NU 580 Mr. C, a 64 year-old faculty member teaching computer science, presents with headache, weakness, and numbness on his left extremities

NU 580 Mr. C, a 64 year-old faculty member teaching computer science, presents with headache, weakness, and numbness on his left extremities

Patient Care

Mr. C, a 64-year-old faculty member teaching computer science, presents with headaches, weakness, and numbness on his left extremities. He’s by himself and a little confused, so his history is “sketchy.”

CC: “I had these problems this morning. I then seemed to improve, and then got worse. Now I’m getting scared.”

Past medical history: Hypertension, possible transient ischemic attacks s last year per verbal history (patient was on vacation). Has been taking ASA 81 mg and amlodipine (Norvasc) 10 mg daily.

Physical exam: Blood pressure, 162/96; respiration rate, 26/min. Patient awake bu

NU 580 Mr C a 64 year old faculty member teaching computer science, presents with headache weakness and numbness on his left extremities

NU 580 Mr C a 64 year old faculty member teaching computer science, presents with headache weakness and numbness on his left extremities

t confused, left foot slightly externally rotated, difficulty walking, bilateral high-pitched carotid bruits, decreased sensation in left lower extremity.

Additional Subjective Data: For a better understanding of the patients presenting condition, the patient is required to provide information regarding the disease movement pattern, activity restrictions, underlying impairments, and societal participation for purposes of planning the intervention (Sibson, & Khadjooi, 2018). Such information includes the onset of the sign and symptoms, progression of the disorder, medication management utilized for the presenting symptoms, and previous therapy. Regarding the patient’s past medical history, information such as present comorbidities, previous neurological conditions, previous hospitalization, allergies, and surgical history must be provided. Information on the patient social history will comprise of social background, family history, use of drugs, diet, support structure, accommodation, and social service support. Additional information comprises activity levels, normal daily routine, employment, leisure activities, mobility, and personal care, among others.

Additional Objective Data: Based on the patients presenting symptoms, physical examination of the ocular fundi, to assess retinopathy, hemorrhage, or emboli, must be conducted to build upon the objective data. Assessment of the heart for irregular rhythm, gallop, or murmurs is also crucial. The peripheral vascular examination will be done by auscultation for a carotid bruit, and palpation of the radial carotid and femoral pulses to assess for any abnormalities. Neurological examination is also crucial to confirm the presence of stroke symptoms, and distinguish between possibilities of stroke from the stroke mimics (Sibson, & Khadjooi, 2018). A neurological examination will include evaluation of the cranial nerves, sensory function, motor function, gait, language, cerebral function and mental status, and level of consciousness. The National Institutes of Health Stroke Scale (NIHSS) will be utilized for neurological examination. The patient’s BMI is also crucial in determining whether his weight puts him at high risk of comorbidities and worsening of his hypertension.

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National Guidelines: The American Heart Association (AHA) and the American Stroke Association (ASA) guidelines will be utilized in the diagnosis and management of the patient’s condition (Boehme et al., 2021). Both the two guidelines exhibit a 1++ level of evidence with sources from high-quality meta-analysis, RCTs, or systemic review of RCT, with very low risks of bias.

Tests Ordered: For the lab works, I will order tests such as complete blood count and basic chemistry panel, to assess for other possibilities causing the patient’s symptoms. Additional tests will include, blood glucose levels, rapid plasma reagent, homocysteine level, rheumatoid factor, antinuclear antibody, erythrocyte sedimentation rate, fasting lipid profile, toxicology screening, and cardiac biomarkers. ECG and Echo will help in determining the progress of the patient’s hypertensive condition, concerning the presenting symptoms (Qureshi et al., 2020). Brain imaging with MRI and CT scan will be required to determine the type of stroke the patient is suffering from, for management purposes. Other imaging studies will include transcranial doppler ultrasonography, chest radiography,  single-photon emission CT (SPECT) scanning, and conventional angiography for purposes of ruling out differential diagnosis.

Consult: For further evaluation of the patient’s condition, it will be necessary to consult with a cardiologist, to avoid incidences of misdiagnosis and promote positive treatment outcomes (Qureshi et al., 2020).

Medical and Nursing Diagnosis: Based on the assessment data, the main nursing diagnoses for the patient include acute pain, disturbed thought processes, impaired verbal communication, impaired physical mobility related to hemiparesis, and disturbed sensory perception (Boehme et al., 2021). The medical diagnosis for this patient is a cerebrovascular accident (stroke), with differentials such as hypertensive emergency, based on the provided assessment data.

