Question

Bonnie is a 70-year-old woman who lives alone. One evening, she felt light-headed and dizzy. When her head began to ache, she decided to take an analgesic and go to bed early. The following morning, upon awakening, she was unable to move the bed sheets with her right arm. At this point she was experiencing tingling sensations in her limbs, and she had difficulty keeping her balance. She dialed 911 for help, and by the time the ambulance arrived, she was confused and unable to articulate her words although she knew what information he was asking of her. Bonnie was transferred to the hospital and assigned to you. Her son and his wife arrive shortly after her transfer and they ask to see you to provide an update on their mother. Answer the following questions as her nurse practitioner:

1.) Based on Bonnie's symptoms, what is your initial and differential diagnoses?

2.) How would you explain your initial diagnosis to Bonnie or her family?

3.) How would you confirm your diagnosis?

4.) What treatment options would you order?

5.) You oversee Bonnie's care throughout her hospital stay and she is now ready to be discharged. What discharge teaching should be included for her?

Answer 1

1. Symptoms like feeling light-headed and dizzy, tingling sensations in her limbs, difficulty in keeping balance, confusion, problem in speaking and unability to move things with right arms (weakness of one side of the body) shows the symptoms of sudden ischemic attack due to a blockage or clot in the flow of oxygen and blood in a paert of brain. The differential diagnosis in this case can be vascular, infectious, inflammatory or degenerative condition in the patient's body.

The condition indicates that there could be chances of developing Cerebral Edema in the patient as Ischemia Stroke and Cerebral Edema are very closely related. It is a condition where swelling occurs in the brain as a result of some injury and here in this case ischemia Stroke is acting as a injury to the human body response.

Cerebral Edema is the swelling of the brain. Ischemia Stroke and Cerebral Edema are correlated due to the fact swelling is the body's response to injury, Ischemic stroke as being the injury present. The pressure increased in the skull which is referred to is ICP, also known as intracranial pressure. Ischemic stroke is a clot being present around the brain causing it to be unable to receive adequate blood flow and oxygen supply, therefore brain cells begin to die and the brain starts to swell.

2. I would tell Bonnie or her family that she was found at her place alone and was confused and could not articulate her conditions in words although she knew what information the healthcare personal was asking of her. This is a condition called Broca’s Aphasia and in this condition patient's ability to speak is severely reduced dur to some issue in the motor of the brain. As a result her access to the vocal functions of the body is reduced, and the patient is usually very difficult to understand. But, Broca’s Aphasia does not affect the ability to understand in a patient and tha patient is able to learn, read and understand but could not speak or write their thoughts. This indicates that there may be a hypoperfusion (reduced blood flow) in the Broca's area of the brain during the ischemic attack.

3. I will confirm the diagnosis by undertaking a test of vision, weakness in muscles and Bonnie's cognitive ability and vocabulary access. I will also ask Bonnie's family to get CT and MRI scan of the brain. Finally, a test of carotid arteries can help in evaluating the exact cause of condition for which this ischemic attack happened.

4. First of all to get the situation in control I will ask the ask the nurse to administer an IV injection of Activase which is a recombinant tissue plasminogen activator used for intervening an ischemic stroke. Then I will prescribe aspirin or prasugre as they are antiplatelet medicine and helps in reducing blood clot. I will also prescribe some anticoagulants like warfarin. We will also keep surgery option in our hand if condition in the patient becomes worst with time.

5. I will ask Bonnie to bring certain changes in her lifestyle that are mentioned below -

i. Avoid smoking and drinking habits

ii. Eat healthy and nutritious diet with a lot of fruits and vegetables and try to maintain an optimal body weight

iii. Exercise regularly

iv. Get adequate and quality sleep and reduce the stress levels

v. Control the sugar, cholesterol and fat level of the body