Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
· Do you agree with your peers’ assessment?
· Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
· Share your thoughts on how you support their opinion and explain why.
· Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Oct 8 5:43am| Last reply Oct 8 4:32pm
Reply from Mallory Palmer
Two questions:
1. When is the last time you remember feeling normal before these symptoms started?
2. Have you had any recent episodes of weakness, numbness, vision loss, or difficulty speaking before this event or have you ever suffered a stroke or TIA before?
Subjective Data:
–Onset of symptoms noticed upon awakening at 5 am (last known normal at 11 PM)
-Slurred speech and left-sided weakness since waking
-Amaurosis Fugax (transient right eye blindness) one month ago, lasting five minutes
-Intermittent bilateral leg pain waking 3 months ago, lasting 15 minutes (suggestive of intermittent claudication)
-PMH: CAD, Hypertension, Hypercholesterolemia, Myocardial infarction at age 50
Medications: Baby aspirin daily, ACE inhibitor, statin
Social History: Former smoker and alcohol user, quit after a heart attack
No reported chest pain, shortness of breath, or other acute complaints
Objective Data:
Vital signs: 195/118mmHg, HR: 106bpm, RR 18, Temp 99.8F, SpO2 97% RA
General: Alert and oriented, but unaware of illness (anosognosia)
Neurological Findings:
-Left-sided hemiplegia
-Left facial weakness
-Left homonymous hemianopsia
-Hyperreflexia and upgoing left great toe (Babinski sign)
-Dysarthria, but fluent and comprehensible speech; good comprehension
-Loss of voluntary eye movement toward the left (gaze preference to the right)
-Left-sided neglect and inattention
Cranial Nerves: Pupils equal and reactive; intact ocular movements; no nystagmus, ptosis, tongue, or uvula deviation
Cardiovascular: Tachycardic, Regular rhythm, no murmurs, or JVD, or carotid bruits
Respiratory: Clear breath sounds bilaterally
Peripheral Vascular: Poor distal perfusion in limbs
Abdomen: Soft, non-tender, normal exam
Social Determinants of Health:
This patient presents with multiple vascular risk factors, including hypertension, hyperlipidemia, coronary artery disease, and prior transient ischemic events. All of the vascular risk factors are strongly influenced by social determinants of health. Safford et al. (2021) found that the number of adverse social determinants of health significantly increased the risk of both fatal and nonfatal coronary heart disease in adults who participated in the REGARDS study. This supports the understanding that factors such as socioeconomic instability, limited access to quality healthcare, and environmental stressors can compound biological risks and exacerbate cardiovascular outcomes. Regarding this patient, previous lifestyle behaviors (smoking, alcohol use), potential barriers to timely medical care, and health literacy levels may have contributed to disease progression and delayed stroke recognition. Addressing social determinants of health through targeted education, community resources, and access to preventive services could reduce recurrent events and improve long-term recovery (Safford et al., 2021).
References:
Safford, M. M., Reshetnyak, E., Sterling, M. R., Richman, J. S., Muntner, P. M., Durant, R. W., … & Pinheiro, L. C. (2021).
Number of social determinants of health and fatal and nonfatal incident coronary heart disease in the REGARDS study.
Circulation, 143(3), 244–253.
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Reply from Jennifer Poulson
Unit 6 Discussion: Neuro Case Study – Jennifer Poulson
Two questions that you can ask this patient are:
· Do you take your medication as prescribed?
· The patient’s BP is 195/118 indicating that his blood pressure is not controlled.
· High blood pressure is a risk factor for stroke.
· When did you first notice the slurred speech and left side weakness?
· The wife noticed the symptoms at 5 am. The patient may have been up throughout the night experiencing symptoms.
· Patients experience better clinical outcomes with early diagnosis and treatment and it is critical to diagnose the subtype of stroke rapidly and accurately (Patel et al., 2022).
· Fast, accurate diagnosis of stroke is vital for selection of appropriate acute stroke treatment, such as tissue plasminogen activator (tPA) or endovascular mechanical thrombectomy treatment (Patel et al., 2022).
Subjective Data:
Wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms-slurred speech and left side weakness.
Wife states that 3 months ago he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes.
Right-handed.
History of coronary artery disease, hypertension, hypercholesterolemia and a heart attack at age 50.
Patient had an episode of amaurosis fugux (blindness) in his right eye one month ago that lasted for 5 minutes.
History of alcohol use and smoking-stopped after his heart attack.
Medications: Baby aspirin daily, ACE inhibitor and statin.
Objective Data:
Vitals: BP 195/118, HR 106, RR 18, T 99.8, O2 sat 97% RA.
Unable to move his left arm and leg.
Hyperreflexia left arm and leg.
Upgoing left great toe.
Mild dysarthria, speech is fluent.
Alert and oriented, does not recognize he is sick. Understands and follows commands.
Neck is supple, there is no jugular vein distension, and there are no bruits.
The lungs are clear.
Heart sounds regular without murmurs.
Abdomen is normal.
The limbs are not well perfused distally
Pupils are equal and reactive, ocular movements are intact, unable to turn eyes voluntarily toward the left side.
Mild weakness on the left side of the face.
Left-sided homonymous hemianopsia, no nystagmus or ptosis, no tongue or uvula deviation.
Loss of awareness and attention with respect to objects or stimuli on his left side.
Social Determinants of Heath:
According to (Yadav et al., 2022), The World Health Organization has defined social determinants of health as “the circumstances in which people are born, grow, live, work, and age, and the systems put in place to deal with illness”. Social determinants determine how health is affected, how they play a significant role in influencing health, and how we can improve health for all (Chelak & Chakole, 2023). A patient’s socioeconomic status influences their incidence of stroke and the outcome. Heart disease prevalence, blood pressure medication nonadherence and age-adjusted obesity are associated with high stroke hospitalization rate (Yadav et al., 2022). The following social determinants of health would be relevant for this patient: availability of nutritious food, access to healthcare services, ability to afford medications along with employment status.
References
Chelak, K., & Chakole, S. (2023). The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. Cureus, 15(1), e33425.
to an external site.
Patil, S., Rossi, R., Jabrah, D., & Doyle, K. (2022). Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives. Frontiers in medical technology, 4, 748949.
to an external site.
Yadav, R. S., Chaudhary, D., Avula, V., Shahjouei, S., Azarpazhooh, M. R., Abedi, V., Li, J., & Zand, R. (2022). Social Determinants of Stroke Hospitalization and Mortality in United States’ Counties. Journal of clinical medicine, 11(14), 4101.
to an external site.
