Nursing Assessment and Stroke Diagnosis

This assignment provides a detailed analysis of a patient's (Mrs. Amari) condition, suspecting a stroke due to slurred speech and drooping facial muscles. The nurse collects vital signs, including abnormal blood pressure levels, which may contribute to the stroke. A summary of nursing assessment practices is also provided, emphasizing the importance of accurate data collection and the use of transcranial magnetic stimulation (TMS) for mapping brain changes.

Case Study: Mrs Amari

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Considering the situation of the patient......................................................................................1
Collecting Cues and Information................................................................................................1
Processing the information..........................................................................................................3
CONCLUSION................................................................................................................................4
REFERENCES...............................................................................................................................5

INTRODUCTION
Mrs Amari was brought in the emergency department after facing some numbness on
right side of her face and in the right arm. Clinical reasoning can be considered as a process
through which nurses can collect the information, understand the specific problem of the patient,
plans and implements the interventions properly before evaluating the outcomes (Norman and
Eva, 2010). The report is about the clinical reasoning of Mrs Amari by considering her situation
properly, gathering related information about it and finally, the interpretation of it.
Considering the situation of the patient
On the basis of cited case situation, patient has a history of tobacco use for 25 years which
was 10 years ago. Further, she had positive family history of heart disease. Occasionally she used
to walk in neighbourhood but it was not regular. Patient lives with her son who married to
Australian girl and have two daughter, Mrs Amari is helpful enough to in care of grandchildren
and plays important role them. As per the present condition faced by the patient, it can probably
be symptoms of stock. In the case of ischemic stroke, brain of the patient gets blocked. Along
with this, brain is also shutting down when related cells die. Due to this, individual or patient is
not in position to perform some previous functions like walking and talking. The main reasons
behind the dead brain cells are the lack of blood and oxygen.
She was already suffering from hypertension and hypercholesterolemia. After the
analysis in the hospital, the report outputs were that she was not having any significant weakness
and was efficiently able to swallow without any trouble. She did not had any nausea or headache
and was still alert (Sposato and et.al, 2015). Her vital signs were diagnosed and everything was
within the normal limits. She was transferred from the emergency wards to the stroke unit. She
stayed there for 24 hours. After the shift of one nurse, it was analysed that the symptoms have
been resolved and she was not facing any issue of numbness as well. But, after self analysing
her, she was still having slurred speech and drooping face. After diagnosing the vital signs, it
was evaluated that her clinical situation has changed.
Collecting Cues and Information
Review of the situation
Emergency Department
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Mrs Amari was shifted to the emergency department when she experienced numbness on
the right side of her face. She was already a patient of hypertension and hypercholesterolemia.
For 25 years, she also had a habit of chewing tobacco as well. At that time, she was also facing
slight facial droop. Although she was not having any weakness and was able to eat and swallow
properly, there was no significance of nystagmus noted in her case. That time her blood pressure
level was 148/97 and the pulse rate was 81 .
Current Situation
After remaining in the emergency ward, she had been shifted in the stroke unit for 24
hours, it was analysed that when she was admitted there, she was suffering from slurred speech
and facial drooping. But the symptoms have been resolved. No asymmetry in face is represented
and no numbness is seen as well. That day only, in afternoon, her speech was still slightly slurred
and the face was drooping also. Then, again her vital signs were diagnosed. Her blood pressure
was 175/105 and her pulse rate was 90 per minute.
Change in the comparison and new assessment
In comparison with the current scenario, her blood pressure was 175/105. Although the
normal level for BP is 120/80, her blood pressure was far over that. The range between 160/110
and 180/110 implies stage 2 Hypertension. It means she was undergoing a huge amount of stress.
These higher levels causes nausea, vomiting, chest pain etc. in a person. She might be suffering
from all these conditions (Rothwell, Algra and Amarenco, 2011). Although when she was in the
emergency department, she was not facing any of these symptoms. Her pulse rate was 90 at that
time. The normal pulse rate is between 60-100 betas per minute. This indicates that after being
shifted to the stroke ward, her problems increased. 90 beats per minute comes within the normal
range but it means the heart is not working efficient when it does as on the lower levels.
Processing the information
Although the normal temperature of a human body is 37 degree Celsius, Mrs Amari was
having 36. 7 degree temperature which is quite below the normal range. Her blood pressure level
was 120 over 80, she was having 148 over 97 which is quite higher than the normal range. This
means she was having a huge amount of mental stress, due to which she was suffering from high
blood pressure. Her heart beat rate was 81, whether the normal pulse rate ranges from 60-100
beats per minute.
Interpret
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Mrs Amari was suffering from hypercholesterolemia and hypertension. She was facing
numbness in the right side of her face and under her right arm. After being admitted to the
emergency ward, she was diagnosed with some vital signs. It included a BP of 148/97 with a
pulse rate of 81 and the respiratory rate (RR) of 14 . After that, she was transferred to the stroke
unit under a neurologist for a diagnosis of a transient ischaemic attack (TIA). It is considered as
a temporal blockage of the flow of blood to the brain. Then her vital signs were a blood pressure
of 175/105, a pulse rate of 90 and the respiratory rate of 13. Mini strokes can be a reason for
transient ischaemic attack (TIA) (Sposato and et.al, 2015). Some factors should be keep in mind
so as to prevent oneself from strokes. These includes exercising, maintaining a normal level of
