia is atrial fibrillation. This secondhand information is highly suggestive of a classic presentation of paroxysmal atrial fibrillation. If atrial fibrillation is persistent, what can it cause if not treated? Embolic event due to blood pooling in the atrium