Question

Location: Neurological Unit 0800

SBAR report from the night nurse:

Situation: Mr. Russell is a 55-year-old Native American male who was admitted with a stroke with mild left hemiplegia yesterday afternoon. He had a head CT and received thrombolytic therapy in the ED. He is nothing by mouth except for medications until the speech therapist has completed a bedside evaluation, which is scheduled for later this morning. He is scheduled for physical therapy later today.

Background: Mr. Russell has a history of hypertension, coronary artery disease, and diabetes mellitus type 2. He has smoked over a pack of cigarettes per day for the past 35 years and does not exercise.

Assessment: We have already checked his blood glucose level this morning. His vital signs have been stable and he slept well last night. He was able to get up to go to the bathroom with the use of a walker. His neurological checks are stable and he continues to have mild left hemiplegia. His hand grasps are almost equal but a little weaker on the left side. His pupils are equal and react to light. Swallow reflex is intact. He is oriented x3. I have already done a Morse Fall Risk assessment with a total high risk score of 60.

Recommendation: You should do a vital signs assessment, perform a neurological assessment, and talk about safety with Mr. Russell. You should also provide patient education on risk and prevention of aspiration. His morning medications are up and should be administered

1. Based on the information, can you tell what side of the brain the stroke affected?

Answer 1

Answer : Right side of brain

The patient had left sided hemiplegia.

Hemiplegia is the weakness /inability to move upper and lower limbs of one side while the other side is normal. It is due to damaging of the corticospinal tract(pyramidal tract) . We know that the corticospinal tract starts from one particular side of the the brain (right or left) and crosses over at the medulla oblongata to supply the opposite side​​​​​​.

Therefore, a lesion in the right brain produces weakness in the left limbs and vice versa.

Since the patient has left sided weakness, the lesion must be in the right brain.

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