blood pressure etc.
Discriminate, Relate and Infer
Although Mrs Amari used to take walk in the neighbourhood, but she was not having a
proper exercising regime. For 25 years, she was also in a habit of chewing tobacco. These factors
like lack of exercising, less water taking etc. which can lead to strokes (Cai, Ren and Shi, 2011).
This is why Mrs Amari had transient ischaemic attack (TIA). She must have taken proper
quantity of water and in routine of exercising. These can help as a prevention from strokes.
It was analysed from the information that she was experiencing hypercholesterolemia and
hypertension already. Along with that she was experiencing numbness on the right side of her
face as well under the right arm (Norman and Eva, 2010). Also, she was undergoing a slight
facial droop. She was being admitted in the emergency department. After diagnosing the vital
signs, she was transferred to the stroke unit, where it was analysed that she had transient
ischaemic attack (TIA). After shifting in the stroke ward, her BP level increases to an extent that
represents the symptoms of stage 2 hypertension. It represents a major change in her clinical
situation.
The actual condition of Mrs Amari was not good when she had to be shifted in the
emergency department. Her speech was slurring and her face was drooping from one side. After
her son realised these symptoms, he shifted her to the emergency department. When he realised
that the symptoms were of stroke, she has been shifted from the emergency department to the
stroke unit. While the diagnosis of her in stroke unit, her conditions were quite critical as her
blood pressure level also increased. Also the pulse rate increased. There, they found that she had
a mini stroke, a transient ischaemic attack (TIA). Periodic limb movement is also one of the main
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disorders that closely influence the patient who is suffering from neurological issue or disease.
In this regard, it is the accountability of nurse or health care professional to measure the response
of patients which in turn clearly indicates the eve of consciousness. Along with this, by using
Glasgow coma scale health care professional can assess the level of consciousness in the case of
neurological issue. Hence, by assessing such aspect health care professionals would become able
to provide Mrs Amari with optimal solution.
CONCLUSION
From the report, it has been concluded that Mrs Amari is suffering from the issue of
hypertension and hypercholesterolemia. Besides this, it can be inferred that due to the symptoms
related to stage 2 hypertension, Mrs Amari was shifted in the emergency department for the
purpose of better treatment. Along with this, it has been articulated that by assessing the level of
disease through using suitable scale health care professionals can recommend suitable solution to
that Mrs Amari.
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REFERENCES
Books and Journals
Cai, Y., Ren, Y. and Shi, J., 2011. Blood pressure levels in patients with subclinical thyroid
dysfunction: a meta-analysis of cross-sectional data. Hypertension Research. 34(10).
pp.1098-1105.
Hankey, G. J. and Eikelboom, J. W., 2010. Antithrombotic drugs for patients with ischaemic
stroke and transient ischaemic attack to prevent recurrent major vascular events. The
Lancet Neurology, 9(3). pp.273-284.
Norman, G. R. and Eva, K. W., 2010. Diagnostic error and clinical reasoning. Medical
education. 44(1). pp.94-100.
Rothwell, P. M., Algra, A. and Amarenco, P., 2011. Medical treatment in acute and long-term
secondary prevention after transient ischaemic attack and ischaemic stroke. The Lancet.
377(9778). pp.1681-1692.
Sposato, L. A. And et.al., 2015. Diagnosis of atrial fibrillation after stroke and transient
ischaemic attack: a systematic review and meta-analysis. The Lancet Neurology. 14(4).
pp.377-387.
Whiteley, W.N. And et.al., 2011. Clinical scores for the identification of stroke and transient
ischaemic attack in the emergency department: a cross-sectional study. Journal of
Neurology, Neurosurgery & Psychiatry. pp.jnnp-2010.
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APPENDIX
Niko, son of Mrs Amari noticed his mother was slurring in her speech, which can also be
termed as Dysarthria, in which the person's language seems quite difficult to understand. It can
happen because of various reasons such as brain injury or stroke etc. Her face was also drooping
on one side. Bell's palsy makes the muscles weaker and causes some sort of paralysis in facial
muscles on any one side of the face. Niko admitted Mrs Amari in the emergency department of
the hospital as he though her of having a stroke.
Change in the comparison and new assessment
At the time when Mrs Amari was admitted in the emergency department, her vital signs
were recorded. Her blood pressure level was 148/97. The normal range of BP in a human body
lies within the range of 120/80 – 140/90 . With changes in the posture, stress, workload etc., BP
level changes but it should be less than 120/80 (Hankey and Eikelboom, 2010). Mr Amari was
having 148/97 BP, which means an abnormal range. This might be the reason why she had stroke
as high blood pressure weakens the blood vessels of brain, causing some sort of narrowing or
leaking. Her pulse rate was 81 at that time. The normal heart beat rate for a human body is from
60 to 100 beats per minute (Hankey and Eikelboom, 2010). A lesser pulse rate means the heart is
functioning more efficiently and is in a better cardiovascular fitness. Her heart beat rate was
within the normal range but might be not efficient as the lower levels. There are lasting changes
that take place within brain due to TIA. For assessment patients go through mapping procedure
using transcranial magnetic stimulation (TMS).
The assessment can be done by the collection, proper organisation, validation and the
documentation of the data. The nurse collects information and data from the surroundings for the
identification of the health status of the patient. Assessments can be made in the initial stage also
and can stay continuous throughout the care of the patient. There are various other processes of
the nurse also that depends on the completeness and validity of the initial data collection
(Hankey and Eikelboom, 2010). While the establishment of the database, they must have proper
and accurate information about the clients. It also includes the health history of the nurse along
with the physical examination, proper history of the physician and the outputs from the
laboratory and diagnostic tests.
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BIBLIOGRAPHY
https://www.ncbi.nlm.nih.gov/pubmed/21796125
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(10)70038-7/abstract
https://www.ncbi.nlm.nih.gov/pubmed/20078760
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