Legal/Ethical Considerations: The main ethical issue in the present case is the assessment of the patient’s decision-making capacity, especially since his cognition and communication are impaired (Qureshi et al., 2020). Legal requirements however support the patients involved in making decisions concerning their health.

Care Plan:

Medical: The medical management of the patients presenting symptoms will comprise of recombinant tissue plasminogen activator with close monitoring for bleeding. Osmotic diuretics may also be prescribed for the management of increased ICP (Boehme et al., 2021). An additional management plan will involve the use of the endotracheal tube, hemodynamic monitoring, and neurologic assessment. The patient will also need to continue taking his hypertension medication.

Nursing: The nursing intervention will involve several activities such as positioning of the patient to prevent contractures, preventing flexion, preventing adduction, preventing edema, providing a full range of motion, regaining balance, encouraging personal hygiene, management of sensory difficulties, and assessment of the patient skin to check for signs of breakdown (Qureshi et al., 2020). The nurse may also consult a speech therapist to evaluate gag reflexes and assist with teaching alternate swallowing techniques.

Complementary therapies: This will involve consulting an occupational therapist to assess the home environment and recommendation of medication which will help the patient become more independent (Boehme et al., 2021). Physical therapy, antidepressant therapy, support group, and assessment of caregivers are also essential in the management of the patient’s presenting symptoms.

Healthy People 2020 Objectives: Concerning taking care of this patient, several HP 2020 objectives will be considered. Such objectives include HDS-3: reduce stroke deaths, HDS-1: increase overall cardiovascular health in the United States population, and HSD-10; increase the percentage of hypertensive adults who meet the recommended guidelines (Temesgen, Teshome,  & Njogu, 2018).

The Circle of Caring: The circle of caring promotes patient-centered care to reach optimal care. In this case scenario, the patient is quite inadequate in providing information regarding his health condition (McCarthy et al., 2021). The patient immediate family members such as the wife, brother or sister, or even parents who have been in close contact with the patient ever since the onset of the symptoms can be used as reliable historians. Documents such as the power of attorney are also needed such that a reliable historian or patient’s close relative can be appointed to make legal and financial decisions for the patient.

Patient Teaching: Patient education will involve the risk factors of stroke, preventive measures, and the signs of cerebrovascular accidents. The patient must also be educated on the importance of adhering to the treatment regimen for positive outcomes (Ekker et al., 2018). It is important for the patient to regularly monitor his blood pressure to determine the effectiveness of his hypertension medication. The patient must also be informed of the possible side effects of the medication prescribed. Lifestyle changes and diet must also be incorporated into the patient’s education.

Billing Codes: For hospital inpatient coding and payment for diagnosis-related groups under medical care, I will recommend billing code 064 for ischemic stroke with medical management only (Bettger et al., 2019).




Sibson, L., & Khadjooi, K. (2018). Initial assessment and management of stroke. British Journal of Cardiac Nursing13(3), 121-127. DOI:10.12968/bjca.2018.13.3.121

Qureshi, A. I., Abd-Allah, F., Al-Senani, F., Aytac, E., Borhani-Haghighi, A., Ciccone, A., … & Wang, Y. (2020). Management of acute ischemic stroke in patients with COVID-19 infection: report of an international panel. International Journal of Stroke15(5), 540-554. DOI: 10.1177/1747493020923234.

Boehme, C., Toell, T., Lang, W., Knoflach, M., & Kiechl, S. (2021). Longer-term patient management following stroke: A systematic review. International Journal of Stroke, 17474930211016963. DOI: 10.1177/17474930211016963

Temesgen, T. G., Teshome, B., & Njogu, P. (2018). Treatment outcomes and associated factors among hospitalized stroke patients at Shashemene Referral Hospital, Ethiopia. Stroke research and treatment2018.

McCarthy, J., Yang, J., Clissold, B., Young, M. J., Fuller, P. J., & Phan, T. (2021). Hypertension Management in Stroke Prevention: Time to Consider Primary Aldosteronism. Stroke, STROKEAHA-120.

Ekker, M. S., Boot, E. M., Singhal, A. B., Tan, K. S., Debette, S., Tuladhar, A. M., & de Leeuw, F. E. (2018). Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology17(9), 790-801.

Bettger, J. P., Jones, S. B., Kucharska-Newton, A. M., Freburger, J. K., Coleman, S. W., Mettam, L. H., … & Rosamond, W. D. (2019). Meeting Medicare requirements for transitional care: Do stroke care and policy align?. Neurology92(9), 427-434.